Bodas de plata: 25 años de la primera demostración del efecto directo del fósforo en la célula paratiroidea

Bover, Jordi; Trinidad, Pedro; Jara, Aquiles; Soler-Majoral, Jordi; Martín‐Malo, Alejandro; Torres, Armando; Frazão, João; Ureña, Pablo; Dusso, Adriana; Arana, Carolt; Graterol, Fredzzia; Romero, Gregorio Sánchez; Troya, Maribel; Samaniego, Diana; D’Marco, Luis; Valdivielso, José Manuel; Fernàndez, Elvira; Arenas, María Dolores; Torregrosa, Vicente; Navarro‐González, Juan F.; Lloret, M.; Ballarín, José; Bosch, Ricardo J.; Górriz, José Luis; Francisco, AGL de; Gutiérrez, Orlando M.; Ara, Jordi; Felsenfeld, Arnold J.; Canalejo, Antonio; Almadén, Yolanda

doi:10.1016/j.nefro.2021.12.005

Cited by 3 publications

(4 citation statements)

References 80 publications

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“…In phosphorus values we had an increase from 2.70 to 3.46 mg/dL, which corresponds to an increase of 28% over five years. This value is compatible with the decrease in renal performance over the period, but still within the values considered acceptable for post-transplant kidney disease 19,20 . Calcium presented a mean value of 1.29 mmol/L at the end of the period, emphasizing that the value used in this study was 1.40 mmol/L, which shows that all individuals in the sample are within the expected standard.…”

Section: Discussionsupporting

confidence: 81%

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Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Rosano

2023

MRAJ

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Introduction: Parathyroid hormone, is one the controllers of calcium homeostasis, is synthesized and secreted by the parathyroid glands. They can become hyper functioning, generate excessive amounts of PTH, and determine the clinical-laboratory picture called hyperparathyroidism. When hyperparathyroidism is a consequence of a pre-existing metabolic imbalance, it is called secondary. Secondary hyperparathyroidism is thus an acquired disorder represented by parathyroid hypersecretion in response to calcium homeostasis disorders. Chronic kidney disease is a condition often associated with secondary hyperparathyroidism. It is a heterogeneous disorder characterized by varying degrees of stimulation and suppression of PTH, being associated with hyperplasia of the parathyroid glands. Material and Method: The present study is a historic prospective cohort analysis of patients undergoing subtotal parathyroidectomy, keeping a parathyroid gland intact in its bed, by tertiary hyperparathyroidism. Result: 44 patients between 30 and 75 years of age were selected, with a median of 49.5 years for the group, divided equally between men and women. Conservative treatment time was 36.75 months and hemodialysis time was 67.33 months. Renal transplantation time was 42.64 months, with PTH value on the day of renal transplantation of 822.03 pg/mL. On the day of surgery, the PTH value was 170.9 pg/mL, reaching an average value of 77.2 after 5 years. The initial value of ionic calcium was 1.477 mmol/L and a final value of 1.299 mmol/L after 5 years. Conclusion: The evaluation of the present study allows us to conclude that subtotal parathyroidectomy, keeping a parathyroid gland intact in its bed, is a safe and effective technical option in the surgical treatment of patients with tertiary hyperparathyroidism.

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Section: Discussionsupporting

confidence: 81%

“…We believe that the joint decision of the multidisciplinary team brings more security and confidence to this indication 17,18 . There is an understanding that performing PTX after kidney transplantation is effective and that all patients with levels below 1.40 mg/dl are considered as standard for calcemia 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Rosano

2023

MRAJ

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“…There is sufficient evidence to demonstrate the direct relationship between serum phosphorus concentration and the onset of the pathophysiological process of vascular calcification and increased cardiovascular risk, as well as the benefit of different calcium and noncalcium drugs used to control hyperphosphatemia, which are usually higher after the use of sevelamer carbonate [28,29]. This real-world study was able to identify the frequency of hyperphosphatemia in International Journal of Nephrology and Kidney Failure…”

Section: International Journal Of Nephrology and Kidney Failurementioning

confidence: 91%

Hyperphosphatemia in Dialysis Patients National Multicenter Study

MD¹,

RS²,

ES³

et al. 2022

Int J Nephrol Kidney Fail

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Introduction: Hyperphosphatemia (HPFT) is a complication that is exacerbated proportionally to the degree of kidney damage, and leads to vascular calcification and increased cardiovascular risk. The objective of the present study is to determine the frequency of hyperphosphatemia in patients with chronic dialysis treatment. Material and methods: This is a cross-sectional, observational, retrospective and analytical study. Real-life national multicenter study, conducted from January 1 to March 31, 2022. It includes subjects with chronic dialysis (>3 months stay), >16 years, from the public and private sectors. Does not include patients treated with phosphate binders or vitamin D receptor analogs; only treated with calcium derivatives in different formulations. Gender, age, causes of kidney failure, serum phosphorus values (mg/dL), calcium (mg/dL) and parathyroid hormone (pg/mL) are identified. Results: 2,176 subjects, 1,205 from the public sector (55%) and 971 private (45%). 1,063 (49%) male and 1,113 female (51%), with a mean age of 51.4 years (range 16-88). 794 with diabetes (36%), 559 arterial hypertension (26%) and 823 unknown (38%). The mean serum calcium values were 8.75 mg/dL (SD ± 1.01; range: 6.1-12.7) and phosphorus 5.15 mg/dL (SD ± 3.04; range: 2.5-18.1). 1,435 subjects presented HPFT (66%), 903 mild (41%), 450 moderate (21%, mean 5.7 mg/dL) and 82 severe (4%, mean: 9.2 mg/dL). Parathyroid hormone was determined in 33% (mean 614.87 pg/ mL, SD 628.64; range: 53.3 -3,803). Conclusions: HPFT is frequent in patients with chronic dialysis, it affects regardless of gender, age, primary cause of kidney disease and even after receiving adequate dialysis treatment. Significant increase in HPFT was observed in peritoneal dialysis patients.

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“…Moreover, VD deficiency (native or active) has been associated with the development of the well-known CKD-associated secondary hyperparathyroidism (SHPT). In fact, 42%–80% of patients with CKD G3–G4 have SHPT with low serum calcidiol levels and/or other related pathophysiological factors (e.g., increasing P load) [ 4 , 39 , 40 , 49 , 50 , 51 , 52 , 53 , 54 ]. The incidence of SHPT increases with decreasing renal function, and VD deficiency is more common in patients with CKD than in the general population [ 39 , 40 , 49 , 55 ].…”

Section: Ckd-mbd Vitamin D Skeletal Fragility and Osteoporosismentioning

confidence: 99%

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

et al. 2023

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Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.

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Bodas de plata: 25 años de la primera demostración del efecto directo del fósforo en la célula paratiroidea

Cited by 3 publications

References 80 publications

Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Hyperphosphatemia in Dialysis Patients National Multicenter Study

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

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