Bone Dysregulation in Acute Kidney Injury

Neyra, Javier A.; Moe, Orson W.

doi:10.1159/000534228

Cited by 2 publications

(1 citation statement)

References 43 publications

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“…These data are consistent with other human studies in the literature confirming acute elevations of PTH with AKI that subsequently returned to normal when AKI resolved. with resolution of AKI.. [ 39 , 40 ] It is postulated that low concentrations of serum 1,25(OH) 2 D and secondary hypocalcaemia may contribute to secondary hyperparathyroidism in AKI.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study

Cameron,

Ledwaba-Chapman,

Voong

et al. 2024

Crit Care

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Background Vitamin D deficiency in critically ill patients is associated with poor outcomes, and vitamin D supplementation is recommended for patients with chronic kidney disease. Whether acute kidney injury (AKI) is associated with altered Vitamin D metabolism is unknown. We aimed to compare the longitudinal profiles of serum 25(OH)D and 1,25(OH)2D concentrations in critically ill patients with and without moderate to severe AKI and explore the impact of renal recovery and parathyroid hormone (PTH). Methods In this prospective, observational study in two centres in the UK, critically ill patients with and without AKI underwent serial measurement of serum 25(OH)D and 1,25(OH)2D and plasma PTH concentrations for 5 days. Linear mixed model analysis and sensitivity analyses were performed. Results Serial data of 137 patients were analysed. Seventy-one patients had AKI stage II/III of whom 23 recovered kidney function during the 5-day study period; 66 patients did not have AKI at enrolment of whom 14 developed new AKI. On day of enrolment, patients’ serum 25(OH)D concentrations were low (median 18 nmol/L) but there was no significant difference between patients with and without AKI. Median serum 1,25(OH)2D levels were significantly lower in patients with AKI II/III (41 pmol/L [IQR 26, 58]) compared to similarly unwell patients without AKI (54 pmol/L [IQR 33, 69]) during the 5-day period. Recovery of kidney function in patients with AKI was associated with a rise in 1,25(OH)2D concentrations. Plasma PTH results were impacted by serum calcium and magnesium levels but not associated with 1,25(OH)2D levels. Conclusions Critically ill patients with moderate-to-severe AKI have significantly lower serum 1,25(OH)2D concentrations than similarly sick patients without AKI but there was no difference in serum 25(OH)D concentrations. Recovery of AKI was associated with a rise in serum 1,25(OH)2D concentrations. More research is needed to investigate the health benefits and safety of supplementation with active vitamin D in critically ill patients with moderate-to-severe AKI. Trial registration Clinicaltrials.gov (NCT02869919), registered on 16 May 2016.

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Section: Discussionmentioning

confidence: 99%

Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study

Cameron,

Ledwaba-Chapman,

Voong

et al. 2024

Crit Care

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Associations between acute kidney injury and bone fractures: a retrospective cohort study

Cheikh Hassan,

Mulholland,

McAlister

et al. 2024

Clinical Kidney Journal

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Background Acute kidney injury (AKI) is common. An AKI episode may disrupt the normal mineral bone balance maintained by normal kidney function, thereby modifying the risk of developing bone fractures. However, it remains unclear whether an AKI episode is associated with the risk of bone fractures. Methods Using retrospective cohort study from an Australian Local Health District, we examined the association between an AKI episode and bone fractures using patient data between 2008 and 2017. Time-varying Cox proportional hazards and propensity-matched analysis were used to examine the association. Sensitivity analyses were undertaken to capture the impact of confirmed AKI status and AKI severity. Results Of 123 426 included patients, 14 549 (12%) had an AKI episode and 12 505 (10%) had a bone fracture. In the unadjusted analysis, AKI was associated with bone fractures [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.88–2.11]. This association persisted in the adjusted analysis (HR 1.50, 95% CI 1.41–1.59) and propensity-matched dataset (HR 1.71, 95% CI 1.59–1.83). The sensitivity analysis yielded similar results, with the AKI patients having a higher risk of fractures compared with no AKI patients in the adjusted analysis (HR 1.34, 95% CI 1.25–1.43) and in the propensity-matched dataset (HR 1.44, 95% CI 1.33–1.55). Similar results were seen in the subsidiary sensitivity analysis excluding patients without baseline creatinine. We did not find an increased risk of bone fractures with increasing AKI severity (P = .7). Interaction tests demonstrated a significant association between sex and age category with AKI status and fractures, but not CKD stage or osteoporosis. Conclusions AKI is associated with a greater risk of bone fractures. This could have implications for managing and screening for bone disease in patients post-AKI episode. This association should be examined in other cohorts and populations for verification.

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Bone Dysregulation in Acute Kidney Injury

Cited by 2 publications

References 43 publications

Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study

Vitamin D metabolism in critically ill patients with acute kidney injury: a prospective observational study

Associations between acute kidney injury and bone fractures: a retrospective cohort study

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