Bone Metabolism Parameters in Hemodialysis Patients With Chronic Kidney Disease and in Patients After Kidney Transplantation

Abstract

Chronic kidney disease adversely affects the structure and metabolism of bone tissue, which may be a result of disturbed biochemical processes in adipose tissue. Renal replacement therapy is a life-saving therapy but it does not restore all metabolic functions and sometimes even escalates some disturbances. The study included 126 subjects: 47 hemodialysis patients (HD), 56 patients after renal transplantation (Tx) and 23 healthy controls (K). Bone density at the femoral neck (FN) and lumbar spine (LS), as well as body composition (adipose tissue content and lean body mass) were measured in each patient using the DXA method. In addition, serum concentrations of glucose, calcium, phosphorus, parathormone, FGF23, Klotho, osteocalcin, leptin, adiponectin and 1,25-dihydroxyvitamin D3 were measured. We observed significantly higher concentrations of leptin, FGF23 and Klotho proteins in the HD patients (77.2±48.1 ng/ml, 54.7±12.4 pg/ml, 420.6±303.8 ng/ml, respectively) and the Tx group (33.2±26.5 ng/ml; 179.8±383.9 pg/ml; 585.4±565.7, respectively) compared to the control group (24.4±24.6 ng/ml, 43.3±37.3 pg/ml, 280.5± 376.0 ng/ml). Significantly lower bone density at FN was observed in the HD and Tx patients in comparison to the controls and in the HD patients compared to the Tx group. There were no significant differences in body mass composition between the studied groups. The results of this study indicate that both hemodialysis and transplantation are associated with increased serum concentrations of leptin, FGF23 and Klotho proteins, as well as lower bone density at femoral neck.

Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study

“…Nevertheless, there was no difference in PTH and 25-OH vitamin D as well as other bone markers such as osteocalcine and c-telopeptide between patients with and without LBD. Indeed, lack of any relationship between LBD and PTH, 25-OH vitamin D, osteocalcine and ctelopeptide were also reported by others [5,9,21,22]. Our study suggests that the use of calcitriol and vitamin D supplements may disrupt the relationship between bone markers and BMD.…”

The Suitability of FGF21 and FGF23 as New Biomarkers in Endometrial Cancer Patients

“…It regulates the metabolism of vitamin D3 and phosphates to inhibit the reabsorption of phosphates in renal tubules. FGF23 is the key humoral regulator of phosphate homeostasis [17,18]. FGF23 induces the synthesis of proinflammatory factors TNFα and macrophages within splenocytes as well as IL6 and CRP in hepatocytes.…”

“…In addition, patients who had renal insufficiency were excluded from the study due to elevated FGF levels. In this case, it would be necessary to determine a correction factor depending on GFR and creatinine, which was not done [17]. All the patients who were involved in the research signed informed consent and agreed to all the requirements.…”

Associação entre estado nutricional, perfil lipídico e adequação dialítica de pacientes submetidos a hemodiálise / Association between nutritional status, lipid profile and dialysis adequacy of patients undergoing hemodialysis

“…Neste trabalho, na avaliação de 2020, apesar de não estarem acima dos valores recomendados, foi demonstrado que os indivíduos com excesso de peso tinham maiores médias de LDL-c e CT-c (p=0,007) e (p=0,005) respectivamente (Tabela 2) podendo inferir um aumento no risco de mortalidade cardiovascular 27 . Na Tabela 3, em adição ao exposto nos quatro parágrafos anteriores, na análise de 2020 os níveis HDL-C foram mais baixos nos pacientes que não possuíam excesso de peso (p=0,013) o que pode ser explicado pela hipótese do sedentarismo nesse subgrupo ocasionado pela maior fragilidade muscular secundária à diminuição da massa magra, em acordo com o estudo O'Donavan et al 28 , e pelas alterações no eixo cálcio-fósforoparatormônio próprias da DRC 29 , porém neste trabalho não foi possível averiguar o pressuposto. No que concerne à bioquímica, no período relacionado à 2020 foi visto que níveis de TG e CT eram mais altos no grupo com sobrepeso e obesidade, em concordância com a Tabela 2.…”