Decrease in Thoracic Vertebral Bone Attenuation With Calcium-Based Phosphate Binders in Hemodialysis

Raggi, Paolo; James, George; Burke, Steven K.; Bommer, Jürgen; Chasan-Taber, Scott; Holzer, Herwig; Braun, Johan; Chertow, Glenn M.

doi:10.1359/jbmr.041221

Cited by 133 publications

(79 citation statements)

References 46 publications

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“…In the study presented here, VBD was assessed by CT, a method that allows distinction between cortical and trabecular bone and avoids miscalculation of the VBD due to the presence of aortic calcification. In dialysis patients, the few studies using CT have found an association between low trabecular VBD and the extent of CAC (8,9). Herein, we demonstrated that such association starts early in the course of CKD.…”

Section: Discussionsupporting

confidence: 50%

“…More importantly, loss of BMD has been implicated with the progression of CAC over time (6,7). In dialysis patients, the few studies using computed tomography (CT) have found an association of vertebral bone density (VBD) with the extent of CAC (8,9). CAC is a highly prevalent condition among CKD patients, and it has been described as a strong predictor of worse outcome in the dialysis population (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

Filgueira

Carvalho

Tomiyama

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Low bone mineral density and coronary artery calcification (CAC) are highly prevalent among chronic kidney disease (CKD) patients, and both conditions are strongly associated with higher mortality. The study presented here aimed to investigate whether reduced vertebral bone density (VBD) was associated with the presence of CAC in the earlier stages of CKD.Design, setting, participants, & measurements Seventy-two nondialyzed CKD patients (age 52 Ϯ 11.7 years, 70% male, 42% diabetics, creatinine clearance 40.4 Ϯ 18.2 ml/min per 1.73 m 2 ) were studied. VBD and CAC were quantified by computed tomography.Results CAC Ͼ 10 Agatston units (AU) was observed in 50% of the patients (median 120 AU [interquartile range 32 to 584 AU]), and a calcification score Ն 400 AU was found in 19% (736 [527 to 1012] AU). VBD (190 Ϯ 52 Hounsfield units) correlated inversely with age (r ϭ Ϫ0.41, P Ͻ 0.001) and calcium score (r ϭ Ϫ0.31, P ϭ 0.01), and no correlation was found with gender, creatinine clearance, proteinuria, lipid profile, mineral parameters, body mass index, and diabetes. Patients in the lowest tertile of VBD had expressively increased calcium score in comparison to the middle and highest tertile groups. In the multiple logistic regression analysis adjusting for confounding variables, low VBD was independently associated with the presence of CAC.Conclusions Low VBD was associated with CAC in nondialyzed CKD patients. The authors suggest that low VBD might constitute another nontraditional risk factor for cardiovascular disease in CKD.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

Filgueira

Carvalho

Tomiyama

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Recent data, however, suggest that these goals often are not met (29,40) with conventional hemodialysis. Newer vitamin D analogues (41), calcimimetics (42), and noncalcium-based phosphate binders (43)(44)(45) all are welcome developments in the effort to improve metabolic control; however, failure to achieve mineral metabolism goals remains a significant problem (46). A consensus on how best to improve achievement of K/DOQI goals for mineral metabolism has not yet been reached in the context of conventional hemodialysis.…”

Section: Mineral Metabolism: How To Get Control?mentioning

confidence: 99%

Left Ventricular Hypertrophy

Achinger

Ayus

2006

Journal of the American Society of Nephrology

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Cardiovascular disease occurs in ESRD patients at rates that are far higher than is seen in the general population, and cardiovascular deaths account for the majority of deaths among dialysis patients. Abnormal mineral metabolism is a novel cardiovascular risk factor among dialysis patients. Recently published results demonstrated that even with good control of BP and anemia, conventional hemodialysis is associated with significant left ventricular hypertrophy (LVH); however, daily hemodialysis was associated with a significant reduction in LV mass index (LVMI). Furthermore, it was shown that control of serum phosphorus correlates with the reduction in LVMI. These data suggest a novel mechanism for the deleterious effect of elevated serum phosphorus on cardiovascular outcomes among hemodialysis patients: LVH. Other investigators have noted an association of hyperphosphatemia and LVH; however, this study was the first to demonstrate that improvement in serum phosphorus is associated with reduction in LVM. In addition, it is shown that daily hemodialysis is an effective modality in improving serum phosphorus through significantly improved phosphorus removal. Elevated serum phosphorus leads to vascular calcification, which can lead to LVH by decreasing vascular compliance. However, our study showed an improvement in LVMI during a 12-mo period. Because vascular calcification is unlikely to remit over this time period, it is proposed that serum phosphorus has a reversible, cardiotoxic effect that leads to LVH that can be reversed successfully with good control of serum phosphorus.

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“…Studies have shown that sevelamer attenuates progression of vascular calcification and prevents reduction in thoracic vertebral bone mineral density. 7,9,10 Bone biopsy is the recognized gold standard for the diagnosis and evaluation of renal bone disease. [11][12][13] Previous reports assessing changes in vertebral bone with phosphate binders by electron-beam tomography (EBT) did not assess changes in bone histology.…”

mentioning

confidence: 99%

“…[11][12][13] Previous reports assessing changes in vertebral bone with phosphate binders by electron-beam tomography (EBT) did not assess changes in bone histology. 9,10 Thus, a study using bone biopsies was conducted to compare the effects of sevelamer hydrochloride and calcium carbonate on bone histology. Figure 1.…”

mentioning

confidence: 99%

Effects of Sevelamer Hydrochloride and Calcium Carbonate on Renal Osteodystrophy in Hemodialysis Patients

Ferreira¹,

Frazão²,

Monier-Faugere³

et al. 2008

Journal of the American Society of Nephrology

153

130

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Disturbances in mineral metabolism play a central role in the development of renal bone disease. In a 54-wk, randomized, open-label study, 119 hemodialysis patients were enrolled to compare the effects of sevelamer hydrochloride and calcium carbonate on bone. Biopsy-proven adynamic bone disease was the most frequent bone abnormality at baseline (59%). Serum phosphorus, calcium, and intact parathyroid hormone were well controlled in both groups, although calcium was consistently lower and intact parathyroid hormone higher among patients who were randomly assigned to sevelamer. Compared with baseline values, there were no changes in mineralization lag time or measures of bone turnover (e.g., activation frequency) after 1 yr in either group. Osteoid thickness significantly increased in both groups, but there was no significant difference between them. Bone formation rate per bone surface, however, significantly increased from baseline only in the sevelamer group (P ϭ 0.019). In addition, of those with abnormal microarchitecture at baseline (i.e., trabecular separation), seven of 10 in the sevelamer group normalized after 1 yr compared with zero of three in the calcium group. In summary, sevelamer resulted in no statistically significant changes in bone turnover or mineralization compared with calcium carbonate, but bone formation increased and trabecular architecture improved with sevelamer. Further studies are required to assess whether these changes affect clinical outcomes, such as rates of fracture. 19: 405-412, 200819: 405-412, . doi: 10.1681 Patients with chronic kidney disease (CKD) typically have abnormal bone histology. Alterations in bone turnover, mineralization, and volume in renal patients depend on several factors. In particular, disturbances in calcium-phosphate, parathyroid hormone (PTH), and vitamin D metabolism are important in the development of renal osteodystrophy (ROD). J Am Soc NephrolThe pattern of ROD observed in patients with stage 5 CKD has changed in recent years. Previously, observed bone conditions in renal patients in order of prevalence were mixed uremic osteodystrophy (MUO), predominant hyperparathyroid bone disease (HPBD), and aluminum-related os-

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Decrease in Thoracic Vertebral Bone Attenuation With Calcium-Based Phosphate Binders in Hemodialysis

Cited by 133 publications

References 46 publications

Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

Left Ventricular Hypertrophy

Effects of Sevelamer Hydrochloride and Calcium Carbonate on Renal Osteodystrophy in Hemodialysis Patients

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