Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Malluche, Hartmut H.; Porter, Daniel; Monier‐Faugere, Marie‐Claude; Mawad, Hanna; Pienkowski, David

doi:10.1681/asn.2010121253

Cited by 117 publications

(97 citation statements)

References 46 publications

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“…Therefore, the relationship between high iPTH and VC cannot be confirmed, but it indicates that lower iPTH is also prone to VC. This result is consistent with recent studies: both high iPTH and low iPTH levels may cause VC [23,24]. A study by London et al [25] showed that HD patients with VC had lower iPTH levels than patients without VC.…”

Section: Discussionsupporting

confidence: 92%

Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Niu

Zhao

et al. 2019

Blood Purif

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Objective: To investigate the occurrence of vascular calcification (VC) in different types of arteries in patients with maintenance peritoneal dialysis (PD) patients and its influencing factors. Methods: This study enrolled PD patients with stable status who has received PD treatment for more than 6 months in Peking University People’s Hospital. We used plain X-ray films of abdomen, pelvis, and hands to quantitatively evaluate VC of large artery (abdominal aorta, iliac artery), medium artery (femoral artery, radial artery), and small artery (finger arteries). Two radiologists read and scored radiographs blindly. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time-average laboratory indices including parameters of calcium phosphorus metabolism, serum albumin, PD adequacy were collected. A logistic regression model was used to estimate the influencing factors of different sites of VC. Results: (1) 154 PD patients were enrolled in this study: seventy-eight males, mean age was 60.4 ± 13.9 years, and median PD duration was 24 (16.39) months. The major primary disease was diabetic nephropathy (39%). (2) Among the 154 PD patients, the proportion of calcification of large artery was the highest (found in 100 patients, accounting for 64.9%); then the medium artery (66, 42.9%); and 15 of small artery, accounting for 9.7%. (3) Logistic regression showed that older age, longer dialysis duration, lower baseline serum intact parathyroid hormone (iPTH), and higher CCI scores were independent risk factors of large artery calcification (p < 0.05), and higher CCI scores, higher baseline serum triglycerides (TG), lower baseline serum iPTH, and time-average iPTH were independent risk factors of medium and small arteries. Conclusions: In PD patients, the occurrence of large artery calcification was higher than others. Among different sites of VC, the abdominal aortic calcification was most likely to occur, and the proportion of small artery calcification was low. Calcification of medium and small arteries can exist alone without calcification of large artery. Large artery calcification was more likely to occur in patients with older age, longer dialysis duration, lower baseline serum iPTH levels and higher CCI scores. Patients with higher CCI scores, higher baseline TG and lower baseline iPTH, and time-average iPTH were more likely to develop small and medium artery calcification.

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Section: Discussionsupporting

confidence: 92%

Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Niu

Zhao

et al. 2019

Blood Purif

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show abstract

“…A recent study evaluated bone quality as assessed by material and mechanical properties. The primary finding was that "bone with low turnover had microstructural abnormalities such as lower cancellous bone volume and reduced trabecular thickness" (18). We did not have access to tests, such as bone alkaline phosphatase, vitamin D levels, or fibroblast growth factor-23, that might have provided information on bone health.…”

Section: Discussionmentioning

confidence: 99%

Bone Parameters and Risk of Hip and Femur Fractures in Patients on Hemodialysis

Fishbane¹,

Hazzan²,

Jhaveri³

et al. 2016

CJASN

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Background and objectives Patients on hemodialysis have a high rate of hip fractures. In this study, we performed a contemporary analysis of mineral and bone parameters and their relationship to hip and femur fracture risk. Results The incidence of hip and femur fractures remained generally unchanged (P=0.40), except among patients who were white and .65 years of age, in whom the rate decreased significantly over the 14-year period (P,0.01).Results from combined multivariable models indicated that the lowest quartiles of time-averaged intact parathyroid hormone were independently associated with higher hip fracture risk (intact parathyroid hormone =181-272 pg/ml: hazard ratio, 1.20; 95% confidence interval [95% CI], 1.03 to 1.41 and intact parathyroid hormone ,181 pg/ml: hazard ratio, 1.20; 95% CI, 1.01 to 1.44; referent third quartile, 273 to ,433 pg/ml). The lowest quartile of time-averaged serum calcium was also associated with higher risk (calcium ,8.7 mg/dl; hazard ratio, 1.17; 95% CI, 1.00 to 1.37) compared with the referent third quartile of 9.1 to ,9.5 mg/dl. ConclusionsWe found an association between lower levels of intact parathyroid hormone and serum calcium and greater risk for hip and femur fractures among patients on hemodialysis. These findings support additional research toward elucidating long-term safety of treatment approaches for hyperparathyroidism in patients with ESRD.

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“…Specifically, bone surface, connectivity density, cortical thickness, and cortical porosity were better preserved in bone biopsies assessed both by mCT and classic histomorphometry versus renal transplant patients receiving potassium chloride as a control treatment. These architectural parameters have been shown to correlate with biochemical bone properties and thus are likely to be relevant for bone quality (30). In addition, serological biomarkers did not change in the potassium citrate group but decreased significantly in patients taking potassium chloride, indicating better maintenance of bone turnover by citrate administration.…”

Section: Discussionmentioning

confidence: 92%

Correction of Metabolic Acidosis with Potassium Citrate in Renal Transplant Patients and its Effect on Bone Quality

Starke

Corsenca

Köhler

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground Acidosis and transplantation are associated with increased risk of bone disturbances. This study aimed to assess bone morphology and metabolism in acidotic patients with a renal graft, and to ameliorate bone characteristics by restoration of acid/base homeostasis with potassium citrate.Methods This was a 12-month controlled, randomized, interventional trial that included 30 renal transplant patients with metabolic acidosis (S- [HCO 3 2 ] ,24 mmol/L) undergoing treatment with either potassium citrate to maintain S- [HCO 3 2 ] .24 mmol/L, or potassium chloride (control group). Iliac crest bone biopsies and dual-energy X-ray absorptiometry were performed at baseline and after 12 months of treatment. Bone biopsies were analyzed by in vitro micro-computed tomography and histomorphometry, including tetracycline double labeling. Serum biomarkers of bone turnover were measured at baseline and study end. Twenty-three healthy participants with normal kidney function comprised the reference group. Results Administration of potassium citrate resulted in persisting normalization of S-[HCO 32 ] versus potassium chloride. At 12 months, bone surface, connectivity density, cortical thickness, and cortical porosity were better preserved with potassium citrate than with potassium chloride, respectively. Serological biomarkers and bone tetracycline labeling indicate higher bone turnover with potassium citrate versus potassium chloride. In contrast, no relevant changes in bone mineral density were detected by dual-energy X-ray absorptiometry.Conclusions Treatment with potassium citrate in renal transplant patients is efficient and well tolerated for correction of metabolic acidosis and may be associated with improvement in bone quality. This study is limited by the heterogeneity of the investigated population with regard to age, sex, and transplant vintage.

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Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Cited by 117 publications

References 46 publications

Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Bone Parameters and Risk of Hip and Femur Fractures in Patients on Hemodialysis

Correction of Metabolic Acidosis with Potassium Citrate in Renal Transplant Patients and its Effect on Bone Quality

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