Fracture risk assessment in patients with chronic kidney disease

Jamal, Sophie A.; West, Sarah; Miller, Paul D.

doi:10.1007/s00198-011-1781-0

Cited by 78 publications

(65 citation statements)

References 75 publications

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“…Furthermore, there is a lack of consensus regarding the diagnosis of osteoporosis in advanced CKD, especially for CKD5 patients on dialysis [14]. The complex etiology of fractures in this population, combined with the technical limitations of BMD, limits the clinical utility of bone mass measurements for fracture prediction in CKD, especially stage 4-5 [16]. In addition, our understanding of postmenopausal bone disease in women without kidney disease may not be fully applicable in women with CKD [17].…”

Section: Discussionmentioning

confidence: 99%

Hypocalcemia Post Denosumab in Patients with Chronic Kidney Disease Stage 4-5

Chiang²,

et al. 2015

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Background: Denosumab, a RANK-ligand inhibitor, is an effective treatment for osteoporosis in postmenopausal women and men. Unlike the bisphosphonates, it is not excreted by the kidney. Little is known, however, about its efficacy and safety in patients with severe chronic kidney disease (CKD). Methods: A retrospective study was performed in CKD 4-5D patients from a tertiary referral hospital who were treated with denosumab between 1st January 2011 and 31st March 2014. Data collected included information about the following: CKD stage, fracture history, bone mineral density, serum calcium levels pre and post denosumab treatment, episodes of hypocalcemia, relevant medications and adverse events. Results: Eight patients with CKD-5 and 6 patients with CKD-4 were identified (all female, mean age 77.1 ± 9.9). The mean pre-denosumab calcium value was 2.42 ± 0.12 mmol/l, PTH 20.2 ± 14.7 pmol/l and 25-OH vitamin D 69.1 ± 30.1 nmol/l. After denosumab treatment, 6/8 patients with CKD-5/5D, and 2/5 patients with CKD-4 developed severe hypocalcemia. Two patients developed direct adverse complications of hypocalcemia (seizure, laryngospasm, prolonged QT_c). Among the patients who developed hypocalcemia, the median time to serum calcium nadir was 21 days and the median time to correction of hypocalcemia was 71 days. Treatment of hypocalcemia required large doses of oral calcium and calcitriol, and increases in dialysate calcium concentration. Conclusions: A high rate of severe hypocalcemia was observed in patients with advanced CKD treated with denosumab. If denosumab is used in patients with severe CKD, close monitoring and aggressive replacement of calcium and calcitriol is required to avoid the development of hypocalcemia.

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Section: Discussionmentioning

confidence: 99%

Hypocalcemia Post Denosumab in Patients with Chronic Kidney Disease Stage 4-5

Chiang²,

et al. 2015

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“…Patients with later stages of CKD share similar risk factors with the general population for osteoporosis and are also affected by bone disease associated with CKD (ref. 3,26,36,37 ). It should be noted that the bone disease associated with CKD is complex and multifactorial and BMD measurements alone may not be adequate to characterize the bone disorder 3 .…”

Section: Both Gender Females Malesmentioning

confidence: 99%

“…Artefacts in DXA measurements at this site are most common in the elderly population 3,37 . The results of our study demonstrate a positive correlation between BMD at the regions of the proximal femur and weight or body mass index.…”

Section: Both Gender Females Malesmentioning

confidence: 99%

Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

Valkovský¹,

R²,

Tvrdík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Patients with chronic kidney disease (CKD) have significant disorders of bone and mineral metabolism. In addition, they can also develop other bone disorders including osteoporosis. This study evaluated the bone mineral density (BMD) of patients at the start of hemodialysis treatment as well as the relationship between BMD and possible risk factors or biochemical markers. Methods. The study was performed in 82 patients (28 females, 54 males). BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur. Results. We found a high prevalence of 25-hydroxyvitamin D deficiency (96%; mean levels 30.0 ± 17.7 nmol/L) and a reduction of BMD in comparison with gender-and age-matched normal population values at the total hip (Z-score = -0.31 ± 1.11) and the femoral neck (Z-score = -0.48 ± 1.16), but not at the lumbar spine (Z-score = 0.68 ± 1.81). The prevalence of T-scores ≤ -2.5 SD in the group of patients over 50 years was 52.0% in females and 33.3% in males. BMD positively correlated: with male gender and calcium levels at all measured sites, with age at the lumbar spine and with weight or BMI at the proximal femur. Conclusion. CKD patients at the start of hemodialysis treatment had a high prevalence of low T-score values, corresponding to values for osteoporosis in the general population. BMD at the proximal femur was below the expected average for age and gender, but at the lumbar spine, BMD in hemodialysis patients was above average in persons without known CKD.

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“…For this reason, kidney essence is so important for bone development, healthy teeth, blood formation, and normal cognitive function. For example, the risk of fracture is significantly higher in chronic kidney disease (CKD) patients than in the general population [21]. The expenditures of oral problems also increased steadily along with the severity of CKD stages [22].…”

Section: Kidney Controls the Bonesmentioning

confidence: 99%

The Connotation of Kidney Stores Essence Theory and Kidney Endocrine Substance

Ling¹,

Dang²,

Ni³

et al. 2017

Chinese Medical Therapies for Diabetes, Infertility, Silicosis and the Theoretical Basis

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Traditional Chinese medicine (TCM) is a traditional healing system with unique theoretical system. The Zang-Fu theory is the closest mapping to body's physiological and pathological changes. Kidney is the most vital Zang organ in TCM system. However, the material basis of kidney essence is still undefined. In this chapter, we propose the idea that kidney endocrine substances, such as renin, kallikrein, erythropoietin (EPO), calcitriol, bone morphogenetic protein (BMP)-7, and klotho, are potential candidates of the material basis of kidney essence. In addition, kidney-nourishing therapy and related Chinese medicinal herbs are also introduced.

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Fracture risk assessment in patients with chronic kidney disease

Cited by 78 publications

References 75 publications

Hypocalcemia Post Denosumab in Patients with Chronic Kidney Disease Stage 4-5

Hypocalcemia Post Denosumab in Patients with Chronic Kidney Disease Stage 4-5

Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

The Connotation of Kidney Stores Essence Theory and Kidney Endocrine Substance

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