High-serum phosphate and parathyroid hormone distinctly regulate bone loss and vascular calcification in experimental chronic kidney disease

Carrillo-López, Natalia; Panizo, Sara; Alonso-Montes, Cristina; Martínez-Arias, Laura; Avello, Noelia; Sosa, Patricia; Dusso, Adriana; Cannata‐Andía, Jorge B.; Naves-Díaz, Manuel

doi:10.1093/ndt/gfy287

Cited by 47 publications

(43 citation statements)

References 31 publications

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“…These data suggest that SP controlled duration is very important in PD patients. Large international studies have shown that elevated SP levels (hyperphosphatemia) are linked with a number of serious clinical complications, including vascular calcification [11,12] and left ventricular hypertrophy [13], as well as increased all-cause mortality and PD withdrawal in patients undergoing dialysis [5][6][7][8][9][10][14][15][16][17]. In the Dialysis Outcomes and Practice Patterns Study (DOPPS), SP levels decreased over time in all countries, and higher SP levels were associated with greater all-cause mortality risk in both baseline and time-dependent models [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Baseline data were collected on demographic characteristics (age, gender, and BMI), reasons for ESRD, medical histories (hypertension, diabetic mellitus, and hepatitis B virus infection), PD vintage, PD modality, and peritoneal equilibration test (PET) types (1 month after PD). Data over time of systolic blood pressure; diastolic blood pressure; left ventricular ejection fraction; dialysate glucose concentration; 24-h PD ultrafiltrate volume; 24-h urine volume; weekly total KT/V; serum levels of Cr, albumin, and calcium; intact parathyroid hormone; and blood hemoglobin were collected at baseline (before PD, 0 month) and at 6,12,24,36,48,72,96, and 120 months after PD. In order to evaluate the detailed information of SP, levels at 0 month and at 3,6,9,12,18,24,30,36,48,72,96, and 120 months after PD were collected and recorded.…”

Section: Data Collection and Calculationmentioning

confidence: 99%

“…Phosphorus metabolism disorder is a common complication of ESRD, which plays an important role in bone integrity, ectopic calcium deposition and calciphylaxis, vascular calcification, and myocardial hypertrophy [11][12][13]. Many studies had clarified the importance of hyperphosphatemia in all-cause mortality and cardiovascular events in patients with PD [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis

Gong¹,

Xiao²,

Zhang³

et al. 2020

Kidney Dis

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Background: Serum phosphorus (SP) level is closely associated with overall mortality and cardiovascular events, while the role of SP controlled duration is not fully recognized. Here, we conducted a retrospective cohort study in our department to identify the relationship of SP controlled duration with clinical outcomes in patients undergoing peritoneal dialysis (PD). Methods: PD patients in our center from January 1, 2009, to June 30, 2019, were followed up at 2-month (the first year) or 5-month (the next follow-up period) intervals, and until death, until PD withdrawal, or until June 30, 2019. Data at each follow-up point were collected from their medical records. SP levels, changed degree of SP over baseline, and SP controlled duration were analyzed with overall mortality, PD withdrawal (including death, transferred to hemodialysis, and received renal transplantation), and combined endpoint (including death, acute heart failure, cardiovascular event, and stroke). Results: A total of 530 patients entered the analysis. Of them, 456 (86.0%) had hyperphosphatemia before dialysis, and the SP levels decreased soon after dialysis. The degree of SP change over baseline was the maximum at the 3rd month after dialysis (−31.0%), and lower degree was associated with higher overall mortality (hazard ratio [HR], 1.012; 95% CI, 1.004-1.020; p = 0.003). The median SP controlled duration was 13 (5-28) months, and longer duration was significantly associated with lower overall mortality (HR, 0.968; 95% CI, 0.956-0.981; p < 0.001). After categorization, duration more than 12 months greatly improved overall mortality with a HR of 0.197 (0.082-0.458; p < 0.001 vs. SP never controlled group) and 0.329 (0.150-0.724; p = 0.006 vs. duration <12 months group). Longer SP controlled duration also improved PD withdrawal and combined endpoint. Conclusions: In summary, both degree and duration of SP control were tightly associated with overall mortality. We should control SP levels as early, as possible, and as long as we could.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis

Gong¹,

Xiao²,

Zhang³

et al. 2020

Kidney Dis

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“…Despite the common view that traditional risk factors may be inferior as compared to novel biomarkers predicting cardiovascular outcomes in CKD [27,28], our results indicate that conventional risk factors, that is age, sex, diabetes, BMI and cholesterol, outperformed many novel biomarkers, suggesting that traditional risk factors are of paramount importance for VC in uraemia. Five biomarkers selected by the RLS algorithm were bone metabolism-related markers, that is, sRANKL, fT3, CTX, OPG and iPTH, suggesting the close interplay between disturbed bone metabolism and ectopic VC [29,30]. In addition, RLS yielded several novel VC biomarkers for which clinical and potential pathophysiological implications are noted in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Phenotypic features of vascular calcification in chronic kidney disease

et al. 2019

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Background Patients with chronic kidney disease stage 5 (CKD5) are predisposed to vascular calcification (VC), but the combined effect of factors associated with VC was sparsely investigated. We applied the relaxed linear separability (RLS) feature selection model to identify features that concomitantly associate with VC in CKD5 patients. Methods Epigastric arteries collected during surgery from living donor kidney transplant recipients were examined to score the histological extent of medial VC. Sixty‐two phenotypic features in 152 patients were entered into RLS model to differentiate between no–minimal VC (n = 93; score 0‐1) and moderate–extensive VC (n = 59; score 2‐3). The subset of features associated with VC was selected on the basis of cross‐validation procedure. The strength of association of the selected features with VC was expressed by the absolute value of ‘RLS factor’. Results Among 62 features, a subset of 17 features provided optimal prediction of VC with 89% of patients correctly classified into their groups. The 17 features included traditional risk factors (diabetes, age, cholesterol, BMI and male sex) and markers of bone metabolism, endothelial function, metabolites, serum antibodies and mitochondrial‐derived peptide. Positive RLS factors range from 1.26 to 4.05 indicating features associated with increased risk of VC, and negative RLS factors range from −0.95 to −1.83 indicating features associated with reduced risk of VC. Conclusion The RLS model identified 17 features including novel biomarkers and traditional risk factors that together concomitantly associated with medial VC. These results may inform further investigations of factors promoting VC in CKD5 patients.

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“…It has been suggested that high PTH is a main contributor to the progression of vascular calcification in hemodialysis patients . However, the study of the role of FGF23 in this regard has yielded contradictory results .…”

Section: Bone Mineral Disease and Mortalitymentioning

confidence: 99%

Parathyroidectomy in dialysis patients: Indications, methods, and consequences

Rodríguez‐Ortiz

Mier

Rodríguez

2019

Seminars in Dialysis

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Secondary hyperparathyroidism, characterized by increased PTH synthesis and secretion, is often seen in advanced stages of chronic kidney disease. Excessive proliferation of parathyroid cells leads to the development of diffuse hyperplasia that subsequently progresses to nodular histology. Refractory hyperparathyroidism occurs when parathyroid glands fail to respond to medical therapy. Parathyroidectomy (PTX), surgical resection of parathyroid glands, is usually performed in cases of persistent serum levels of PTH above 1000 pg/mL associated with hypercalcemia or when hyperparathyroidism is refractory to conservative therapy. Parathyroidectomy can be carried out using different procedures: subtotal PTX or total PTX with or without parathyroid autotransplantation. Parathyroid surgery may have undesirable consequences due to PTH oversuppression, such as the development of adynamic bone disease; hungry bone syndrome is quite common after this surgery. However, PTX improves survival and parameters of mineral metabolism. Parathyroidectomy needs to be considered in those patients with severe hyperparathyroidism with a poor response to pharmacological treatment and with distinct undesirable effects of PTH on bone and mineral metabolism parameters. K E Y W O R D S chronic kidney disease, parathyroidectomy, secondary hyperparathyroidism wileyonlinelibrary.com/journal/sdi Seminars in Dialysis. 2019;32:444-451.

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High-serum phosphate and parathyroid hormone distinctly regulate bone loss and vascular calcification in experimental chronic kidney disease

Abstract: In hyperphosphataemic CKD, a defective suppression of high PTH exacerbates HP-mediated osteogenic VSMC differentiation and reduces vascular levels of anti-calcifying sclerostin.

Cited by 47 publications

References 31 publications

Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis

Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis

Phenotypic features of vascular calcification in chronic kidney disease

Parathyroidectomy in dialysis patients: Indications, methods, and consequences

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