Predictors and consequences of altered mineral metabolism: The Dialysis Outcomes and Practice Patterns Study

Young, Eric W.; Albert, Justin M.; Satayathum, Sudtida; Goodkin, David A.; Pisoni, Ronald L.; Akiba, Takashi; Akizawa, Tadao; Kurokawa, Kiyoshi; Bommer, Jürgen; Piera, L; Port, Friedrich K.

doi:10.1111/j.1523-1755.2005.00185.x

Cited by 673 publications

(564 citation statements)

References 17 publications

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“…Block et al (8) reported that the lowest multivariable adjusted relative risk for death occurred for serum phosphorus of 4.0 to 5.0 mg/dl with an adjusted 10% relative increase for 5.0 to 5.5 mg/dl. In Dialysis Outcomes and Practice Patterns Study (DOPPS), a serum phosphorus of 4.5 to 5.0 mg/dl had the lowest multivariable adjusted relative risk for death, with a 12% relative increase for 5.0 to 5.5 mg/dl (29). These and other findings from a European dialysis population (30) suggest that current K/DOQI goals may be too permissive of hyperphosphatemia Ͼ5.0 mg/dl (8,29,30).…”

Section: Elusive Target: Ideal Serum Phosphorusmentioning

confidence: 77%

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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Section: Elusive Target: Ideal Serum Phosphorusmentioning

confidence: 77%

Left Ventricular Hypertrophy

Achinger

Ayus

2006

Journal of the American Society of Nephrology

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“…Thus, PTX rates in CKD are clearly affected by trends in the medical treatment (4A) [6,10,11]. Prevalent basic PTX rates and PTX incidence at follow-up/ 100 patients/year between 1996 and 2001 were approximated per country in the Dialysis Outcome and Practice Pattern study (DOPPS) as follows: France 14.3 %, 1.8; Germany 6 %, 1; Italy 5 %, 0.9; Japan 4.1 %, 0.6; Spain 5.7 %, 1.5; UK 9.2 %, 1.5; USA 4 %, 0.5 [12].…”

Section: Resultsmentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

108

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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“…14 Young e cols., analisando os resultados do primeiro Dialysis Outcomes and Practice Patterns Study (DOPPS), encontraram uma elevação de 13% no risco de mortalidade geral para cada aumento de 1 mEq/L de Ca no dialisato. 15 Essa preocupação com a sobrecarga de Ca foi um dos pontos determinantes para a recomendação de uma concentração de 2,5 mEq/L de Ca no dialisato pelo K/DOQI para a maioria dos pacientes, exceto em situações específicas, quando este pode ser mais alto ou baixo. 1 Na prática clínica, o primeiro DOPPS mostrou que apenas 40% dos pacientes estavam em uso de uma Cad recomendada pelo K/ DOQI.…”

Section: Racionalunclassified

“…Na Europa e no Japão, apenas 24% e 20% estavam em uso de Cad de 2,5 mEq/L, respectivamente. 15 No mais recente guia para o tratamento dos distúrbios do metabolismo mineral e ósseo da DRC foi sugerido o uso de Cad de 2,5 ou 3,0 mEq/L. 3 Apesar das poucas evidências sobre a concentração ideal de Ca no dialisato, algumas considerações devem ser observadas.…”

Section: Racionalunclassified

“…14 Ingestão de Ca na dieta, o tipo de quelante de P utilizado, o uso de vitamina D 2 ou D 3 , uso de calcimimético, nível sérico do PTH e concentração de Ca no dialisato podem influenciar a concentração sérica de Ca nesses pacientes. 15 A ingestão diária de Ca inclui não só o aporte alimentar, mas também o Ca proveniente do quelante de P. Atualmente, recomenda-se que a ingestão diária de Ca, considerando aquela proveniente do quelante de P, não exceda a 2 g/dia. A quantidade de Ca elementar contida no carbonato e acetato de Ca é 40% e 25% respectivamente.…”

Section: Racionalunclassified

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