PTH and the Risks for Hip, Vertebral, and Pelvic Fractures Among Patients on Dialysis

Danese, Mark D.; Kim, John; Doan, Quan V.; Dylan, Michelle; Griffiths, Robert I.; Chertow, Glenn M.

doi:10.1053/j.ajkd.2005.09.024

Cited by 281 publications

(195 citation statements)

References 25 publications

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“…39 In patients with ESRD, data regarding iPTH and fracture are conflicting. Some studies found no association between iPTH and fracture 40,41 whereas others suggest that low [42][43][44] or high 44,45 iPTH levels are associated with fracture. Studies in patients with predialysis CKD demonstrated that higher iPTH is inversely associated with aBMD by DXA 7,25,27,46 and total and cortical vBMD by HR-pQCT.…”

Section: Clinical Research Wwwjasnorgmentioning

confidence: 99%

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Nickolas

Cremers²,

Zhang³

et al. 2011

Journal of the American Society of Nephrology

125

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Patients with chronic kidney disease (CKD) have higher rates of fracture than the general population. Increased bone remodeling, leading to microarchitectural deterioration and increased fragility, may accompany declining kidney function, but there are no reliable methods to identify patients at increased risk for fracture. In this cross-sectional study of 82 patients with predialysis CKD, high-resolution imaging revealed that the 23 patients with current fractures had significantly lower areal density at the femoral neck; total, cortical, and trabecular volumetric bone density; cortical area and thickness; and trabecular thickness. Compared with levels in the lowest tertile, higher levels of osteocalcin, procollagen type-1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b were associated with higher odds of fracture, even after adjustment for femoral neck T-score. Discrimination of fracture prevalence was best with a femoral neck T-score of Ϫ2.0 or less and a value in the upper two tertiles for osteocalcin, procollagen type-1 N-terminal propeptide, or tartrate-resistant acid phosphatase 5b; these values corresponded to the upper half of the normal premenopausal reference range. In summary, these cross-sectional data suggest that measurement of bone turnover markers may increase the diagnostic accuracy of densitometry to identify patients with CKD at high risk for fracture.

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Section: Clinical Research Wwwjasnorgmentioning

confidence: 99%

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Nickolas

Cremers²,

Zhang³

et al. 2011

Journal of the American Society of Nephrology

125

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“…Secondary hyperparathyroidism is characterized by elevated levels of PTH, comprising a major component of CKD mineral and bone disorder (CKD-MBD) (14). CKD-MBD is a common complication in hemodialysis patients and is associated with not only bone disease (15)(16)(17) but also mortality and cardiovascular disease (17)(18)(19)(20). Clinical guidelines therefore recommend maintaining target levels of intact PTH (iPTH), phosphorus, and calcium (21-23).…”

Section: Introductionmentioning

confidence: 99%

Prescription Patterns and Mineral Metabolism Abnormalities in the Cinacalcet Era

Fukagawa

Fukuma

Ônishi³

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Prescription patterns for hemodialysis patients with secondary hyperparathyroidism have varied widely since market introduction of cinacalcet. This study examined associations between prescription patterns and subsequent laboratory values. Design, setting, participants, & measurements Using a Mineral and Bone Disorder Outcomes Study for Japanese CKD Stage 5D Patients subcohort, 1716 prevalent hemodialysis patients (4048 sets for repeated measures between January 2008 and July 2009) with an intact parathyroid hormone (iPTH) level >180 pg/ml who used intravenous vitamin D receptor activator (VDRA) without cinacalcet were selected. Prescription patterns were defined based on cinacalcet administration (starting or not) and VDRA dosage change (decreased [<−25%], stable [−25% to 25%], or increased [>25%]). Proportion differences (PDs) were determined for decreasing iPTH levels by at least one category (<180, 180–299, 300–499, and ≥500 pg/ml) and for achieving target phosphorus (3.5–6.0 mg/dl) and calcium (8.4–10.0 mg/dl) levels, adjusting for potential confounders. Results The starting cinacalcet and increased VDRA patterns were associated with decreasing iPTH levels (PD, 0.25 and 0.13; 95% confidence intervals [95% CIs], 0.19–0.31 and 0.09–0.17, respectively); combination use had an additive association (PD, 0.34; 95% CI, 0.20–0.42). The starting cinacalcet and decreased VDRA combination was associated with simultaneously achieving target phosphorus (PD, 0.12; 95% CI: 0.04–0.20) and calcium (PD, 0.09; 95% CI, 0.01–0.17) levels. Conclusions Certain combinations of cinacalcet and VDRA were associated with decreasing iPTH and achieving targets for phosphorus and calcium. Combinations may prove advantageous versus VDRA alone in managing secondary hyperparathyroidism.

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“…Secondary hyperparathyroidism (SHPT) is a common complication of dialysis, and it increases the risk of bone disease (1,2) and cardiovascular diseases (3)(4)(5)(6)(7). Long-term disorders of bone-mineral metabolism can be seen as a systemic condition (chronic kidney disease-related mineral and bone disorders [CKD-MBD]) (8), and the prognosis for dialysis patients might be improved if SHPT is controlled (8,9).…”

Section: Introductionmentioning

confidence: 99%

Decreases in PTH in Japanese Hemodialysis Patients with Secondary Hyperparathyroidism

Akizawa

Kido

Fukagawa

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Control of serum concentrations of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) is essential for management of secondary hyperparathyroidism (SHPT).Design, setting, participants, & measurements This is a planned interim analysis of a longitudinal cohort study. The settings are dialysis facilities in Japan. Eligible patients comprise all those who were receiving hemodialysis at one of 86 participating facilities and who have SHPT. Using data from a random sample (n ϭ 3276) of the participants from January 2008 through June 2009, we measured changes in the percentages of patients who were within the national guideline-specified target ranges of Ca (8.4 to 10 mg/dl), P (3.5 to 6.0 mg/dl), and intact PTH (iPTH) (60 to 180 pg/ml), and changes in prescriptions of drugs targeting SHPT. We used regression models to identify factors affecting the achievement of the guideline-specified targets.Results There were no notable changes in the percentage of patients who were within the guideline for Ca, P, or both. The percentage who were within the iPTH guideline increased from 14.5% to 43.3% (P Ͻ 0.001). There were no remarkable changes in the percentage of patients receiving vitamin D or phosphate binders. The percentage who received cinacalcet increased from 0% to 29%. Prescription of cinacalcet was associated with improvement or target-achievement for iPTH and for Ca by 16.8 percentage points (95% CI: 8.1 to 17.0) and by 12.6 percentage points (13.7 to 19.9), respectively. ConclusionsIn the routine care of hemodialysis patients, increasing use of cinacalcet was associated with better control of SHPT.

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PTH and the Risks for Hip, Vertebral, and Pelvic Fractures Among Patients on Dialysis

Cited by 281 publications

References 25 publications

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Discriminants of Prevalent Fractures in Chronic Kidney Disease

Prescription Patterns and Mineral Metabolism Abnormalities in the Cinacalcet Era

Decreases in PTH in Japanese Hemodialysis Patients with Secondary Hyperparathyroidism

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