The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up

Figurek, Andreja; Vlatković, Vlastimir; Vojvodic, Dragan; Gašić, Branislav; Grujičić, Milorad

doi:10.1515/rjim-2017-0021

Cited by 5 publications

(2 citation statements)

References 28 publications

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“…In patients with chronic kidney disease (CKD) and more specifically those on haemodialysis therapy (HD), secondary hyperparathyroidism (SHPT) in frequently observed as reported in French and European dialysis cohorts [ 1 , 2 ]. Together with effects of SHPT on bone, such as an increase in the bone turnover rate and increased risk of fractures [ 3 ], the main consequences of SHPT are cardiovascular calcification [ 4 ] and a higher mortality rate [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort

et al. 2018

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BackgroundSecondary hyperparathyroidism (SHPT) is a frequent complication of renal disease and most commonly occurs in patients on haemodialysis (HD) with metabolic, vascular, endocrine, and bone complications. The aim of this study was to analyze the evolution of mineral metabolism parameters during the first 36 months of HD treatment and identify the initial factors associated with severe SHPT.MethodsSerum parathyroid hormone (PTH), calcium and phosphate levels were measured monthly; bone-specific alkaline phosphatase (b-ALP) and beta-CrossLaps (CTX) were measured biannually. Severe SHPT was defined as the need for cinacalcet treatment. Patients with less than 24 months of follow-up were excluded.ResultsOne hundred thirty-three incident HD patients were included. Baseline mean PTH was 275 ± 210 pg/mL. After an initial drop at the third month (172 ± 133 pg/mL), the serum PTH level progressively increased to the maximum at 36 months (367 ± 254 pg/mL). This initial drop was associated with the initial correction of both hypocalcaemia and hyperphosphataemia. Serum CTX and b-ALP revealed no significant changes over time. Severe SHPT was observed in 18% of patients and was associated with higher mean calcaemia and phosphataemia. In logistic regression, the initial factors associated with the risk of severe SHPT were: female sex, higher baseline PTH and CTX values. A receiver operation characteristic curve analysis identified a cut-off value of >374 pg/mL for baseline PTH and >1.2 μg/L for CTX for increased risk of developing severe SHPT. The relative risk of developing severe SHPT was 3.7 (1.8–7.5, p = 0.002) for high baseline CTX, 4.9 (2.4–9.7, p = 0.001) for high baseline PTH, and 7.7 (3.6–16, p< 0.0001) when both criteria were present.ConclusionAfter an initial drop, a progressive increase in the serum PTH level during the first 3 years of HD treatment was observed despite aggressive therapy. High baseline levels of PTH and CTX increased the risk of developing severe SHPT.

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Section: Introductionmentioning

confidence: 99%

Severe secondary hyperparathyroidism in patients on haemodialysis is associated with a high initial serum parathyroid hormone and beta-CrossLaps level: Results from an incident cohort

et al. 2018

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“…Bisphosphonates are not as effective in patients with low bone turnover, which is more common in patients with severe (stages 4-5) CKD. The benefits of bisphosphonate, antiresorptive drugs is limited in patients with severe CKD because some of these patients have significantly diminished bone turnover (1).…”

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confidence: 99%