The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure

Martínez, Isabel; Saracho, Ramón; Montenegro, Jesús Lechuga; Llach, Francisco

doi:10.1016/s0272-6386(97)90330-9

Cited by 212 publications

(126 citation statements)

References 19 publications

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“…It is hypothesized that below a creatinine clearance of 60 ml/min [20] or 50 ml/ min [21], the renal conversion of 25(OH)D 3 to 1.25(OH) 2 D 3 becomes insufficient [20,21]. Several studies [8,9,22] suggest that even a slight decrease in 1.25(OH) 2 D 3 and a corresponding slight increase in iPTH serum levels, observed when creatinine clearance (CrCl) decreases to 60-80 ml/min [23], is associated with subclinical myopathy and balance trouble. It is nowadays accepted that the related increased occurrence of falling, together with increased skeletal fragility, has a larger effect on age-related increased frequency of fractures than bone mass alone [22,24].…”

Section: Introductionmentioning

confidence: 99%

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

et al. 2004

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Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36 weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65 ml/min. Results: At baseline, serum levels of 1.25(OH) 2 D 3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001, p=0.001, respectively), whereas serum levels of 25(OH)D 3 were not associated with CrCl. Below a CrCl of 65 ml/min, 1.25(OH) 2 D 3 serum levels steadily declined. We therefore chose a CrCl of 65 ml/min as cutoff for further analyses. During the 36 weeks of observation, elderly people with a CrCl of <65 ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of ‡65 ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48-10.98; p=0.006), and a significantly higher incidence of falls (28/70 vs 23/ 116; OR=3.68; 95% CI, 1.38-9.82; p=0.009). Conclusions: For the first time we showed that in a communitydwelling population of elderly men and women, a CrCl of less than 65 ml/min is a significant and independent risk factor for fallers and falls.

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Section: Introductionmentioning

confidence: 99%

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

et al. 2004

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“…Although severe osteodystrophy is less common in earlier stages of CKD, elevated intact parathyroid hormone (iPTH) levels, considered one of the earliest markers of abnormal bone mineral metabolism in CKD, have been reported frequently in clinic-based studies of patients with renal insufficiency (3)(4)(5)(6)(7)(8)(9)(10). Also, even moderate reductions in renal function have been associated with significant increases in the risk of hip fracture (11,12).…”

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Association of Serum Intact Parathyroid Hormone with Lower Estimated Glomerular Filtration Rate

Muntner¹,

Jones²,

Hyre³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Results: The geometric mean iPTH level was 39.3 pg/ml. The age-standardized prevalence of elevated iPTH was 8.2%, 19.3%, and 38.3% for participants with eGFR > 60, 45 to 59, and 30 to 44 ml/min/1.73 m 2 , respectively (P-trend < 0.001). After adjustment for age; race/ethnicity; sex; menopausal status; education; income; cigarette smoking; alcohol consumption; body mass index; hypertension; diabetes mellitus; vitamin D supplement use; total calorie and calcium intake; and serum calcium, phosphorus, and 25-hydroxyvitamin D levels-and compared with their counterparts with an eGFR > 60 ml/min/1.73 m 2 -the prevalence ratios of elevated iPTH were 2.30 and 4.69 for participants with an eGFR of 45 to 59 and 30 to 44 ml/min/1.73 m 2 , respectively (P-trend < 0.001). Serum phosphorus > 4.2 mg/dl and 25-hydroxyvitamin D < 17.6 ng/ml were more common at lower eGFR levels. No association was present between lower eGFR and serum calcium < 9.4 mg/dl.Conclusions: This study indicates that elevated iPTH levels are common among patients with moderate CKD.

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“…As alterações na glândula paratireóide ocorrem precocemente no desenvolvimento da diminuição da função renal, antes mesmo de o paciente necessitar de diálise (7). Em pacientes com a taxa de filtração glomerular menor que 60ml/minuto, 50% das biópsias ósseas apresentam histologia anormal (8,9). Ao cair para 20 a 40ml/minuto, praticamente todas as biópsias estão alteradas (10).…”

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Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

Lacativa¹,

Filho

Gonçalves³

et al. 2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 6 Dezembro 2003 644 RESUMOO hiperparatireoidismo é uma manifestação comum na insuficiência renal crônica (IRC), com alta morbi-mortalidade e difícil manejo clínico. As indicações clássicas da paratireoidectomia são: hipercalcemia persistente, principalmente após transplante renal, prurido intratável, fraturas patológicas, dor óssea refratária ao tratamento medicamentoso e calcificação metastática. Infelizmente, esta última não responde à paratireoidectomia e a calcificação dos vasos está relacionada ao aumento da mortalidade. Assim, novos critérios para indicação mais precoce de paratireoidectomia são necessários. Níveis séricos de PTH maiores que 10 vezes o limite da normalidade, apesar da adequada reposição de cálcio e calcitriol, produto cálcio x fósforo maior que 70(mg/dl) 2 , tumor marrom quando é urgente a regressão da massa, artrite e/ou periartrite incapacitantes e ruptura de tendões estão entre outras indicações a serem consideradas. Alguns cuidados são necessários para excluir doenças ósseas concomitantes, como amiloidose e intoxicação por alumínio. Esta revisão visa a orientar os endocrinologistas sobre as indicações e melhor momento de realizar paratireoidectomia no hiperparatireoidismo da IRC. Hyperparathyroidism is a common complication of end-stage renal insufficiency, with a high morbi-mortality and difficult medical control. Classical indications for parathyroidectomy are: persistent hypercalcemia, especially after kidney transplantation, untreatable pruritus, pathologic fractures, bone pain refractory to medical treatment, and metastatic calcifications. Unfortunately, this latter complication does not respond to parathyroidectomy, and blood vessels calcifications are associated with increased mortality. Severe osteitis fibrosa and bone deformities also never disappear. Thus, new criteria for early parathyroidectomy are needed. Serum intact PTH higher than 10 times the upper limit of normality despite adequate calcium and calcitriol supplements, calcium-phosphorus product higher than 70(mg/dL) 2 , "brown tumor" whenever a rapid regression is needed, incapacitating arthritis and/or periarthritis, and rupture of tendons are among other indications that should be considered. Care must be taken to exclude concomitant diseases such as amiloidosis and aluminum intoxication. This review intends to advise endocrinologists about the indications and timing of surgery in hyperparathyroidism due to chronic renal failure.

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The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure

Cited by 212 publications

References 19 publications

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

Association of Serum Intact Parathyroid Hormone with Lower Estimated Glomerular Filtration Rate

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

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