Mineral metabolism disturbances start early in the course of CKD. The first alterations to take place are a 1,25-dihydroxyvitamin D decrease, a 24 h urine phosphate decrease and a PTH elevation, which show significant level variation when the glomerular filtration rate falls below 60 ml/min. K/DOQI recommended levels for mineral metabolism parameters are difficult to accomplish, in particular for PTH levels.

There is a stronger influence of mineral metabolism on cardiovascular death among European patients when compared to the American population.

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The progression of hyperparathyroidism is slower in predialysis patients with BB genotypes than in the other genotypes. Also, calcitriol levels are less reduced in the BB genotype, which may act to lessen the severity of secondary hyperparathyroidism.

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Background Models developed to predict hospital-acquired AKI (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow to establish a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI, integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI. Methods Study set: 36,852 non-critically ill hospitalized patients admitted from January to December 2017. Using stepwise logistic analyses, including demography, chronic comorbidities, and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI. This model was then externally validated in 21,545 non-critical patients admitted to the validation center in the period from June 2017 to December 2018. Results The incidence of AKI in the study set was 3.9%. Among chronic comorbidities, the highest odds ratios, were conferred by chronic kidney disease, urologic and liver disease. Among acute complications, the highest odd ratios were associated with acute respiratory failure, anemia, systemic inflammatory response syndrome (SIRS), circulatory shock and major surgery. The model showed an AUC of 0.907(95% CI 0.902 to 0.908), a sensitivity of 82.7 (95% CI 80.7–84.6) and a specificity of 84.2 (95% CI 83.9-84.6) to predict HA-AKI, with an adequate goodness-of-fit for all risk categories (Chi2:6.02, p:0.64). In the validation set, prevalence of AKI was 3.2%. The model showed an AUC of 0.905 (95% CI 0.904-0.910) a sensitivity of 81.2 (95% CI 79.2–83.1) and a specificity of 82.5 (95% CI 82.2- 83) to predict HA-AKI and had an adequate goodness-of-fit for all risk categories (Chi2:4.2, p:0.83). An online tool predaki.amalfianalytics.com is available to calculate the risk of AKI in other hospital environments. Conclusions By using electronic health data records, our study provides a model that can be used in clinical practice to obtain an accurate dynamic and updated assessment of the individual risk of HA-AKI along the hospital admission period in non-critically ill patients.

In patients over 40 years, renal function is going to deteriorate as long as the excess of weight persists. Laparoscopic sleeve gastrectomy has shown to improve the renal function 12 months after surgery.