Association of Secondary Hyperparathyroidism with CKD Progression, Health Care Costs and Survival in Diabetic Predialysis CKD Patients

Schumock, Glen T.; Andress, Dennis L.; Marx, Steven E.; Sterz, Raimund; Joyce, Amie T.; Kalantar-Zadeh, Kamyar

doi:10.1159/000228076

Cited by 43 publications

(37 citation statements)

References 25 publications

(16 reference statements)

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“…Similar results indicating that secondary hyperparathyroidism is a risk factor associated with progression to dialysis or death have been obtained in cohort studies of the health costs of CKD in pre-dialysis patients [9,10]. …”

Section: Clinical Studies and Biological Plausibilitysupporting

confidence: 80%

CKD Patients: The Dilemma of Serum PTH Levels

et al. 2010

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Recent observational studies of patients with stage 3–5 chronic kidney disease (CKD) not undergoing dialysis have shown that even slight increases in parathyroid hormone (PTH) levels are associated with an increased cardiovascular risk, regardless of the serum levels of calcium and phosphorus and vitamin D therapy. These studies suggest paying particular attention to monitoring PTH levels from the early stages of CKD, and preventing any mineral metabolism disorders that may trigger the excessive synthesis and secretion of PTH. However, it is not easy to determine when an appropriate response becomes maladaptive and requires the pharmacological suppression of the parathyroid gland because the gland’s adaptive response can vary widely from one person to another. Furthermore, PTH levels are not always a good predictor of bone turnover and current PTH assays have various methodological limitations. Treating the early mineral metabolism abnormalities of CKD may help prevent the cardiovascular complications whose frequency, costs and mortality have a profound effect on society as a whole. For this reason, there is great interest in establishing adequate target ranges for PTH at different stages of CKD, and determining the most appropriate strategies for reaching them.

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Section: Clinical Studies and Biological Plausibilitysupporting

confidence: 80%

CKD Patients: The Dilemma of Serum PTH Levels

et al. 2010

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“…In a large series of 602 CKD patients, Tanaka and co-workers have shown an independent association between diabetes and high phosphate levels as well as low PTH, FGF-23, and vitamin D levels (29). The consequent expansion of the phosphorus pool, coupled with a poor vitamin D status, might contribute to acceleration of arterial function and structure deterioration as well as explain the excessive risk of all-cause mortality associated with hyperphosphatemia in patients with diabetes (30,31).…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease Progression and Outcome According to Serum Phosphorus in Mild-to-Moderate Kidney Dysfunction

Bellasi

Mandreoli

Baldrati

et al. 2011

Clinical Journal of the American Society of Nephrology

135

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SummaryBackground and objectives Several factors might alter serum phosphate homeostasis and induce hyperhosphatemia in patients with chronic kidney disease (CKD) not requiring dialysis. However, whether and to what extent hyperphosphatemia is associated with a poor prognosis in different CKD patient groups remain to be elucidated.Design, setting, participants & measurements We utilized the "Prevenzione Insufficienza Renale Progressiva" (PIRP) database, a large project sponsored by the Emilia-Romagna Health Institute. PIRP is a collaborative network of nephrologists and general practitioners located in the Emilia-Romagna region, Italy, aimed at increasing awareness of CKD complications and optimizing CKD patient care. We identified 1716 patients who underwent a GFR and serum phosphorous assessment between 2004 and 2007. We tested whether phosphate levels Ն4.3 mg/dl are associated with the risk of CKD progression or all causes of death.Results Older age and male sex were associated with lower phosphate levels. Instead, higher phosphate levels were noted in patients with diabetes. Patients with phosphate levels Ն4.3 mg/dl were at an increased risk of starting dialysis or dying (hazard ratio 2.04; 95% confidence interval [1.44, 2.90]). Notably, subgroup analyses revealed that the magnitude of the risk associated with hyperphosphatemia varied depending on age, sex, diabetes, and different stages of CKD.Conclusions These analyses lend support to the hypothesis that phosphorous abnormalities might have a negative effect on the residual renal function and prognosis in different groups of CKD patients. However, the risk associated with hyperphosphatemia might vary in specific CKD patient subgroups.

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“…In addition, SHPT is associated with a faster rate of CKD progression [36]. The meta-analysis suggested that every 1 mg/dL increase in serum Pi was independently associated with an increased risk for kidney failure (HR 1.36; 95% CI 1.20–1.55) [37].…”

Section: Discussionmentioning

confidence: 99%

Dietary Changes Involving Bifidobacterium longum and Other Nutrients Delays Chronic Kidney Disease Progression

et al. 2018

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Background: Recent studies suggest that prebiotic and/or probiotic treatments ameliorate kidney function in humans and animals by improving the gut environment. However, the gut microbiota and kidney disease interactions remain to be determined. This study investigated whether synbiotics modulate the gut microbiota and ameliorate kidney function using a rat model of chronic kidney disease (CKD). As uremic toxins are associated with CKD-related mineral and bone disorder, the secondary aim was to evaluate the relationship between synbiotics and secondary hyperparathyroidism (SHPT). Methods: 5/6 nephrectomy (Nx) rats were developed as the CKD model. Sham-operated (sham) rats were used as the control. To investigate the effectiveness of prebiotics (glutamine, dietary fiber, and oligosaccharide) and probiotics (Bifidobacterium longum strain; GFOB diet), rats were randomly assigned to 4 groups: Nx group fed the GFOB diet (n = 10); Nx group fed the control (CON) diet (n = 10); sham group fed the GFOB diet (n = 5); and sham group fed the control diet (n = 5). Blood, feces, and kidney samples were collected and analyzed. Results: Serum creatinine (Cre) and blood urea nitrogen in the Nx GFOB group were significantly lower than those in the Nx CON group. Serum indoxyl sulfate in the Nx GFOB group was lower than that in the Nx CON group, and significantly correlated with serum Cre. Inorganic phosphorus and intact parathyroid hormone in the Nx GFOB group were significantly lower than those in the Nx CON group. Conclusion: Improving the gut environment using synbiotics ameliorated kidney function and might be a pharmacological treatment for SHPT without any serious adverse events.

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Association of Secondary Hyperparathyroidism with CKD Progression, Health Care Costs and Survival in Diabetic Predialysis CKD Patients

Cited by 43 publications

References 25 publications

CKD Patients: The Dilemma of Serum PTH Levels

CKD Patients: The Dilemma of Serum PTH Levels

Chronic Kidney Disease Progression and Outcome According to Serum Phosphorus in Mild-to-Moderate Kidney Dysfunction

Dietary Changes Involving <b><i>Bifidobacterium</i></b> <b><i>longum</i></b> and Other Nutrients Delays Chronic Kidney Disease Progression

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