Hyperphosphatemia and hyperparathyroidism in incident chronic kidney disease patients

Ramos, Ana; Albalate, Marta; Vázquez, Silvia; Caramelo, Carlos; Egido, Jesús; Ortíz, Alberto

doi:10.1038/ki.2008.543

Cited by 24 publications

(17 citation statements)

References 22 publications

(31 reference statements)

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“…Hyperphosphatemia was present in 73.8% of our patients. The reported prevalence of hyperphosphatemia in dialysis patients based on different studies is between 50% and 70% [16][17][18][19]. Our results are in line with these published studies, although there is a slightly higher prevalence of hyperphosphatemia in our study population which can be attributed to the variability in the age, gender, BMI and ethnic backgrounds between our patients and those previously studied.…”

Section: Discussionsupporting

confidence: 61%

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

Rabbani

Sathvik

Rao

et al. 2017

Int J Pharm Pharm Sci

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Objective: Hyperphosphatemia is significantly associated with increased mortality among end-stage renal disease (ESRD) patients on hemodialysis.There is a paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis. Methods:Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with the high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, haemoglobin, serum calcium, and hypertensive nephropathy as the cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), a higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, haemoglobin and PTH independently correlated with hyperphosphatemia. Conclusion:We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia.

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Section: Discussionsupporting

confidence: 61%

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

Rabbani

Sathvik

Rao

et al. 2017

Int J Pharm Pharm Sci

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“…In this regard, the vast majority of patients had normal serum phosphate levels and only 5 (0.7%) had serum phosphate >4.5 mg/dl. This is not surprising since, given the toxicity of excess phosphate [13,14], compensatory mechanisms such as increased serum FGF23 and PTH levels are activated very early in the course of CKD and hyperphosphatemia is typically not observed until eGFR categories G4 and mainly G5 [2,15]. Thus, the main CKD-MBD associated changes in the present coronary artery disease cohort were observed for PTH and FGF23.…”

Section: Resultsmentioning

confidence: 56%

“…G3a (Mildly to moderately decreased, 45-59), G3b (Moderately to severely decreased, [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], G4 (Severely decreased [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and G5 (Kidney failure <15). CKD is defined as either an eGFR <60 ml/min/1.73 m 2 or evidence of kidney injury such as a urinary albumin/creatinine ratio (UACR) >30 mg/g [1].…”

Section: The Kdigo 2012 Clinical Practice Guidelines For the Evaluatimentioning

confidence: 99%

Important abnormalities of bone mineral metabolism are present in patients with coronary artery disease with a mild decrease of the estimated glomerular filtration rate

et al. 2015

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Chronic kidney disease mineral bone disorder (CKD-MBD) is characterized by increased circulating levels of parathormone (PTH) and fibroblast growth factor-23 (FGF23), bone disease and vascular calcification, and is associated with adverse outcomes. We studied the prevalence of mineral metabolism disorders, and the potential relationship between decreased estimated glomerular filtration rate (eGFR) and CKD-MBD in coronary artery disease patients in a cross-sectional study of 704 outpatients 7.5±3.0 months after an acute coronary syndrome. Mean eGFR (CKD-EPI formula) was 75.8±19.1 ml/min/1.73 m 2 . Our patients showed lower calcidiol plasma levels than a healthy cohort from the same geographical area. In the case of men, this finding was present in spite of similar creatinine levels in both groups and older age of the healthy subjects. Most patients (75.5%) had an eGFR<90 ml/min/1.73 m 2 (G2-G5 CKD stages) vitamin D levels were the main independent determinants of serum PTH. Mean FGF23 levels were 69.9 (54.5-96.3) RU/ml, and 33% of patients had FGF23>85.5 RU/mL. This value was 18.4% in G1, 30.0% in G2, and 59.2% in G3-5 (p<0.001). In multivariate analysis, eGFR was the main predictor of PTH and FGF23 levels. Increased phosphate levels were present in 0.7% of the whole sample, 0% in G1, 0.3% in G2 and 2.8% in G3-5 (p=0.011). Ninety-nine percent of cases showed calcidiol insufficiency without significant differences among the different degrees of eGFR. In conclusion, in patients 4 with coronary artery disease there is a large prevalence of increased FGF23 and PTH levels. These findings have an independent relationship with decreased eGFR, and are evident at eGFR 60-89 ml/min/1.73 m 2 . Then, mild decrements in eGFR must be taken in consideration by the clinician, since they are associated with progressive abnormalities of mineral metabolism.

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“…Hyperphosphatemia is universally observed in chronic kidney disease (CKD) patients (42, 43) and is a potent predictor of cardiovascular morbidity and mortality (44). Controlling blood Pi by restriction of intake (45, 46), phosphate binder (47, 48) and more efficient dialysis (49) all improve clinical outcome in CKD patients.…”

Section: Klotho: a Novel Phosphatoninmentioning

confidence: 99%

Klotho and Chronic Kidney Disease

Hu¹,

Kuro‐o²,

Moe³

2013

Contributions to Nephrology

230

204

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Through alternative splicing, Klotho protein exists both as a secreted and a membrane form whose extracellular domain could be shed from the cell surface by secretases and released into the circulation to act as endocrine factor. Unlike membrane Klotho which functions as a coreceptor for fibroblast growth factor-23 (FGF23) to modulate FGF23 signal transduction, soluble Klotho is a multi-function protein present in the biological fluids including blood, urine, cerebrospinal fluid and plays important roles in anti-aging, energy metabolism, inhibition of Wnt signaling, anti-oxidation, modulation of ion transport, control of parathyroid hormone and 1,25(OH)2VD3 production, and antagonism of renin-angiotensin-aldosterone system. Emerging evidence from clinical and basic studies reveal that chronic kidney disease is a state of endocrine and renal Klotho deficiency, which may serve as an early biomarker and a pathogenic contributor to chronic progression and complications in chronic kidney disease including vascular calcification, cardiac hypertrophy, and secondary hyperparathyroidism. Supplementation of exogenous Klotho and/or up-regulation of endogenous Klotho production by using rennin angiotensin system inhibitors, HMG CoA reductase inhibitors, vitamin D analogues, peroxisome proliferator-activated receptors-gamma agonists, or anti-oxidants may confer renoprotection from oxidation and suppression of renal fibrosis, and also on prevention or alleviation of complications in chronic kidney disease. Therefore, Klotho is a highly promising candidate on the horizon as an early biomarker, and as a novel therapeutic agent for chronic kidney disease.

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Hyperphosphatemia and hyperparathyroidism in incident chronic kidney disease patients

Abstract: In incident CKD patients there is a high prevalence of out-of-target mineral and bone analytical parameters. The currently authorized therapeutic arsenal for these patients may not be adequate to deal with the problem.

Cited by 24 publications

References 22 publications

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

Hyperphosphatemia in End Stage Renal Disease: Prevalence and Patients Characteristics of Multiethnic Population of United Arab Emirates

Important abnormalities of bone mineral metabolism are present in patients with coronary artery disease with a mild decrease of the estimated glomerular filtration rate

Klotho and Chronic Kidney Disease

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