Mineral and bone disorders in conventional hemodialysis: Challenges and solutions

Hamano, Takayuki

doi:10.1111/sdi.12729

Cited by 9 publications

(9 citation statements)

References 61 publications

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“…Low BMD is associated with the occurrence of new fractures, reduced quality of life, and increased mortality (1,2). Thus, it is important to manage mineral and bone disorders (MBD) associated with CKD (CKD-MBD) (3). Additionally, HD patients commonly have decreased skeletal muscle mass and decreased muscle strength, known as sarcopenia (4).…”

Section: Introductionmentioning

confidence: 99%

Skeletal Muscle Mass Index Is Positively Associated With Bone Mineral Density in Hemodialysis Patients

Ookawara

Hibino³

et al. 2020

Front. Med.

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Background: Patients with chronic kidney disease (CKD) are at risk for bone loss and sarcopenia because of associated mineral and bone disorders (MBD), malnutrition, and chronic inflammation. Both osteoporosis and sarcopenia are associated with a poor prognosis; however, few studies have evaluated the relationship between muscle mass and bone mineral density (BMD) in hemodialysis (HD) patients. The present study examined the association between skeletal muscle mass index (SMI) and BMD in the lumbar spine and femoral neck in HD patients. Methods: Fifty HD patients (mean age, 69 ± 10 years; mean HD duration, 9.0 ± 8.8 years) in Minami-Uonuma City Hospital were evaluated. BMD was measured by dual-energy X-ray absorptiometry, and SMI was measured by bioelectrical impedance analysis (InBody TM) after HD. The factors affecting lumbar spine and femoral neck BMD were investigated, and multivariate analysis was performed. Results: In simple linear regression analysis, the factors that significantly affected the lumbar spine BMD were sex, presence of hypertension, presence of diabetes mellitus, body mass index, triglyceride level, grip strength, and SMI; the factors that significantly affected the femoral neck BMD were sex, HD duration, serum creatinine level, tartrate-resistant acid phosphatase 5b level, undercarboxylated osteocalcin (ucOC) level, N-terminal propeptide of type I procollagen level, grip strength, and SMI. In multivariate analysis, SMI (standardized coefficient: 0.578) was the only independent factor that affected the lumbar spine BMD; the independent factors that affected the femoral neck BMD were SMI (standardized coefficient: 0.468), ucOC (standardized coefficient: −0.366) and sex (standardized coefficient: 0.231).

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Section: Introductionmentioning

confidence: 99%

Skeletal Muscle Mass Index Is Positively Associated With Bone Mineral Density in Hemodialysis Patients

Ookawara

Hibino³

et al. 2020

Front. Med.

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“…Despite growth in knowledge, the predictors for VC are not fully understood. Furthermore, correcting a disturbed mineral metabolism also fails to substantially improve clinical outcomes [8] and controlling the relentless progression of VC has become even more challenging [9].…”

Section: Introductionmentioning

confidence: 99%

Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

et al. 2019

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Background and aims Malnutrition and inflammation are closely linked to vascular calcification (VC), the severity of which correlate with adverse outcome. However, there were few studies on the interplay between malnutrition, inflammation and VC progression, rather than VC presence per se. We aimed to determine the relationship of malnutrition, inflammation, abdominal aortic calcification (AAC) progression with survival in hemodialysis (HD) patients. Methods Malnutrition and inflammation were defined as low serum albumin (< 40 g/L) and high hs-CRP (≥ 28.57 nmol/L), respectively. We defined AAC progression as an increase in AAC score using lateral lumbar radiography at both baseline and one year later. Patients were followed up to investigate the impact of AAC progression on all-cause and cardiovascular mortality. Results AAC progressed in 54.6% of 97 patients (mean age 58.2±11.7 years, 41.2% men) at 1-year follow-up. Hypoalbuminemia (Odds ratio 3.296; 95% confidence interval 1.178–9.222), hs-CRP (1.561; 1.038–2.348), low LDL-cholesterol (0.976; 0.955–0.996), and the presence of baseline AAC (10.136; 3.173–32.386) were significant risk factors for AAC progression. During the mean follow-up period of 5.9 years, 38(39.2%) patients died and 27(71.0%) of them died of cardiovascular disease. Multivariate Cox regression analysis adjusted for old age, diabetes, cardiovascular history, and hypoalbuminemia determined that AAC progression was an independent predictor of all-cause mortality (2.294; 1.054–4.994). Conclusions Malnutrition and inflammation were significantly associated with AAC progression. AAC progression is more informative than AAC presence at a given time-point as a predictor of all-cause mortality in patients on maintenance HD.

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“…One of the most common causes of death in patients with CKD is CVD. Uremic vascular calcification might be the primary reason for poor CVD outcomes in patients with CKD [ 12 , 13 ]. Vascular calcification was thought to be a passive and degenerative condition without any proposed efficient treatment solutions.…”

Section: Chronic Kidney Disease–mineral Bone Disorder (Ckd-mbd) and U...mentioning

confidence: 99%

Biological Activity of Different Forms of Oxidized Parathyroid Hormone

Hasan

Hocher

Kleuser

et al. 2022

IJMS

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Preclinical studies have shown that parathyroid hormone (PTH) loses its biological effects through oxidation. PTH can be oxidized at methionines 8 and 18. Three possible variations of oxidized PTH (oxPTH) exist: Met8(ox)PTH, Met18(ox)PTH, and Met8, Met18(di-ox)PTH. A recent study showed that Met18(ox)PTH retained biological activity and was able to upregulate Fgf23 gene expression, whereas Met8(ox)PTH and Met8, Met18(di-ox)PTH showed less or no biological activity. An earlier study likewise showed that the oxidation of Met18 has minor effects on the secondary structure of PTH, whereas the oxidation of Met8 causes substantial structural changes, consistent with another study showing that oxidization just at Met8 blocks the generation of the second messenger cAMP, whereas the effect of the oxidation of Met18 is much less potent in inhibiting cAMP formation. A considerable percentage of circulating PTH in chronic kidney disease (CKD) patients is oxidized. However, we do not know the relative amounts of the different forms of oxPTH with agonistic, partial agonistic, or even antagonistic biological actions in different CKD populations. This might explain different clinical findings in the different CKD populations analyzed so far. The currently available method that was used in these clinical studies just distinguishes between oxPTH and noxPTH without being able to differentiate between different forms of oxPTH. Only methods of PTH measurement that are able to differentiate between PTH forms (noxPTH, Met8(ox)PTH, Met18(ox)PTH, and Met8, Met18(di-ox)PTH) have the potential to improve patient care, because only these methods will definitively separate bioactive from non-bioactive PTH forms. Such methods need to be developed, validated, and used in prospective randomized clinical trials to define the potential value of bioactive PTH forms as a predictor of cardiovascular events, mortality, and bone turnover.

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Mineral and bone disorders in conventional hemodialysis: Challenges and solutions

Cited by 9 publications

References 61 publications

Skeletal Muscle Mass Index Is Positively Associated With Bone Mineral Density in Hemodialysis Patients

Skeletal Muscle Mass Index Is Positively Associated With Bone Mineral Density in Hemodialysis Patients

Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

Biological Activity of Different Forms of Oxidized Parathyroid Hormone

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