Mineral bone disorders in chronic kidney disease

Hou, Yi‐Chou; Lu, Cheng Wei; Lu, Kuo‐Cheng

doi:10.1111/nep.13457

Cited by 79 publications

(77 citation statements)

References 106 publications

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“…This is associated with severe complications such as fracture, stroke, cardiovascular disease, and mortality [1,2]. Prior to beginning dialysis, 50% of patients with CKD will experience fracture [3,4]. Furthermore, patients with ESRD or young patients with CKD are at a higher risk of fractures [5].…”

Section: Introductionmentioning

confidence: 99%

Lower Serum Fibroblast Growth Factor 21 Levels are Associated with Normal Lumbar Spine Bone Mineral Density in Hemodialysis Patients

Hsu

Wang

et al. 2020

IJERPH

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Recent evidence has indicated that fibroblast growth factor 21 (FGF21) regulates longitudinal bone growth, with increased FGF21 levels leading to bone loss. The present study evaluated the relationship between bone mineral density (BMD) and serum FGF21 levels in patients undergoing hemodialysis (HD). We analyzed blood samples from 95 patients undergoing HD and measured BMD using dual-energy X-ray absorptiometry of the lumbar vertebrae (L2–L4). Serum FGF21 concentrations were determined using a commercially available enzyme-linked immunosorbent assay kit. Thirteen (11.6%) patients were found to have osteoporosis, 27 (28.4%) osteopenia, and 57 patients had normal BMD. Advanced age and decreased body mass index, height, body weight, waist circumference, and triglyceride level were associated with lower lumbar T-scores, as were increased alkaline phosphatase, urea reduction rate, fractional clearance index for urea, and FGF21 levels. Low log-FGF21, increased body mass index, increased pre-HD body weight, and increased logarithmically transformed triglycerides (log-TG) were found to be significantly and independently associated with lumbar BMD by multivariate forward stepwise linear regression analysis with adjustment for significant confounders. We conclude that high serum FGF21 level is negatively associated with BMD in patients undergoing HD.

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Section: Introductionmentioning

confidence: 99%

Lower Serum Fibroblast Growth Factor 21 Levels are Associated with Normal Lumbar Spine Bone Mineral Density in Hemodialysis Patients

Hsu

Wang

et al. 2020

IJERPH

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“…Hence, UTs might alter bone quality but not the BMD. For example, IxS leads to skeletal resistance to PTH [ 29 ] (involved in ABD) [ 36 , 37 ] but does not affect BMD [ 1 , 2 ]. Thirdly, we did not have DXA data for the time of transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic kidney disease-mineral and bone disorder (CKD-MBD) is characterized by one or more of the following manifestations: (i) renal osteodystrophy (ROD), (ii) vascular and soft tissue calcification, and (iii) abnormal metabolism of calcium, phosphorus, parathyroid hormone (PTH) or vitamin D [ 1 ]. In uremic patients, ROD comprises histologically evidenced abnormalities in bone turnover, mineralization, volume, linear growth, and strength [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation

Batteux

Bodeau

André

et al. 2020

Toxins

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Although uremic osteoporosis is a component of mineral and bone disorder in chronic kidney disease, uremic toxin (UT) concentrations in patients with end-stage kidney disease and bone mineral density (BMD) changes after kidney transplantation have not previously been described. We hypothesized that elevated UT concentrations at the time of transplantation could have a negative impact on bone during the early post-transplantation period. Hence, we sought to determine whether concentrations of UTs (trimethylamine-N-oxide, indoxylsulfate, p-cresylsulfate, p-cresylglucuronide, indole-3-acetic acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-furanpropionic acid) upon transplantation are predictive markers for (i) osteoporosis one month after transplantation, and (ii) a BMD decrease and the occurrence of fractures 12 and 24 months after kidney transplantation. Between 2012 and 2018, 310 kidney transplant recipients were included, and dual-energy X-ray absorptiometry was performed 1, 12, and 24 months after transplantation. The UT concentrations upon transplantation were determined by reverse-phase high-performance liquid chromatography. Indoxylsulfate concentrations upon transplantation were positively correlated with BMD one month after transplantation for the femoral neck but were not associated with osteoporosis status upon transplantation. Concentrations of the other UTs upon transplantation were not associated with osteoporosis or BMD one month after transplantation. None of the UT concentrations were associated with BMD changes and the occurrence of osteoporotic fractures 12 and 24 months after transplantation. Hence, UT concentrations at the time of kidney transplantation were not predictive markers of osteoporosis or fractures.

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“…The main contributing factor for secondary hyperparathyroidism is the "trade-off" theory of the decreased renal excretion of phosphate. A decrease in the glomerular filtration rate results in decreased renal excretion of phosphate, thereby activating phosphaturic hormone excretion, such as fibroblast growth factor 23 or parathyroid hormone, such that there is an increase in the reabsorption of phosphate through the sodium-phosphate cotransporter in remnant nephrons [32]. The parathyroid hormone reduces RBC formation by inhibiting their maturation in the bone marrow [33].…”

Section: Discussionmentioning

confidence: 99%

Tc-99m TRODAT-1 SPECT is a Potential Biomarker for Restless Leg Syndrome in Patients with End-Stage Renal Disease

Hou

Fan

Huang

et al. 2020

JCM

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Rationales: Restless leg syndrome (RLS) is a common complication in patients with end-stage renal disease (ESRD). However, there is a lack of biomarkers linking uremic RLS to dopaminergic neurons. Previous studies demonstrated that Tc-99m TRODAT-1 SPECT was a biomarker for RLS but the correlation between the physiologic parameter was lacking. Methods: Overall, 32 patients were enrolled in the study and divided into the following 3 groups: (1) control (n = 13), (2) ESRD without RLS (n = 8) and (3) ESRD with RLS (n = 11). All patients had a clinical diagnosis of RLS and received Tc-99m TRODAT-1 SPECT. A subgroup analysis was performed to compare differences between the control and ESRD with RLS groups. Tc-99m TRODAT-1 SPECT was performed and activities in the striatum and occipital areas were measured using manually delineated regions of interest (ROIs) by an experienced nuclear medicine radiologist who was blinded to clinical data. Results: The total ratio of Tc-99m TRODAT SPECT was lower in the ESRD with RLS group (p = 0.046). The uptake ratio of TRODAT negatively correlated with serum parathyroid hormone (r = −0.577, p = 0.015) and ferritin (r = −0.464, p = 0.039) concentrations. However, the uptake positively correlated with the hemoglobin concentration (r = 0.531, p = 0.011). The sensitivity and specificity of the total TRODAT ratio for predicting RLS in the overall population were 95.0% and 67.7%, respectively, at a cutoff value of 0.980 (area under the curve of receiver operating characteristic curve was 0.767, p = 0.024). Conclusion: In patients with ESRD and RLS, Tc-99m TRODAT might be a potential biomarker. Dysregulated hemoglobin, serum parathyroid hormone and serum ferritin concentrations might influence the uptake of the TRODAT ratio.

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Mineral bone disorders in chronic kidney disease

Cited by 79 publications

References 106 publications

Lower Serum Fibroblast Growth Factor 21 Levels are Associated with Normal Lumbar Spine Bone Mineral Density in Hemodialysis Patients

Lower Serum Fibroblast Growth Factor 21 Levels are Associated with Normal Lumbar Spine Bone Mineral Density in Hemodialysis Patients

Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation

Tc-99m TRODAT-1 SPECT is a Potential Biomarker for Restless Leg Syndrome in Patients with End-Stage Renal Disease

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