Parathyroidectomy Increases Heart Rate Variability and Leptin Levels in Patients with Stage 5 Chronic Kidney Disease

Jiang, Yao; Shen, Zhi-Xiang; Zhang, Jingjing; Xing, Changying; Zha, Xiaoming; Shen, Chong; Zhang, Ming; Yang, Guang; Mao, Huijuan; Zhang, Bo; Yu, Xiangbao; Sun, Bin; Ouyang, Chun; Ge, Yifei; Zhang, Lína; Chen, Cheng; Zhang, Jing; Chen, Yin; Chen, Huimin; Wang, Ningning

doi:10.1159/000449018

Cited by 9 publications

(8 citation statements)

References 53 publications

(61 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Together, they constitute a self-amplifying downhill vortex that drives disturbed mineral metabolism worse and worse. Given that CKD-MBD contributes to the high morbidity and mortality of cardiovascular disease in CKD/ESRD patients [97, 113–116], the increase in soluble Klotho in the circulation should aid in the disruption of this downhill vortex and improvement of CKD-MBD, and hence potentially reduces the risk for cardiovascular morbidfity and mortality [23, 117]. Therefore, FGF23-FGF receptor/Klotho pathway can be a new drug target for disorders of phosphate and bone metabolism [118].…”

Section: Klotho Deficiency As a Pathogenic Intermediate For Bone Dmentioning

confidence: 99%

Potential application of klotho in human chronic kidney disease

Neyra

2017

Bone

View full text Add to dashboard Cite

The extracellular domain of transmembrane alpha-Klotho (αKlotho, hereinafter simply called Klotho) is cleaved by secretases and released into the circulation as soluble Klotho. Soluble Klotho in the circulation starts to decline early in chronic kidney disease (CKD) stage 2 and urinary Klotho possibly even earlier in CKD stage 1. Therefore soluble Klotho could serve as an early and sensitive marker of kidney function decline. Moreover, preclinical animal data support Klotho deficiency is not just merely a biomarker, but a pathogenic factor for CKD progression and extrarenal CKD complications including cardiovascular disease and disturbed mineral metabolism. Prevention of Klotho decline, re-activation of endogenous Klotho production or supplementation of exogenous Klotho are all associated with attenuation of renal fibrosis, retardation of CKD progression, improvement of mineral metabolism, amelioration of cardiomyopathy, and alleviation of vascular calcification in CKD. Therefore Klotho is not only a diagnostic and/or prognostic marker for CKD, but the treatment of Klotho deficiency may be a promising strategy to prevent, retard, and decrease the burden of comorbidity in CKD.

show abstract

Section: Klotho Deficiency As a Pathogenic Intermediate For Bone Dmentioning

confidence: 99%

Potential application of klotho in human chronic kidney disease

Neyra

2017

Bone

View full text Add to dashboard Cite

show abstract

“…Total parathyroidectomy (tPTX) with autotransplantation (AT) is routinely performed in our hospital for all patients with severe SHPT who need PTX [2]. According to KDIGO guidelines and our previous work [2,17,19], the surgical indications for PTX include: (1) an iPTH > 800 pg/ml with hypercalcemia or hyperphosphatemia;…”

Section: Participantsmentioning

confidence: 99%

Effects of Parathyroidectomy on Plasma iPTH and (1–84) PTH Levels in Patients with Stage 5 Chronic Kidney Disease

et al. 2018

View full text Add to dashboard Cite

Currently, the second-generation intact parathyroid hormone (iPTH) assay is commonly used for measuring PTH levels. The iPTH assay detects both full-length (1-84)PTH and (7-84)PTH fragments, which have antagonistic effects on (1-84)PTH in bones and kidneys. The third-generation PTH assay is specific for (1-84)PTH. This study examined the features of different PTH fragments in stage 5 chronic kidney disease (CKD) and the effects of parathyroidectomy (PTX) on the above markers in severe secondary hyperparathyroidism (SHPT) patients. The cross-sectional study included 262 stage 5 CKD patients and 90 controls. A prospective follow-up study was then conducted in 34 PTX patients. Second- and third-generation assays were used to measure plasma iPTH and (1-84)PTH levels, respectively. Circulating (7-84)PTH levels were calculated by subtracting the (1-84)PTH value from the iPTH value. Different plasma PTH fragments were higher, and (1-84)PTH/iPTH was lower in CKD patients than in controls. Plasma (1-84)PTH and (7-84)PTH concentrations increased as iPTH levels increased, and (7-84)PTH increased more evidently. Plasma iPTH, (1-84)PTH and (7-84)PTH levels were 1530.5 (885.0-2111.5) pg/ml, 683.1 (431.4-1018.0) pg/ml, and 739.3 (452.6-1261.0) pg/ml, respectively, in PTX patients. Plasma iPTH, (1-84)PTH and (7-84)PTH concentrations decreased considerably, and the (1-84)PTH/iPTH ratio increased after PTX (median follow-up interval: 10.9 months). Stage 5 CKD patients had higher plasma levels of different PTH fragments, and lower (1-84)PTH/iPTH ratio. PTX could significantly reverse these abnormalities in severe SHPT patients. The iPTH assay overestimated the function of the parathyroid glands; thus, the third-generation PTH assay is likely better for the management of CKD patients.

show abstract

“…A decrease in the HRV has an independent predictive value for the occurrence of various CVDs, especially ventricular arrhythmias and sudden cardiac death [ 8–10 ]. Our previous study proved that HRV indices decreased significantly in CKD5 patients, especially in patients with severe SHPT, while PTX could improve the reduced HRV parameters [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of parathyroidectomy on plasma PTH fragments and heart rate variability in stage 5 chronic kidney disease patients

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction Circulating intact parathyroid hormone (iPTH) levels include full-length (1-84) PTH and long C-PTH fragments, but primarily (7-84) PTH, which have been reported to have antagonistic effects on the bones and kidneys. However, their effects on the cardiovascular system remain unclear. In this study, the relationships between the plasma PTH fragments levels and heart rate variability (HRV) in stage 5 chronic kidney disease (CKD5) patients are explored. Furthermore, the effects of parathyroidectomy (PTX) on the above indices are investigated. Methods In this cross-sectional study, 164 healthy controls and 354 CKD5 patients, including 208 secondary hyperparathyroidism (SHPT) subgroup with PTX, were enrolled. Circulating (7-84) PTH levels were calculated by subtracting plasma (1-84) PTH levels from iPTH levels. The HRV parameters were measured using a 24-hour Holter. Results The baseline levels of plasma iPTH, (1-84) PTH, and (7-84) PTH in the CKD5 patients were 930.40 (160.65, 1792.50) pg/mL, 448.60 (99.62, 850.45) pg/mL, and 468.20 (54.22, 922.55) pg/mL, respectively. In the CKD5 patients, plasma (1-84) PTH levels were independently correlated with the standard deviation of the normal-to-normal R-R intervals (SDNN) and the standard deviation of the five-minute average of the normal R-R intervals (SDANN). With a median follow up time of 6.50 months after PTX in the SHPT patients ( n = 30), improved SDNN and SDANN markers were related with decreased (1-84) PTH levels. Furthermore, an improved SDNN was related with decreased (7-84) PTH levels. Conclusions The CKD5 patients’ baseline (1-84) PTH levels were correlated with the SDNN and SDANN. After PTX, an improved SDNN was related with decreased (1-84) PTH and (7-84) PTH levels, while improved SDANN was related with decreased (1-84) PTH levels. No antagonistic effects of (1-84) PTH and (7-84) PTH on HRV were found in the CKD5 patients.

show abstract

Parathyroidectomy Increases Heart Rate Variability and Leptin Levels in Patients with Stage 5 Chronic Kidney Disease

Cited by 9 publications

References 53 publications

Potential application of klotho in human chronic kidney disease

Potential application of klotho in human chronic kidney disease

Effects of Parathyroidectomy on Plasma iPTH and (1–84) PTH Levels in Patients with Stage 5 Chronic Kidney Disease

Effects of parathyroidectomy on plasma PTH fragments and heart rate variability in stage 5 chronic kidney disease patients

Contact Info

Product

Resources

About