Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease

Levin, Adeera; Bakris, George L.; Molitch, Mark E.; Smulders, Maartje; Tian, Jinying; Williams, Laura A.; Andress, Dennis L.

doi:10.1038/sj.ki.5002009

Cited by 1,306 publications

(1,072 citation statements)

References 20 publications

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“…(23,24) Our study has limitations. Although parathyroid hormone (PTH) was not measured in all subjects at baseline, women were excluded if they had a current diagnosis of hyperparathyroidism, which is seen often in individuals with intrinsic kidney disease and reduced GFR, (22) and this limits our ability to generalize our findings to these groups. We were unable to use a direct measure of GFR.…”

Section: Discussionmentioning

confidence: 99%

Effects of denosumab on fracture and bone mineral density by level of kidney function

Jamal

Ljunggren

Stehman‐Breen

et al. 2011

Journal of Bone and Mineral Research

299

176

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The incidences of osteoporosis and chronic kidney disease (CKD) both increase with increasing age, yet there is a paucity of data on treatments for osteoporosis in the setting of impaired kidney function. We examined the efficacy and safety of denosumab (DMAb) among subjects participating in the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) Study. We estimated creatinine clearance (eGFR) using Cockcroft-Gault and classified levels of kidney function using the modified National Kidney Foundation classification of CKD. We examined incident fracture rates; changes in bone mineral density (BMD), serum calcium, and creatinine; and the incidence of adverse events after 36 months of follow-up in subjects receiving DMAb or placebo, stratified by level of kidney function. We used a subgroup interaction term to determine if there were differences in treatment effect by eGFR. Most (93%) women were white, and the mean age was 72.3 AE 5.2 years; 73 women had an eGFR of 15 to 29 mL/min; 2817, between 30 to 59 mL/min; 4069, between 60 to 89 mL/min, and 842 had an eGFR of 90 mL/min or greater. None had stage 5 CKD. Fracture risk reduction and changes in BMD at all sites were in favor of DMAb. The test for treatment by subgroup interaction was not statistically significant, indicating that treatment efficacy did not differ by kidney function. Changes in creatinine and calcium and the incidence of adverse events were similar between groups and did not differ by level of kidney function. It is concluded that DMAb is effective at reducing fracture risk and is not associated with an increase in adverse events among patients with impaired kidney function. ß

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Section: Discussionmentioning

confidence: 99%

Effects of denosumab on fracture and bone mineral density by level of kidney function

Jamal

Ljunggren

Stehman‐Breen

et al. 2011

Journal of Bone and Mineral Research

299

176

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“…Secondary hyperparathyroidism (SHPT) is common in patients with CKD, and is characterized by a progressive increase in parathyroid hormone (PTH) and growth of the parathyroid glands (1,2). A major factor in the development and progression of SHPT is the steady decline in serum calcitriol levels, the active form of vitamin D (1).…”

Section: Introductionmentioning

confidence: 99%

“…A major factor in the development and progression of SHPT is the steady decline in serum calcitriol levels, the active form of vitamin D (1). The incidence and severity of SHPT increases as renal function worsens, with 35% of patients with stage 3 CKD and 70% of patients with stage 4 CKD carrying this diagnosis (1).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Multicenter Trial of Paricalcitol versus Calcitriol for Secondary Hyperparathyroidism in Stages 3–4 CKD

Coyne

Goldberg

Faber

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Calcitriol is used to treat secondary hyperparathyroidism in patients with CKD. Paricalcitol is less calcemic and phosphatemic in preclinical studies and in some trials in dialysis patients, but head-to-head comparisons in nondialysis patients are lacking. A large meta-analysis of trials concluded that these agents did not consistently reduce parathyroid hormone (PTH) and increased the risk of hypercalcemia and hyperphosphatemia. Therefore, the objective of this multicenter trial was to compare the rate of hypercalcemia between calcitriol and paricalcitol, while suppressing PTH 40%-60%.Design, setting, participants, & measurements Patients with stages 3-4 CKD (n=110) with a PTH level .120 pg/ml were recruited and randomized to 0.25 mg/d of calcitriol or 1 mg/d of paricalcitol between April 2009 and July 2011. Subsequent dose adjustments were by protocol to achieve 40%-60% PTH suppression below baseline. The primary endpoint was the rate of confirmed hypercalcemia of .10.5 mg/dl between groups.Results Forty-five patients in each group completed the 24 weeks of treatment. Both agents suppressed PTH effectively (252% with paricalcitol and 246% with calcitriol; P=0.17), although the paricalcitol group reached a 40% reduction in PTH sooner at a median 8 weeks (interquartile range [IQR], 4, 12) versus 12 weeks (IQR,8,18; P=0.02) and had a lower pill burden of 240 (IQR, 180, 298) versus 292 (IQR, 231, 405; P=0.01). Confirmed hypercalcemia was very low in both groups (three with paricalcitol and one with calcitriol) and was not significantly different (P=0.36). Both groups had small increases in calcium and phosphorus levels (0.3-0.4 mg/dl in each electrolyte) and significant decreases in alkaline phosphatase, a marker of high bone turnover, with no significant differences between groups.Conclusions These results show that both calcitriol and paricalcitol achieved sustained PTH and alkaline phosphatase suppression in stages 3-4 CKD, with small effects on serum calcium and phosphorus and a low incidence of hypercalcemia.

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“…Whereas the traditional cardiovascular risk factors do not account for the increased mortality in CKD patients (3,4), measures of mineral and bone disorders (MBD), including hyperphosphatemia, are associated with increased death risk (5)(6)(7)(8)(9). Hyperphosphatemia may be involved in the pathogenesis of vascular calcification (10)(11)(12).…”

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confidence: 99%

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

Noori¹,

Kalantar-Zadeh²,

Kövesdy³

et al. 2010

Clinical Journal of the American Society of Nephrology

195

127

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Background and objectives: Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.Design, setting, participants, & measurements: Food frequency questionnaires were used to conduct a cohort study to examine the survival predictability of dietary phosphorus and the ratio of phosphorus to protein intake. At the start of the cohort, Cox proportional hazard regression was used in 224 MHD patients, who were followed for up to 5 years (2001 to 2006).Results: Both higher dietary phosphorus intake and a higher dietary phosphorus to protein ratio were associated with significantly increased death hazard ratios (HR) in the unadjusted models and after incremental adjustments for case-mix, diet, serum phosphorus, malnutrition-inflammation complex syndrome, and inflammatory markers. The HR of the highest (compared with lowest) dietary phosphorus intake tertile in the fully adjusted model was 2.37. Across categories of dietary phosphorus to protein ratios of <12, 12 to <14, 14 to <16, and >16 mg/g, death HRs were 1.13, 1.00 (reference value), 1.80, and 1.99, respectively. Cubic spline models of the survival analyses showed similar incremental associations.Conclusions: Higher dietary phosphorus intake and higher dietary phosphorus to protein ratios are each associated with increased death risk in MHD patients, even after adjustments for serum phosphorus, phosphate binders and their types, and dietary protein, energy, and potassium intakes.

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Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease

Cited by 1,306 publications

References 20 publications

Effects of denosumab on fracture and bone mineral density by level of kidney function

Effects of denosumab on fracture and bone mineral density by level of kidney function

A Randomized Multicenter Trial of Paricalcitol versus Calcitriol for Secondary Hyperparathyroidism in Stages 3–4 CKD

Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

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