Proceedings: Pathogenesis and Treatment of Renal Osteodystrophy

Slatopolsky, Eduardo; Gonzalez, E. M.; Martin, Kévin

doi:10.1159/000072552

Cited by 41 publications

(33 citation statements)

References 46 publications

(50 reference statements)

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“…Hyperphosphatemia is a component of chronic kidney disease that is associated with mineral and bone disorders, 1 and has been linked to poor outcomes among patients receiving dialysis. 2 Racial and ethnic disparities exist in the treatment of end-stage renal disease (ESRD) 3 , and hyperphosphatemia is more common and more severe in non-whites compared to whites.…”

Section: Introductionmentioning

confidence: 99%

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Umeukeje

Merighi

Browne

et al. 2015

Journal of Renal Nutrition

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Summary Objective Hyperphosphatemia is common in end-stage renal disease (ESRD), and associates with mortality. Phosphate binders reduce serum phosphorus; however, adherence is often poor. This pilot study aims to assess patients’ self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. Design Cross-sectional Participants and measurements Subjects were enrolled from one academic medical center dialysis practice from July–November 2012. Self-motivation to adhere to phosphate binders was assessed with the Autonomous Regulation (AR) scale (range: 1–7), and self-reported medication adherence with the Morisky Medication Adherence Scale (MMAS). Linear regression models adjusting for age, gender, health literacy and medication adherence were applied to determine associations with serum phosphorus level, including any evidence of interaction by race. Results Among 100 participants, mean age was 51 years (± 15), 53% were male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus level was 5.7 [±1.6] mg/dL. More than half (57%) reported the maximum AR score (7). Higher AR scores were noted in those reporting better health overall (p=0.001) and those with higher health literacy (p=0.01). AR score correlated with better medication adherence (r=0.22; p=0.02), and medication adherence was negatively associated with serum phosphorus (r= −0.40; p<0.001). In sub-group analysis among non-whites, higher AR scores correlated with lower serum phosphorus (High vs. Lower AR Score: 5.55 (1.5) vs. 6.96 (2.2); p=0.01). Associations between AR score (β 95% CI: −0.37 (−0.73 – −0.01); p=0.04), medication adherence (β 95% CI: −0.25 (−0.42 – −0.07); p=0.01) and serum phosphorus, persisted in adjusted analyses. Conclusions Self-motivation was associated with phosphate binder adherence and phosphorus control, and this differed by race. Additional research is needed to determine if personalized, culturally sensitive strategies to understand and overcome motivational barriers may optimize mineral bone health in ESRD.

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Section: Introductionmentioning

confidence: 99%

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Umeukeje

Merighi

Browne

et al. 2015

Journal of Renal Nutrition

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“…Maintenance of normal calcium balance and serum calcium concentrations is dependent upon a complex regulation of calcium absorption by the intestinal tract, excretion of calcium by the kidney when it is functional, and release of calcium from and deposition into the bone [32,40]. PTH increases serum calcium levels by stimulating bone resorption and renal distal tubular calcium reabsorption, and by promoting the conversion of 1-α-hydroxylation of 25(OH)D 3 to calcitriol [1,25(0H) 2 D 3 ] in the kidney [41,42].…”

Section: Discussionmentioning

confidence: 99%

Association of Cumulatively Low or High Serum Calcium Levels with Mortality in Long-Term Hemodialysis Patients

et al. 2010

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Background: The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the ‘cumulative’ effect of calcium burden over time. Methods: We employed a Cox model using up-to-5-year (7/2001–6/2006) time-averaged values to examine the mortality-predictability of cumulative serum calcium levels in 107,200 hemodialysis patients prior to the use of calcimimetics, but during the time where other calcium-lowering interventions, including lower dialysate calcium, were employed. Results: Both low (<9.0 mg/dl) and high (>10.0 mg/dl) calcium levels were associated with increased mortality (reference: 9.0 to <9.5 mg/dl). Whereas mortality of hypercalcemia was consistent, hypocalcemia mortality was most prominent with higher serum phosphorus (>3.5 mg/dl) and PTH levels (>150 pg/ml). Higher paricalcitol doses shifted the calcium range associated with the greatest survival to the right, i.e. from 9.0 to <9.5 to 9.5 to <10.0 mg/dl. African-Americans exhibited the highest death hazard ratio of hypocalcemia <8.5 mg/dl, being 1.35 (95% CI: 1.22–1.49). Both a rise and drop in serum calcium over 6 months were associated with increased mortality compared to the stable group. Conclusions: Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.

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“…21,25 Hyperphosphatemia appears to have an important role; it can directly stimulate PTH synthesis and parathyroid hyperplasia and indirectly promotes secondary hyperparathyroidism by decreasing the free calcium level. 26 Medical management is the mainstay for treatment of secondary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

Leontiasis Ossea: A Presentation of Hyperparathyroidism in an Indigenous Australian Man Secondary to Chronic Renal Failure

Collum

Jones

Lynham

et al. 2013

Journal of Oral and Maxillofacial Surgery

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Proceedings: Pathogenesis and Treatment of Renal Osteodystrophy

Cited by 41 publications

References 46 publications

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Association of Cumulatively Low or High Serum Calcium Levels with Mortality in Long-Term Hemodialysis Patients

Leontiasis Ossea: A Presentation of Hyperparathyroidism in an Indigenous Australian Man Secondary to Chronic Renal Failure

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