Recomendaciones de la Sociedad Española de Nefrología para el manejo de las alteraciones del metabolismo óseo-mineral en los pacientes con enfermedad renal crónica: 2021 (SEN-MM)

Torregrosa, José-Vicente

doi:10.1016/j.nefro.2022.03.007

Cited by 13 publications

(54 citation statements)

References 243 publications

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“…Serum 25-hydroxy-vitamin D [25(OH) D] levels between 20 and 30 ng/mL are considered insufficient and <20 ng/mL deficient [ 114 ]. Recent guidelines recommend measuring and treating vitamin D insufficiency in patients with CKD categories G3–G5 [ 115 ]. However, the active molecule and the dose to be used are still debated.…”

Section: Vitamin D Aging and Ckdmentioning

confidence: 99%

Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?

et al. 2023

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As life expectancy increases in many countries, the prevalence of age-related diseases also rises. Among these conditions, chronic kidney disease is predicted to become the second cause of death in some countries before the end of the century. An important problem with kidney diseases is the lack of biomarkers to detect early damage or to predict the progression to renal failure. In addition, current treatments only retard kidney disease progression, and better tools are needed. Preclinical research has shown the involvement of the activation of cellular senescence-related mechanisms in natural aging and kidney injury. Intensive research is searching for novel treatments for kidney diseases as well as for anti-aging therapies. In this sense, many experimental shreds of evidence support that treatment with vitamin D or its analogs can exert pleiotropic protective effects in kidney injury. Moreover, vitamin D deficiency has been described in patients with kidney diseases. Here, we review recent evidence about the relationship between vitamin D and kidney diseases, explaining the underlying mechanisms of the effect of vitamin D actions, with particular attention to the modulation of cellular senescence mechanisms.

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Section: Vitamin D Aging and Ckdmentioning

confidence: 99%

Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?

et al. 2023

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“…In addition, VD is involved in many other genomic, biochemical, and clinical pathways, with stimulatory or inhibitory effects on the occurrence of morphological and/or functional changes in vital organs, which confer on VD its systemic functions beyond bone [ 45 , 46 , 47 ]. Specifically, VD deficiency is not merely one of the laboratory abnormalities in need of clinical monitoring but rather is associated with all of the other components (bone disease, vascular calcification, fractures, cardiovascular disease, and mortality) ( Figure 1 ) [ 39 , 40 , 43 , 44 , 48 ]. Moreover, VD deficiency (native or active) has been associated with the development of the well-known CKD-associated secondary hyperparathyroidism (SHPT).…”

Section: Ckd-mbd Vitamin D Skeletal Fragility and Osteoporosismentioning

confidence: 99%

“…Although controversies still exist [ 30 , 35 , 36 , 37 , 38 ], diagnosis and treatment of VD deficiency [with either nutritional (native) or active forms of VD] have not yet been excluded from nephrology practice and guidelines [ 22 , 31 , 39 , 40 ], and despite the poor quality of available evidence, much data may still support VD use in populations with VD deficiency or certain special characteristics, such as CKD patients [ 36 , 39 , 40 ]. Furthermore, when an optimized prediction tool was recently developed using machine-learning techniques, both parathyroid hormone (PTH) and calcidiol were found to be among the seven variables identified as having the best predictive value for 2-year all-cause mortality in patients with CKD G4-G5 [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

et al. 2023

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Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.

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“…Es un agente calcimimético que se une al receptor sensible de Ca de la glándula paratiroidea y lo modifica alostérica mente, de manera que lo hace más sensible a las acciones del calcio extracelular. Reduce de forma significativa los niveles de PTH, y como consecuencia, reduce los valores séricos de calcio y, eventualmente, también de fósforo (7).…”

Section: Cinacalcetunclassified

“…El cinacalcet se ha utilizado en España desde el año 2006 para el manejo del HPT pos TR considerándolo un medicamento seguro y costo efectivo (7), aunque su uso es considerado una indicación off label, existen varios estudios que ratifican su eficacia clínica en el manejo de estos pacientes.…”

Section: Cinacalcetunclassified

Manejo del hiperparatiroidismo en el Paciente Postransplante Renal: Cinacalcet versus Paratiroidectomía. Revisión de la Literatura

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2022

RC_UCR-HSJD

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El hiperparatiroidismo posterior a trasplante renal es una entidad prevalente en esta población, genera un efecto negativo sobre el injerto renal, presentando un mayor riesgo de disfunción del injerto, además le confiere riesgo de fractura, de calcificación vascular y mortalidad; el manejo adecuado de esta entidad es imperativo para minimizar los efectos secundarios. La paratiroidectomía genera una disminución documentada del 25% de la tasa de filtración glomerular basal en las diferentes series revisadas. Sobre la sobrevida del injerto la evidencia es contradictoria, algunos estudios indican que genera una disminución de la sobrevida del injerto, mientras que, en otras series no se documenta alteración de la sobrevida del trasplante. Parece ser el método tradicional más efectivo para el control de la paratohormona y calcio. El manejo farmacológico con cinacalcet impresiona presentarse como una alternativa adecuada en el manejo de la hipercalcemia por el hiperparatiroidismo sin adenoma documentado, logra un adecuado control del calcio, sin embargo, no es tan adecuado para el control de la paratohormona, no hay alteración propuesta sobre la función renal o sobrevida del injerto. Por tanto, impresiona que se debería considerar el manejo farmacológico en los pacientes con hiperparatiroidismo pos trasplante renal, al menos por un año, y reservar la paratiroidectomía solo en aquellos casos con adenoma documentado o con falla al tratamiento con cinacalcet.

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Recomendaciones de la Sociedad Española de Nefrología para el manejo de las alteraciones del metabolismo óseo-mineral en los pacientes con enfermedad renal crónica: 2021 (SEN-MM)

Cited by 13 publications

References 243 publications

Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?

Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines

Manejo del hiperparatiroidismo en el Paciente Postransplante Renal: Cinacalcet versus Paratiroidectomía. Revisión de la Literatura

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