Renal Osteodystrophy in Predialysis and Hemodialysis Patients: Comparison of Histologic Patterns and Diagnostic Predictivity of Intact PTH

Coen, G; Ballanti, P.; Bonucci, E.; Calabria, Santo; Costantini, Sergio; Ferrannini, Michele; Giustini, Marco; Giordano, Rosaria; Nicolai, Giulia; Manni, Micaela; Sardella, Daniela; Taggi, Franco

doi:10.1159/000057611

Cited by 107 publications

(64 citation statements)

References 18 publications

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“…The increased fracture risk among ESRD patients may relate to the more advanced underlying metabolic bone disease (CKD-mineral and bone disorder) observed in this population than in those with earlier stages of CKD (12,28). Of note, most of our patients had eGFR $30 ml/min per 1.73 m 2 , and although we did not have access to measures of mineral metabolism, other studies would suggest that even nondialysis patients with eGFR ,30 ml/min per 1.73 m 2 may not develop disordered mineral metabolism (29,30).…”

Section: Discussionmentioning

confidence: 99%

Estimated GFR and Fracture Risk

Elliott¹,

James

Quinn³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Although patients with ESRD have a higher fracture risk than the general population, there is conflicting evidence regarding fracture incidence in those with CKD. This study sought to determine the association between estimated GFR (eGFR) and fracture rates.Design, setting, participants, & measurements This study identified 1,815,943 community-dwelling adults who had at least one outpatient serum creatinine measurement between 2002 and 2008. Patients with eGFR ,15 ml/min per 1.73 m 2 and those who required dialysis were excluded. Incident fractures of the hip, wrist, and vertebrae were identified using diagnostic and procedure codes. Poisson regression was used to determine adjusted rates of each fracture type by eGFR, age, and sex.Results The median age of the cohort was 47 years (interquartile range, 24), and 7.1% had eGFR ,60 ml/min per 1.73 m 2 . Over a median follow-up of 4.4 years, fracture rates increased with age at all sites. Within each age stratum, unadjusted rates increased with declining eGFR; however, adjusted rates were similar across eGFR categories. For example, among women aged 65-74 years, adjusted hip fracture rates were 3.41 per 1000 personyears (95% confidence interval, 2.30 to 4.53) and 4.58 per 1000 person-years (95% confidence interval, 0.02 to 9.14) in those with eGFR $90 and 15-29 ml/min per 1.73 m 2 , respectively. Similar results were observed for wrist and vertebral fractures. ConclusionsIn contrast to earlier studies, patients with eGFR,60 ml/min per 1.73 m 2 do not appear to have increased rates of hip, wrist, and vertebral fractures independent of age and sex.

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Section: Discussionmentioning

confidence: 99%

Estimated GFR and Fracture Risk

Elliott¹,

James

Quinn³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The KDIGO CKD-MBD guideline recommends keeping the PTH level 2-9 times the upper limit of normal for the assay in dialysis patients (37) based on a number of bone biopsy studies which demonstrated that PTH poorly predicts underlying bone turnover within this range (38)(39)(40).Whilst a very low or very high PTH levels can predict low-turnover and high-turnover bone disease, PTH remains a poor marker of underlying bone histomorphometry within the target range. Alkaline phosphatase (ALP) may improve the sensitivity of PTH in predicting high/low bone turnover (41,42) and mortality in dialysis patients (43,44).…”

Section: Management Of Shpt In Ckdmentioning

confidence: 99%

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

Salam

Khwaja

Wilkie

2016

Drugs

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or Article Brief (if supplied by editors): As a 'Therapy in Practice' article, we would like this to provide a succinct, up-to-date clinically orientated guide to the optimum management of secondary hyperparathyroidism in patients with chronic kidney disease. The review should include an appropriate background to the development of SHPT. It should focus primarily on pharmacological treatments but as appropriate, non-pharmacological approaches (dietary, surgical) may be discussed to fully place pharmacological therapy in context. Submission date: 31 st March 2016Word count: 4156 Compliance with Ethical StandardsFunding and conflict of interest statement from each author: Takeaway messages from the article SHPT is associated with adverse outcomes in CKD and dialysis patients  Optimum PTH level is unclear in pre-dialysis CKD and the recommended range is wide for dialysis patients.  Management of SHPT is largely pharmacological focussing on lowering PTH  PTH lowering treatment has not shown improved cardiovascular risk, fractures and mortality. AbstractSecondary hyperparathyroidism (SHPT) is a common complication of CKD and is part of the chronic kidney disease-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality, thus SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between predialysis CKD and dialysis patients which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.

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“…Osteoartrit, kas krampları, kemik ağrısı, spontan kemik kırığı ve osteoporoz prevalansı üçüncü grupta daha yüksekti. HD hastalarımızın %30'u yaşam kalitesi soru formunu yardımcısız doldurdu ve ortalama fonksiyonel durum, psikolojik durum, ağrı ölçeği, yorgunluk ölçeği, global değerlendirme ve eklem sayımı sırasıyla 3 Psychological status: Scale of 0 to 10, 10 being impossible, on ability to get a good night's sleep, deal with feelings of anxiety or nervousness, and deal with depression or feeling blue.…”

Section: Study Design and Populationunclassified

The Impact of Chronic Kidney Disease - Mineral and Bone Disorder on the Locomotor System and Quality of Life in Hemodialysis Patients

Fouad¹,

Boraie²

2015

Turk Neph Dial Transpl

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OBJectIVe: Chronic kidney disease -mineral and bone disorder (CKD -BMD) is a worldwide challenge in hemodialysis patients (HD). Widespread use and improved methods of HD may have changed the spectrum of locomotor system disorders in this population. Locomotor system disorders have an impact on health-related quality of life (QOL). The objective of this study was to assess the effect of CKD-BMD on the locomotor system (bone, joint, muscle, tendon and bursa) and document the prevalence of locomotor system disorders in HD populations and its impact in QOL. MAterIAL and MetHOds:550 HD patients were enrolled in this study. Each HD patient received complete locomotor system examination and specific diagnostic investigation. iPTH level classified study population into three groups. Group 1. (149 patients) iPTH level < 100 pg/ml, low-turnover renal osteopathy, Group 2. (126 patients) iPTH from 150-300 pg/mL, Group 3. (275 patients) iPTH > 300 pg/ mL, high turnover bone disease. Patients were offered a self-administered QOL questionnaire, which assessed various QOL variables. resuLts: 75% of hemodialysis patients suffered from one or more locomotor system disorders and the commonest was bone pain 60%, followed by muscle cramps 36%, proximal muscle weakness 30%, osteoarthritis 25%, osteoporosis 16%, rotator cuff syndrome15%, gout pre-HD 12.5%, carpal tunnel syndrome 12%, bone fracture 7%, fibromyalgia 7%, tenosynovitis 6%, periarticular calcification 5%, Dupuytren's contracture 2%, septic arthritis 0.9% and osteomyelitis 0.9%. The three studied groups were represented by 27%, 23% and 50% respectively. The prevalence of osteoarthritis, muscle cramps, bone pain, spontaneous bone fracture and osteoporosis were higher in the third group. 30% of our HD patients completed the QOL questionnaire without assistance and their mean functional status, psychological status, pain scale, fatigue scale, global assessment and joint count were 3.24±2. 24, 3.13 ±1.67, 4.07 ±1.7, 4.95 ±1. 8, 3.97 ±1.55 and 9.65±9.95 respectively. QOL variables pronouncedly worsen in HD patients, however the second group patients have a better quality of life than other groups (P<0.001).cONcLusION: Locomotor system involvement is still very common in our HD patients, especially in high turnover bone disease group and can compromise the QOL.

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Renal Osteodystrophy in Predialysis and Hemodialysis Patients: Comparison of Histologic Patterns and Diagnostic Predictivity of Intact PTH

Cited by 107 publications

References 18 publications

Estimated GFR and Fracture Risk

Estimated GFR and Fracture Risk

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

The Impact of Chronic Kidney Disease - Mineral and Bone Disorder on the Locomotor System and Quality of Life in Hemodialysis Patients

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