The renal osteodystrophy pattern in Brazil and Uruguay: An overview

Araújo, Sônia Maria Holanda Almeida; Ambrosoni, Pablo; Lobão, Rosélia Rs; Caorsi, Hena; Moysés, Rosa Maria Affonso; Barreto, Fellype Carvalho; Olaizola, Inés; Cruz, Elisa A.S.; Petraglia, Alicia; Reis, Luciene M. dos; Duarte, Maria Eugênia Leite; Jorgetti, Vanda; Carvalho, Aluízio Barbosa de

doi:10.1046/j.1523-1755.63.s85.13.x

Cited by 48 publications

(25 citation statements)

References 16 publications

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“…Although Al-containing PO 4 binders are no longer recommended, they are still frequently used, and Al still seems to be implicated in a high percentage of low-turnover bone disease. 39,40 With the introduction of calcimimetics into the therapeutic armamentarium, the incidence of surgical PTX has decreased but not disappeared, and postsurgical hypoparathyroidism is still seen and represents a major cause of hypoparathyroidism. 41 In conclusion, in hemodialysis patients with ESRD, aortic stiffness and calcifications were significantly associated with both Ca load and bone activity, with a significant Ca load*bone activity interaction.…”

Section: Discussionmentioning

confidence: 99%

Association of Bone Activity, Calcium Load, Aortic Stiffness, and Calcifications in ESRD

London¹,

Marchais²,

Guérin³

et al. 2008

Journal of the American Society of Nephrology

257

181

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An inverse relationship between arterial calcifications and bone activity has been documented in patients with ESRD. Calcium overload is associated with arterial calcification, which is associated with arterial stiffening. Whether bone activity interacts with calcium load, aortic stiffness, or arterial calcification is unknown. This study assessed the impact of bone activity on the relationships between the dosage of calcium-containing phosphate binders and aortic stiffness (measured by pulse wave velocity) or abdominal aorta calcification score. Aortic stiffness and calcification were both positively associated with calcium load and negatively associated with bone activity. A significant interaction was found between dosage of calcium-containing phosphate binders and bone activity such that calcium load had a significantly greater influence on aortic calcifications and stiffening in the presence of adynamic bone disease. Independent of any other factor, including dosage of calcium-containing phosphate binders, adynamic bone was associated with greater aortic stiffening, suggesting cross-talk between the bone and arterial walls.

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Section: Discussionmentioning

confidence: 99%

Association of Bone Activity, Calcium Load, Aortic Stiffness, and Calcifications in ESRD

London¹,

Marchais²,

Guérin³

et al. 2008

Journal of the American Society of Nephrology

257

181

View full text Add to dashboard Cite

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“…Assim, as indicações da realização da biópsia óssea são: importante exposição ao alumínio, exposição leve ou moderada de alumínio em pacientes diabéticos, e quando se deseja estabelecer o diagnóstico de doença adinâmi-ca do osso em pacientes com dor óssea e/ou fratura patológica, cujos níveis de PTH e fosfatase alcalina não são elevados. Entretanto, outros autores ainda indicam biópsia óssea em pacientes sintomáticos com níveis de PTH intermediários (entre 100 a 450pg/ml, ou menores que 10x o valor de referência) (77).…”

Section: Contra-indicações à Paratireoidectomia E Diagnóstico Diferenunclassified

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

Lacativa¹,

Filho

Gonçalves³

et al. 2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 6 Dezembro 2003 644 RESUMOO hiperparatireoidismo é uma manifestação comum na insuficiência renal crônica (IRC), com alta morbi-mortalidade e difícil manejo clínico. As indicações clássicas da paratireoidectomia são: hipercalcemia persistente, principalmente após transplante renal, prurido intratável, fraturas patológicas, dor óssea refratária ao tratamento medicamentoso e calcificação metastática. Infelizmente, esta última não responde à paratireoidectomia e a calcificação dos vasos está relacionada ao aumento da mortalidade. Assim, novos critérios para indicação mais precoce de paratireoidectomia são necessários. Níveis séricos de PTH maiores que 10 vezes o limite da normalidade, apesar da adequada reposição de cálcio e calcitriol, produto cálcio x fósforo maior que 70(mg/dl) 2 , tumor marrom quando é urgente a regressão da massa, artrite e/ou periartrite incapacitantes e ruptura de tendões estão entre outras indicações a serem consideradas. Alguns cuidados são necessários para excluir doenças ósseas concomitantes, como amiloidose e intoxicação por alumínio. Esta revisão visa a orientar os endocrinologistas sobre as indicações e melhor momento de realizar paratireoidectomia no hiperparatireoidismo da IRC. Hyperparathyroidism is a common complication of end-stage renal insufficiency, with a high morbi-mortality and difficult medical control. Classical indications for parathyroidectomy are: persistent hypercalcemia, especially after kidney transplantation, untreatable pruritus, pathologic fractures, bone pain refractory to medical treatment, and metastatic calcifications. Unfortunately, this latter complication does not respond to parathyroidectomy, and blood vessels calcifications are associated with increased mortality. Severe osteitis fibrosa and bone deformities also never disappear. Thus, new criteria for early parathyroidectomy are needed. Serum intact PTH higher than 10 times the upper limit of normality despite adequate calcium and calcitriol supplements, calcium-phosphorus product higher than 70(mg/dL) 2 , "brown tumor" whenever a rapid regression is needed, incapacitating arthritis and/or periarthritis, and rupture of tendons are among other indications that should be considered. Care must be taken to exclude concomitant diseases such as amiloidosis and aluminum intoxication. This review intends to advise endocrinologists about the indications and timing of surgery in hyperparathyroidism due to chronic renal failure.

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“…The magnitude of this risk may vary by bone histology types depending on, for instance, the presence of osteomalacia, high turnover bone disease, or adynamic bone disease 6, 7 . In addition, the presence of certain risk factors including abnormal parathyroid hormone (PTH) levels and the use of narcotics and psycho-active medications may increase the likelihood of fracture 2, 3, 8 .…”

Section: Introductionmentioning

confidence: 99%

High rates of death and hospitalization follow bone fracture among hemodialysis patients

Tentori

McCullough

Kilpatrick

et al. 2014

Kidney International

299

236

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Altered bone structure and function contribute to the high rates of fractures in dialysis patients compared to the general population. Fracture events may increase the risk of subsequent adverse clinical outcomes. Here we assessed incidence of post-fracture morbidity and mortality in an international cohort of 34, 579 in-center hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). We estimated country-specific rates of fractures requiring a hospital admission and associated length of stay in the hospital. Incidence rates of death and of a composite event of death/re-hospitalization were estimated for the 1-year post-fracture. Overall, 3% of participants experienced a fracture. Fracture incidence varied across countries, from 12 events/1000 patient year (p-y) in Japan to 45/1000 p-y in Belgium. In all countries, fracture rates were higher in the hemodialysis group compared to those reported for the general population. Median length of stay ranged from 7 to 37 days in the United States and Japan, respectively. In most countries, post-fracture mortality rates exceeded 500/1000 p-y and death/re-hospitalization rates exceeded 1500/1000 p-y. Fracture patients had higher unadjusted rates of death (3.7- fold) and death/re-hospitalization (4.0-fold) compared to the overall DOPPS population. Mortality and hospitalization rates were highest in the first month after the fracture and declined thereafter. Thus, the high frequency of fractures and increased adverse outcomes following a fracture pose a significant health burden for dialysis patients. Fracture prevention strategies should be identified and applied broadly in nephrology practices.

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The renal osteodystrophy pattern in Brazil and Uruguay: An overview

Abstract: A better control of Al overload may lead to a change in histologic pattern, as evidenced by the increasing prevalence of HP.

Cited by 48 publications

References 16 publications

Association of Bone Activity, Calcium Load, Aortic Stiffness, and Calcifications in ESRD

Association of Bone Activity, Calcium Load, Aortic Stiffness, and Calcifications in ESRD

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

High rates of death and hospitalization follow bone fracture among hemodialysis patients

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