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Rashid A, Chaudhary Hauge S, Suetta C, Hansen D. "Sarcopenia and risk of osteoporosis, falls and bone fractures in patients with chronic kidney disease: A systematic review". PLoS One 2022; 17:e0262572. [PMID: 35061818 PMCID: PMC8782402 DOI: 10.1371/journal.pone.0262572] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
Background Chronic kidney disease [CKD] has been suggested to increase the risk of osteoporosis, sarcopenia, falls, and fractures. The aim of this systematic review was to explore the occurrence of osteoporosis, falls, and fractures in patients with sarcopenia and CKD, and to explore the possible association between sarcopenia and osteoporosis, falls, and fractures in patients with CKD. Methods This systematic review was conducted according to the PRISMA guideline. The protocol was registered at PROSPERO. The systematic literature search was conducted in Pubmed [1966 to present] and EMBASE [1974 to present] on December 4, 2020. We searched for articles on CKD and sarcopenia, and then we selected them with outcomes such as osteoporosis, falls, and bone fractures. The risk of bias was assessed with the Newcastle-Ottawa Scale. Results Five studies were eligible and included. No studies reported the occurrence of osteoporosis, falls, and bone fractures in patients with CKD and sarcopenia. Sarcopenia had a significant association with low bone mineral density [BMD] and osteoporosis in patients with CKD. The risk of bias assessed with the Newcastle-Ottawa Scale varied from 3–7 stars [median of 7]. Due to the included studies’ heterogeneity, a meta-analysis could not be conducted. Conclusion The occurrence of osteoporosis, falls, and bone fractures in patients with sarcopenia and CKD could not be assessed from the included studies, but an association between sarcopenia and decreased BMD/osteoporosis in patients with CKD was found. The potential mechanistic link between sarcopenia and osteoporosis in CKD needs to be investigated in future studies.
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Affiliation(s)
- Anahita Rashid
- Department of Nephrology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- * E-mail:
| | | | - Charlotte Suetta
- Geriatric Research Unit, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Geriatric Research Unit, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- CopenAge–Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
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Makowka A, Nowicki M. Different Effect of Lanthanum Carbonate and Sevelamer Hydrochloride on Calcium Balance in Patients with Moderate to Advanced Chronic Kidney Disease. Ther Clin Risk Manag 2021; 17:1145-1151. [PMID: 34754193 PMCID: PMC8572109 DOI: 10.2147/tcrm.s330649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Opposite to lanthanum carbonate (LC), sevelamer hydrochloride (SH) may increase intestinal calcium absorption. The study compared the effects of LC and SH on serum and urine phosphate and calcium, and on hormones regulating mineral-bone metabolism. Patients and Methods A prospective randomized crossover study included 34 patients with eGFR <60 mL/min. A single oral dose of LC (1,000 mg) or SH (2,400 mg) was administered in random order 15 minutes after a standardized meal fortified with 5 g calcium carbonate. Serum calcium, phosphate, and parathormone were measured before and 3, 6, 12, and 24 hours after each medication. Bone alkaline phosphatase (BAP), sclerostin, calcitriol, and FGF-23 were measured at baseline and after 12 and 24 hours. A 24-hour calcium and phosphate excretion was measured after each drug. Results Serum calcium increased 3 and 6 hours after SH then returned to baseline. After LC calcium was unchanged for up to 3 hours then transiently increased and eventually returned to baseline. The area under curve (AUC) of serum calcium for 12 hours after SH was larger than after LC (p=0.04). Serum phosphate decreased after each drug with a nadir 3 hours post-SH and 6 hours post-LC. AUC of serum phosphate was similar after both medications. PTH decreased transiently after both drugs. BAP did not change. FGF-23 was constant for the first 12 hours but later decreased after each drug. Conclusion A 2,400 mg SH and 1,000 mg LC are similarly effective in lowering serum phosphate in CKD, but LC induce in less intestinal calcium absorption after a meal. The trial was registered on February 23, 2018 in the clinicaltrial.gov database – NCT03451019.
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Affiliation(s)
- Agnieszka Makowka
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
| | - Michal Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
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3
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Alwani M, Al-Zoubi RM, Al-Qudimat A, Yassin A, Aboumarzouk O, Al-Rumaihi K, Talib R, Al-Ansari A. The impact of long-term Testosterone Therapy (TTh) in renal function (RF) among hypogonadal men: An observational cohort study. Ann Med Surg (Lond) 2021; 69:102748. [PMID: 34471531 PMCID: PMC8387920 DOI: 10.1016/j.amsu.2021.102748] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Testosterone therapy (TTh) is the main treatment for elderly men with hypogonadism. No evidence of the long-term effectiveness of TTh on renal function is reported to date. METHODS In this study, we evaluated the long-term TTh of testosterone undecanoate (TU) administration on renal function parameters in 496 symptomatic hypogonadal men, with T levels ≤350 ng/dL. The treatment group (T-group) consisted of 312 patients and obtained TU 1000 mg for 12 weeks followed by 6-week intervals and for up to 8 years. The remaining 184 hypogonadal men, who opted against TTh, served as a control group (C-group). The two groups were similar in criteria prior to treatment. We evaluated renal function by calculating serum creatinine, urea, uric acid, and glomerular filtration rate (GFR) according to Mayo Clinic guidelines for 8 years. This study obeys the ethical guidelines of German medical association according to Section 15 of the Professional Code, document for AY- Ref. EK/CH/AU signed on Jun 2015. RESULTS During the study period, the T-group exhibited lower levels of urea (47.0 ± 11.8 to 34.0 ± 13.9 mg/dL), uric acid (6.57 ± 1.2 to 5.49 ± 1.5 mg/dL), serum creatinine (0.90 ± 0.10 to 1.12 ± 0.9 mg/dL), and higher-level in GFR (87.0 ± 12.9 to 98.0 ± 8.0 mL/min/1.73 m2), which were significant. Alternatively, the C-group exhibited an increase in their serum creatinine (1.16 ± 0.31 to 1.19 ± 0.58 mg/dL), an increase in uric acid (5.54 ± 1.2 to 5.44 ± 1.7 mg/dL), and a decrease in GFR (92.0 ± 20.1 to 87.0 ± 26.1 mL/min/1.73 m2). A total of 25 deaths (7.8%) was recorded in the T-group, among them 11 (44%) were cardiovascular. On the other hand, 28 patients (15.2%) died in C-group and all deaths (100%) were found to cardiovascular causes. CONCLUSION The results suggest that long-term TTh could improve renal function in hypogonadal men comparing to slight deterioration observed in patients without intervention. In addition to reduce mortality in cardiovascular patients, almost to the half.
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Affiliation(s)
- Mustafa Alwani
- Surgical Research Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
- School of Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Ahmad Al-Qudimat
- Surgical Research Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
| | - Aksam Yassin
- Surgical Research Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
- Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar
- Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Omar Aboumarzouk
- Surgical Research Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
| | - Khaled Al-Rumaihi
- Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar
| | - Raidh Talib
- Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery Hamad Medical Corporation, Doha, Qatar
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4
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Lamberti A, Loconte F, Spinarelli A, Baldini A. Bilateral Extensor Mechanism Allograft Reconstruction for Chronic Spontaneous Rupture: A Case Report and Review of the Literature. JBJS Case Connect 2019; 9:e0058. [PMID: 31140984 DOI: 10.2106/jbjs.cc.18.00058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 51-year-old woman, affected by end-stage renal disease, presented with 16-month-old ruptures of the right patellar tendon and the left quadriceps tendon. Since she had been nonambulatory for more than a year, the authors decided to perform a bilateral one-staged reconstruction with an Achilles tendon allograft on the right side and a full extensor mechanism allograft on the left side, achieving excellent clinical and functional results at 57 months' follow-up. CONCLUSIONS Bilateral spontaneous rupture of the extensor mechanism of the knee is a rare but dramatic occurrence. Allograft can be considered as a treatment option in case of chronic lesion or delayed reconstruction, with satisfactory midterm outcomes.
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Affiliation(s)
| | | | - Antonio Spinarelli
- Ospedale Policlinico Università di Bari, Piazza Giulio Cesare, Bari, Italy
| | - Andrea Baldini
- IFCA, Istituto Fiorentino di Cura e Assistenza, Florence, Italy
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5
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Scialla JJ, Lin PH. Revamping the ‘renal’ diet: using foods to control phosphorus physiology. Nephrol Dial Transplant 2019; 34:1619-1622. [DOI: 10.1093/ndt/gfz019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Julia J Scialla
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Stedman Center for Nutrition and Metabolism, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Stedman Center for Nutrition and Metabolism, Duke University School of Medicine, Durham, NC, USA
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6
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Risk factors for severe hypocalcemia after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Sci Rep 2018; 8:7743. [PMID: 29773914 PMCID: PMC5958068 DOI: 10.1038/s41598-018-26142-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/03/2018] [Indexed: 12/11/2022] Open
Abstract
Severe hypocalcemia (SH) is a common and serious complication in dialysis patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX). The aim is to explore the risk predictors of SH in post-PTX dialysis ESRD patients with SHPT. 129 consecutive dialysis patients with SHPT underwent PTX were retrospectively reviewed. A total of 22 clinical parameters were included in the study. SH was defined as the minimum values of serum calcium lower than 1.875 mmol/L (7.5 mg/dL) after surgery. Univariate analysis showed that pruritus, lumbar X-ray changes of renal osteodystrophy, pre- and post-operative intact parathyroid hormone (iPTH), Calcium, alkaline phosphatase, and gland mass were significantly different between SH and non-SH groups. In the multivariate logistic regression model, the pre-operative serum iPTH, calcium, and pruritus were independent risk predictors of SH. AUCs for pre-operative serum iPTH, calcium and pruritus were 0.810, 0.714 and 0.591, respectively. Patients with higher level of pre-operative serum iPTH, lower level of serum calcium and with no/mild symptoms of pruritus are at greater risk of developing SH after PTX.
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7
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Oronsky B, Caroen S, Oronsky A, Dobalian VE, Oronsky N, Lybeck M, Reid TR, Carter CA. Electrolyte disorders with platinum-based chemotherapy: mechanisms, manifestations and management. Cancer Chemother Pharmacol 2017; 80:895-907. [PMID: 28730291 PMCID: PMC5676816 DOI: 10.1007/s00280-017-3392-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022]
Abstract
Platinum chemotherapy, particularly cisplatin, is commonly associated with electrolyte imbalances, including hypomagnesemia, hypokalemia, hypophosphatemia, hypocalcemia and hyponatremia. The corpus of literature on these dyselectrolytemias is large; the objective of this review is to synthesize the literature and summarize the mechanisms responsible for these particular electrolyte disturbances in the context of platinum-based treatment as well as to present the clinical manifestations and current management strategies for oncologists and primary care physicians, since the latter are increasingly called on to provide care for cancer patients with medical comorbidities. Correct diagnosis and effective treatment are essential to improved patient outcomes.
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Affiliation(s)
- Bryan Oronsky
- EpicentRx Inc, 4445 Eastgate Mall, Suite 200, San Diego, CA, 92121, USA.
| | - Scott Caroen
- EpicentRx Inc, 4445 Eastgate Mall, Suite 200, San Diego, CA, 92121, USA
| | - Arnold Oronsky
- InterWest Partners, 2710 Sand Hill Road #200, Menlo Park, CA, 94025, USA
| | - Vaughn E Dobalian
- Beaches Family Medicine, 465 3rd St N, Jacksonville Beach, FL, 32250, USA
| | - Neil Oronsky
- CFLS Data, 800 W El Camino Real, Suite 180, Mountain View, CA, 94040, USA
| | - Michelle Lybeck
- EpicentRx Inc, 4445 Eastgate Mall, Suite 200, San Diego, CA, 92121, USA
| | - Tony R Reid
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA, 92093, USA
| | - Corey A Carter
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA
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8
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Suzuki T, Kitabatake A, Koide Y. Reaction of Thymidine with Hypobromous Acid in Phosphate Buffer. Chem Pharm Bull (Tokyo) 2017; 64:1235-8. [PMID: 27477666 DOI: 10.1248/cpb.c16-00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
When thymidine was treated with hypobromous acid (HOBr) in 100 mM phosphate buffer at pH 7.2, two major product peaks appeared in the HPLC chromatogram. The products in each peak were identified by NMR and MS as two isomers of 5-hydroxy-5,6-dihydrothymidine-6-phosphate (a novel compound) and two isomers of 5,6-dihydroxy-5,6-dihydrothymidine (thymidine glycol) with comparable yields. 5-Hydroxy-5,6-dihydrothymidine-6-phosphate was relatively stable, and decomposed with a half-life of 32 h at pH 7.2 and 37°C generating thymidine glycol. The results suggest that 5-hydroxy-5,6-dihydrothymidine-6-phosphate in addition to thymidine glycol may have importance for mutagenesis by the reaction of HOBr with thymine residues in nucleotides and DNA.
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9
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Wei Y, Lin J, Yang F, Li X, Hou Y, Lu R, Shi X, Liu Z, Du Y. Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease. Exp Ther Med 2016; 12:1206-1212. [PMID: 27446345 PMCID: PMC4950648 DOI: 10.3892/etm.2016.3438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/29/2016] [Indexed: 12/22/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD), and its development and progression are affected by various factors. The aim of the present study was to identify the risk factors for SHPT in patients with CKD. A retrospective study was performed in 498 patients (305 males and 193 females) with CKD, observed in the The First Hospital of Jilin University between January 2008 and December 2012. The demographic, clinical and laboratory data were collected. Patients were divided into the SHPT group (n=424) with elevated serum parathyroid hormone (PTH) expression levels and the control group (n=74) with normal serum PTH expression levels. Univariate and multivariate regression analyses were employed to explore the risk factors for SHPT. Serum PTH expression levels in women with CKD were significantly higher than in men (P=0.047). Serum PTH expression levels were positively correlated with the expression levels of serum creatinine (P<0.01), phosphorus (P<0.01), C-reactive protein (P<0.05), triglyceride (P<0.05), cholesterol (P<0.05) and low-density lipoprotein cholesterol (P<0.05), but were negatively correlated with the expression levels of hemoglobin (P<0.05), calcium (P<0.01) and CO2 combining power (P<0.01) in patients with CKD. Multivariate analysis showed that the serum expression levels of creatinine [µmol/l; odds radio (OR), 1.003; 95% confidence interval (CI), 1.002-1.004; P=0.001] and phosphorus (mmol/l; OR, 2.19; 95% CI, 1.254-3.826; P=0.006) in patients with CKD significantly influenced serum PTH expression levels. The SHPT risk factors include female gender, low calcium, high phosphorus, acidosis, anemia, hypertension, hyperlipidemia and micro-inflammation, with blood phosphorus and creatinine being independent risk factors.
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Affiliation(s)
- Yudan Wei
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Lin
- Department of Nephrology, The First Affiliated Hospital of Luohe Medical College, Luohe, Henan 462000, P.R. China
| | - Fan Yang
- Reproductive Center of the First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiujiang Li
- Department of Intensive Care Unit, Jilin Tumor Hospital, Changchun, Jilin 130021, P.R. China
| | - Yue Hou
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ronghua Lu
- Department of Nephrology, Jilin City Central Hospital, Changchun, Jilin 132000, P.R. China
| | - Xiaonv Shi
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi Liu
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yujun Du
- Department of Nephrology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
- Correspondence to: Dr Yujun Du, Department of Nephrology, First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin 130021, P.R. China, E-mail:
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10
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Kestenbaum B. Con: Phosphate binders in chronic kidney disease. Nephrol Dial Transplant 2015; 31:189-94. [PMID: 26681747 DOI: 10.1093/ndt/gfv406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/22/2022] Open
Abstract
Phosphate binders are prescribed to chronic kidney disease (CKD) patients based on associations of serum phosphate concentrations with mortality and calcification, experimental evidence for direct calcifying effects of phosphate on vascular smooth muscle tissue and the central importance of phosphate retention in CKD-mineral and bone disorder (CKD-MBD). Current knowledge regarding phosphate metabolism in CKD provides important insight into disease mechanisms and supports future clinical trials of phosphate binders in CKD patients to determine the impact of these medications on clinically relevant outcomes. The risks and benefits of phosphate binders cannot be inferred from association studies of serum phosphate concentrations, which are inconsistent and subject to confounding, animal-experimental data, which are based on conditions that differ from human disease, or physiological arguments, which are limited to known regulatory factors. Many interventions that targeted biochemical pathways suggested by association studies and suspected biological importance have yielded null or harmful results. Clinical trials of phosphate binders are of high clinical and scientific importance to nephrology. Demonstration of reduced rates of clinical disease in such trials could lead to important health benefits for CKD patients, whereas negative results would refocus efforts to understand and treat CKD-MBD. Clinical trials that employ highly practical or 'pragmatic' designs represent an optimal approach for determining the safety and effectiveness of phosphate binders in real-world settings. Absent clinical trial data, observational studies of phosphate binders in large CKD populations could provide important information regarding the benefits, risks and/or unintended side effects of these medications.
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Affiliation(s)
- Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Harborview Medical Center, Seattle, WA, USA
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Lopez-Fernandez I, Schepelmann M, Brennan SC, Yarova PL, Riccardi D. The calcium-sensing receptor: one of a kind. Exp Physiol 2015; 100:1392-9. [PMID: 26105576 DOI: 10.1113/ep085137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/19/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Sarah C Brennan
- School of Biosciences, Museum Avenue, Cardiff University, Cardiff, UK
| | - Polina L Yarova
- School of Biosciences, Museum Avenue, Cardiff University, Cardiff, UK
| | - Daniela Riccardi
- School of Biosciences, Museum Avenue, Cardiff University, Cardiff, UK
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12
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Genêt F, Kulina I, Vaquette C, Torossian F, Millard S, Pettit AR, Sims NA, Anginot A, Guerton B, Winkler IG, Barbier V, Lataillade JJ, Le Bousse-Kerdilès MC, Hutmacher DW, Levesque JP. Neurological heterotopic ossification following spinal cord injury is triggered by macrophage-mediated inflammation in muscle. J Pathol 2015; 236:229-40. [PMID: 25712044 DOI: 10.1002/path.4519] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 12/18/2022]
Abstract
Neurological heterotopic ossification (NHO) is the abnormal formation of bone in soft tissues as a consequence of spinal cord or traumatic brain injury. NHO causes pain, ankyloses, vascular and nerve compression and delays rehabilitation in this high-morbidity patient group. The pathological mechanisms leading to NHO remain unknown and consequently there are no therapeutic options to prevent or reduce NHO. Genetically modified mouse models of rare genetic forms of heterotopic ossification (HO) exist, but their relevance to NHO is questionable. Consequently, we developed the first model of spinal cord injury (SCI)-induced NHO in genetically unmodified mice. Formation of NHO, measured by micro-computed tomography, required the combination of both SCI and localized muscular inflammation. Our NHO model faithfully reproduced many clinical features of NHO in SCI patients and both human and mouse NHO tissues contained macrophages. Muscle-derived mesenchymal progenitors underwent osteoblast differentiation in vitro in response to serum from NHO mice without additional exogenous osteogenic stimuli. Substance P was identified as a candidate NHO systemic neuropeptide, as it was significantly elevated in the serum of NHO patients. However, antagonism of substance P receptor in our NHO model only modestly reduced the volume of NHO. In contrast, ablation of phagocytic macrophages with clodronate-loaded liposomes reduced the size of NHO by 90%, supporting the conclusion that NHO is highly dependent on inflammation and phagocytic macrophages in soft tissues. Overall, we have developed the first clinically relevant model of NHO and demonstrated that a combined insult of neurological injury and soft tissue inflammation drives NHO pathophysiology.
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Affiliation(s)
- François Genêt
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia.,Department of Physical Medicine and Rehabilitation, Hôpital Raymond Poincaré, APHP, CIC-IT 1429, Garches, France.,Université Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM, UFR des Sciences de la Santé-Simone Veil, Montigny le Bretonneux, France
| | - Irina Kulina
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia.,School of Medicine, University of Queensland, Herston, Australia
| | - Cedryck Vaquette
- Institute of Health Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Frédéric Torossian
- Institut National de la Santé et de la Recherche Médicale, Unité 972, Villejuif, France.,Université Paris-Sud, Institut André Lwoff, Paris, France
| | - Susan Millard
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia
| | - Allison R Pettit
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia
| | - Natalie A Sims
- St Vincent's Institute of Medical Research, Fitzroy, Australia
| | - Adrienne Anginot
- Institut National de la Santé et de la Recherche Médicale, Unité 972, Villejuif, France.,Université Paris-Sud, Institut André Lwoff, Paris, France
| | - Bernadette Guerton
- Institut National de la Santé et de la Recherche Médicale, Unité 972, Villejuif, France.,Université Paris-Sud, Institut André Lwoff, Paris, France
| | - Ingrid G Winkler
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia
| | - Valérie Barbier
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia
| | - Jean-Jacques Lataillade
- Institut National de la Santé et de la Recherche Médicale, Unité 972, Villejuif, France.,Centre de Transfusion Sanguine des Armées, Clamart, France
| | - Marie-Caroline Le Bousse-Kerdilès
- Institut National de la Santé et de la Recherche Médicale, Unité 972, Villejuif, France.,Université Paris-Sud, Institut André Lwoff, Paris, France
| | - Dietmar W Hutmacher
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia
| | - Jean-Pierre Levesque
- Blood and Bone Diseases Programme, Mater Research Institute, University of Queensland, Woolloongabba, Australia.,School of Medicine, University of Queensland, Herston, Australia
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Liu S, Zhu W, Li S, Cui T, Li Z, Zhang B, Li Z, Wu J, Liang X, Lin Z, Shi W. The effect of bovine parathyroid hormone withdrawal on MC3T3-E1 cell proliferation and phosphorus metabolism. PLoS One 2015; 10:e0120402. [PMID: 25775025 PMCID: PMC4361577 DOI: 10.1371/journal.pone.0120402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 01/25/2015] [Indexed: 11/18/2022] Open
Abstract
Hypocalcemia and hypophosphatemia are common complications after parathyroidectomy (PTX). Sudden removal of high circulating levels of parathyroid hormone (PTH) causes decreased osteoclastic resorption resulting in a decreased bone remodeling space. These phenomena are likely due to an increased influx of calcium and phosphorus into bone. However, there are currently no data to support this hypothesis. In this study, we found that PTX significantly reduced levels of PTH, calcium and phosphate. Compared with preoperative levels, after 1 year, postoperative PTH, calcium and phosphate levels were 295.6 ± 173.7 pg/mL (P < 0.05), 86.62 ± 15.98 mg/dL (P < 0.05) and 5.56 ± 2.03 mg/dL (P < 0.05), respectively. We investigated continuous bovine PTH administration as well as withdrawal of bovine PTH stimulation in the mouse osteoblast precursor cell line MC3T3-E1. MC3T3-E1 cells were cultured with continuous bovine PTH treatment for 20 days or with transient bovine PTH treatment for 10 days. High doses of continuous bovine PTH exposure strongly reduced cell proliferation, alkaline phosphatase activity and the number of mineralized calcium nodules. However, withdrawal of bovine PTH (100 ng/mL) significantly increased the number of mineralized calcium nodules and caused a rapid decline in calcium and phosphorus content of culture medium. In conclusion, continuous exposure to bovine PTH inhibited osteoblast differentiation and reduced the formation of mineralized nodules. However, this inhibition was removed and mineralized nodule formation resumed with withdrawal of bovine PTH. According to the results of our clinical examinations and in vitro experiments, we hypothesize that the sudden removal of high levels of PTH may cause an increased influx of calcium and phosphorus into bone after PTX.
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Affiliation(s)
- Shuangxin Liu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Weiping Zhu
- Department of Nephrology, the Fifth Affiliated Hospital of Sun Yat-sen University, No.52 Meihua Road, Zhuhai, China
| | - Sijia Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Tongxia Cui
- Department of Nephrology, the Fifth Affiliated Hospital of Sun Yat-sen University, No.52 Meihua Road, Zhuhai, China
| | - Zhonghe Li
- Department of Nephrology, the Fifth Affiliated Hospital of Sun Yat-sen University, No.52 Meihua Road, Zhuhai, China
| | - Bin Zhang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Zhuo Li
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Jianxiong Wu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Xinling Liang
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Zheng Lin
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
| | - Wei Shi
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan No. 2 Road, Guangzhou, China
- * E-mail:
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Floege J, Covic AC, Ketteler M, Mann JFE, Rastogi A, Spinowitz B, Chong EMF, Gaillard S, Lisk LJ, Sprague SM. Long-term effects of the iron-based phosphate binder, sucroferric oxyhydroxide, in dialysis patients. Nephrol Dial Transplant 2015; 30:1037-46. [PMID: 25691681 PMCID: PMC4438742 DOI: 10.1093/ndt/gfv006] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/24/2014] [Indexed: 11/21/2022] Open
Abstract
Background Hyperphosphatemia necessitates the use of phosphate binders in most dialysis patients. Long-term efficacy and tolerability of the iron-based phosphate binder, sucroferric oxyhydroxide (previously known as PA21), was compared with that of sevelamer carbonate (sevelamer) in an open-label Phase III extension study. Methods In the initial Phase III study, hemo- or peritoneal dialysis patients with hyperphosphatemia were randomized 2:1 to receive sucroferric oxyhydroxide 1.0−3.0 g/day (2−6 tablets/day; n = 710) or sevelamer 2.4−14.4 g/day (3−18 tablets/day; n = 349) for 24 weeks. Eligible patients could enter the 28-week extension study, continuing the same treatment and dose they were receiving at the end of the initial study. Results Overall, 644 patients were available for efficacy analysis (n = 384 sucroferric oxyhydroxide; n = 260 sevelamer). Serum phosphorus concentrations were maintained during the extension study. Mean ± standard deviation (SD) change in serum phosphorus concentrations from extension study baseline to Week 52 end point was 0.02 ± 0.52 mmol/L with sucroferric oxyhydroxide and 0.09 ± 0.58 mmol/L with sevelamer. Mean serum phosphorus concentrations remained within Kidney Disease Outcomes Quality Initiative target range (1.13–1.78 mmol/L) for both treatment groups. Mean (SD) daily tablet number over the 28-week extension study was lower for sucroferric oxyhydroxide (4.0 ± 1.5) versus sevelamer (10.1 ± 6.6). Patient adherence was 86.2% with sucroferric oxyhydroxide versus 76.9% with sevelamer. Mean serum ferritin concentrations increased over the extension study in both treatment groups, but transferrin saturation (TSAT), iron and hemoglobin concentrations were generally stable. Gastrointestinal-related adverse events were similar and occurred early with both treatments, but decreased over time. Conclusions The serum phosphorus-lowering effect of sucroferric oxyhydroxide was maintained over 1 year and associated with a lower pill burden, compared with sevelamer. Sucroferric oxyhydroxide was generally well tolerated long-term and there was no evidence of iron accumulation.
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Affiliation(s)
| | - Adrian C Covic
- Gr.T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | | | | | | | | | | | | | | | - Stuart M Sprague
- NorthShore University Health System University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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15
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Wong BX, Tsatsanis A, Lim LQ, Adlard PA, Bush AI, Duce JA. β-Amyloid precursor protein does not possess ferroxidase activity but does stabilize the cell surface ferrous iron exporter ferroportin. PLoS One 2014; 9:e114174. [PMID: 25464026 PMCID: PMC4252103 DOI: 10.1371/journal.pone.0114174] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/04/2014] [Indexed: 01/24/2023] Open
Abstract
Ceruloplasmin is a ferroxidase that interacts with ferroportin to export cellular iron, but is not expressed in neurons. We recently reported that the amyloid precursor protein (APP) is the analogous iron-exporting chaperone for neurons and other cells. The ferroxidase activity of APP has since been called into question. Using a triplex Fe2+ oxidation assay, we analyzed the activity of a soluble form of APP (sAPPα) within a buffer of physiological pH and anionic charge, and determined that iron oxidation originated from phosphate. Using various techniques such as flow-cytometry to measure surface presented proteins, we confirmed that endogenous APP is essential for ferroportin persistence on the neuronal surface. Therefore, despite lacking ferroxidase activity, APP still supports iron export from neurons.
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Affiliation(s)
- Bruce X. Wong
- Oxidation Biology Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Tsatsanis
- School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Linh Q. Lim
- Oxidation Biology Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul A. Adlard
- Oxidation Biology Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Ashley I. Bush
- Oxidation Biology Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
- * E-mail: (AIB); (JAD)
| | - James A. Duce
- Oxidation Biology Unit, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, United Kingdom
- Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
- * E-mail: (AIB); (JAD)
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Okamoto T, Taguchi M, Osaki T, Fukumoto S, Fujita T. Phosphate enhances reactive oxygen species production and suppresses osteoblastic differentiation. J Bone Miner Metab 2014; 32:393-9. [PMID: 24052209 DOI: 10.1007/s00774-013-0516-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/11/2013] [Indexed: 01/02/2023]
Abstract
Phosphate has been shown to work as a signaling molecule in several cells including endothelial cells and chondrocytes. However, it is largely unknown how phosphate affects osteoblastic cells. In the present study, we investigated the effects of phosphate on reactive oxygen species (ROS) production and osteoblastic differentiation in murine osteoblastic MC3T3-E1 cells. Phosphate increased production of ROS in MC3T3-E1 cells and the inhibitors of sodium-phosphate cotransporter and NADPH oxidase suppressed ROS production by phosphate. Silencing Nox1 and Nox4 also inhibited the increase of ROS by phosphate. Phosphate also decreased alkaline phosphatase activity induced by bone morphogenetic protein 2 and this inhibition was abrogated by an inhibitor of NADPH oxidase. Furthermore, phosphate decreased the expression of osteoblastic marker genes in MC3T3-E1 cells. These results indicate that phosphate suppresses osteoblastic differentiation at least in part by enhancing ROS production in MC3T3-E1 cells.
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Affiliation(s)
- Takaaki Okamoto
- Department of Nephrology and Endocrinology, University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-8655, Japan,
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17
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Drug-drug interactions between sucroferric oxyhydroxide and losartan, furosemide, omeprazole, digoxin and warfarin in healthy subjects. J Nephrol 2014; 27:659-66. [PMID: 24699894 PMCID: PMC4242982 DOI: 10.1007/s40620-014-0080-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Abstract
Background The novel iron-based phosphate binder sucroferric oxyhydroxide is being investigated for the treatment of hyperphosphatemia. Patients with chronic kidney disease often have multiple comorbidities that may necessitate the daily use of several types of medication. Therefore, the potential pharmacokinetic drug–drug interactions between sucroferric oxyhydroxide and selected drugs commonly taken by dialysis patients were investigated. Methods Five Phase I, single-center, open-label, randomized, three-period crossover studies in healthy volunteers investigated the effect of a single dose of sucroferric oxyhydroxide 1 g (based on iron content) on the pharmacokinetics of losartan 100 mg, furosemide 40 mg, omeprazole 40 mg, digoxin 0.5 mg and warfarin 10 mg. Pharmacokinetic parameters [including area under the plasma concentration–time curve (AUC) from time 0 extrapolated to infinite time (AUC0–∞) and from 0 to 24 h (AUC0–24)] for these drugs were determined: alone in the presence of food; with sucroferric oxyhydroxide in the presence of food; 2 h after food and sucroferric oxyhydroxide administration. Results Systemic exposure based on AUC0–∞ for all drugs, and AUC0–24 for all drugs except omeprazole (for which AUC 0–8 h was measured), was unaffected to a clinically significant extent by the presence of sucroferric oxyhydroxide, irrespective of whether sucroferric oxyhydroxide was administered with the drug or 2 h earlier. Conclusions There is a low risk of drug–drug interactions between sucroferric oxyhydroxide and losartan, furosemide, digoxin and warfarin. There is also a low risk of drug–drug interaction with omeprazole (based on AUC0–∞ values). Therefore, sucroferric oxyhydroxide may be administered concomitantly without the need to adjust the dosage regimens of these drugs.
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18
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Floege J, Covic AC, Ketteler M, Rastogi A, Chong EMF, Gaillard S, Lisk LJ, Sprague SM. A phase III study of the efficacy and safety of a novel iron-based phosphate binder in dialysis patients. Kidney Int 2014; 86:638-47. [PMID: 24646861 PMCID: PMC4150998 DOI: 10.1038/ki.2014.58] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/23/2013] [Accepted: 01/02/2014] [Indexed: 01/09/2023]
Abstract
Efficacy of PA21 (sucroferric oxyhydroxide), a novel calcium-free polynuclear iron(III)-oxyhydroxide phosphate binder, was compared with that of sevelamer carbonate in an open-label, randomized, active-controlled phase III study. Seven hundred and seven hemo- and peritoneal dialysis patients with hyperphosphatemia received PA21 1.0–3.0 g per day and 348 received sevelamer 4.8–14.4 g per day for an 8-week dose titration, followed by 4 weeks without dose change, and then 12 weeks maintenance. Serum phosphorus reductions at week 12 were −0.71 mmol/l (PA21) and −0.79 mmol/l (sevelamer), demonstrating non-inferiority of, on average, three tablets of PA21 vs. eight of sevelamer. Efficacy was maintained to week 24. Non-adherence was 15.1% (PA21) vs. 21.3% (sevelamer). The percentage of patients that reported at least one treatment-emergent adverse event was 83.2% with PA21 and 76.1% with sevelamer. A higher proportion of patients withdrew owing to treatment-emergent adverse events with PA21 (15.7%) vs. sevelamer (6.6%). Mild, transient diarrhea, discolored feces, and hyperphosphatemia were more frequent with PA21; nausea and constipation were more frequent with sevelamer. After 24 weeks, 99 hemodialysis patients on PA21 were re-randomized into a 3-week superiority analysis of PA21 maintenance dose in 50 patients vs. low dose (250 mg per day (ineffective control)) in 49 patients. The PA21 maintenance dose was superior to the low dose in maintaining serum phosphorus control. Thus, PA21 was effective in lowering serum phosphorus in dialysis patients, with similar efficacy to sevelamer carbonate, a lower pill burden, and better adherence.
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Affiliation(s)
- Jürgen Floege
- Division of Nephrology, RWTH University Hospital Aachen, Aachen, Germany
| | - Adrian C Covic
- 8216;Grigore T Popa' University of Medicine and Pharmacy, Iasi, Romania
| | | | - Anjay Rastogi
- University of California, Los Angeles, California, USA
| | | | | | | | - Stuart M Sprague
- NorthShore University Health System University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
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Kauther MD, Neuerburg C, Wefelnberg F, Bachmann HS, Schlepper R, Hilken G, Broecker-Preuss M, Grabellus F, Schilling AF, Jäger M, Wedemeyer C. RANKL-associated suppression of particle-induced osteolysis in an aged model of Calcitonin and α-CGRP deficiency. Biomaterials 2013; 34:2911-9. [DOI: 10.1016/j.biomaterials.2013.01.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 01/04/2013] [Indexed: 12/15/2022]
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Nawrot-Wawrzyniak K, Misof BM, Roschger P, Pańczyk-Tomaszewska M, Ziółkowska H, Klaushofer K, Fratzl-Zelman N. Changes in bone matrix mineralization after growth hormone treatment in children and adolescents with chronic kidney failure treated by dialysis: a paired biopsy study. Am J Kidney Dis 2013; 61:767-77. [PMID: 23465957 DOI: 10.1053/j.ajkd.2012.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 12/12/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) develop renal osteodystrophy with alterations in bone turnover, mineralization, and volume (TMV). A specific skeletal complication in children is growth impairment, which currently is treated by recombinant human growth hormone (rhGH). The effects on bone material properties are poorly understood. This study assesses the effects of rhGH treatment on bone matrix mineralization. STUDY DESIGN Observational study. SETTING & PARTICIPANTS 18 short children and adolescents (aged 3.6-16 years) with CKD on dialysis therapy. PREDICTOR rhGH treatment for 1 year. OUTCOMES Tetracycline-labeled bone biopsy classified according to the TMV system. MEASUREMENTS Bone mineralization density distribution (BMDD) was evaluated by quantitative backscattered electron imaging in trabecular and cortical compartments. Additional data for patients' height and biochemical bone serum parameters were obtained. RESULTS Prior to rhGH treatment, our cohort showed low bone turnover and high mineralization densities versus reference data: Ca(mean) (weighted mean calcium content) in cancellous bone, +3.3% (P = 0.04); Ca(mean) in cortical bone, +6.7% (P < 0.001); Ca(peak) (mode of the BMDD) in cancellous bone, +5.0% (P < 0.001); Ca(peak) in cortical bone, +8.2% (P < 0.001); Ca(width) (heterogeneity in mineralization), no significant difference for cancellous (P = 0.2) and cortical (P = 0.1) bone; Ca(high) (portion of fully mineralized bone) in cancellous bone, 5-fold greater (P < 0.001); Ca(high) in cortical bone, 14-fold greater (P < 0.001); Ca(low) (portion of low mineralized bone) in cancellous bone, +23.9% (P = 0.02); Ca(low) in cortical bone, -22.2% (P = 0.05). After rhGH treatment, height increased by 9.1 cm (P < 0.001) and bone turnover indices to normal values or beyond. Matrix mineralization was lesser and more heterogeneous compared to baseline: Ca(width) for cancellous bone, +15.3% (P < 0.001); Ca(width) for cortical bone, +34.1% (P < 0.001). Ca(mean), Ca(peak), and Ca(high) for cancellous bone and Ca(mean) and Ca(peak) for cortical bone were no longer significantly different from reference data. Ca(high) for cortical bone dramatically decreased after treatment but was still substantially greater than reference data. LIMITATIONS Low case number per TMV subgroup, no measurements of fibroblast growth factor 23. CONCLUSIONS Children and adolescents with CKD and growth deficiency are at risk of having low bone turnover. rhGH treatment improves height and concomitantly bone modeling/remodeling, which appears beneficial for bone matrix mineralization.
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Affiliation(s)
- Kamilla Nawrot-Wawrzyniak
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
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21
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Kim MK, Baek KH, Kang MI, Park SE, Rhee EJ, Park CY, Lee WY, Oh KW. Serum alkaline phosphatase, body composition, and risk of metabolic syndrome in middle-aged Korean. Endocr J 2013; 60:321-8. [PMID: 23149655 DOI: 10.1507/endocrj.ej12-0331] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Some papers have suggested that alkaline phosphatase (ALP) level is a predictor of the metabolic syndrome (MetS) in the general population. However, the association is still controversial, and the mechanisms underlying an association between ALP level and the MetS have not been elucidated. We analyzed the association between serum ALP level and the development of the MetS over a 4-year period. A total of 14,224 subjects who visited the Health Promotion Center for a medical examination in 2005 were followed up after 4 years. Serum ALP level correlated positively with body fat mass and visceral fat mass. The adjusted geometric mean ALP levels were higher in subjects with elevated C-reactive protein level or greater fat mass (P < 0.001). None of the subjects had the MetS at baseline, but 1,179 exhibited the MetS at the 4-year follow-up. After multiple adjustments, the odds ratio (OR) was substantially higher for development of the MetS (OR 1.56, 95% confidence intervals, 1.21-2.01) in subjects in the highest ALP quintile compared with those in the lowest quintile. After adjusting for various covariates, we found significant associations between the quintile of serum ALP level and abdominal obesity, low high-density lipoprotein cholesterol level, and high triglyceride level. Higher serum ALP level was a significant predictor of the MetS in middle-aged Koreans. Serum ALP level correlated positively with body fat mass and independently with a more atherogenic lipid profile in the general population in Korea.
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Affiliation(s)
- Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Cooper K, Quarles D, Kubo Y, Tomlin H, Goodman W. Relationship between Reductions in Parathyroid Hormone and Serum Phosphorus during the Management of Secondary Hyperparathyroidism with Calcimimetics in Hemodialysis Patients. Nephron Clin Pract 2012. [DOI: 10.1159/000345164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Gupta D, Brietzke S, Hayden MR, Kurukulasuriya LR, Sowers JR. Phosphate Metabolism in Cardiorenal Metabolic Disease. Cardiorenal Med 2011; 1:261-270. [PMID: 22096458 DOI: 10.1159/000332388] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hyperphosphatemia is a major risk factor for cardiovascular disease, abnormalities of mineral metabolism and bone disease, and the progression of renal insufficiency in patients with chronic renal disease. In early renal disease, serum phosphate levels are maintained within the 'normal laboratory range' by compensatory increases in phosphaturic hormones such as fibroblast growth factor-23 (FGF-23). An important co-factor for FGF-23 is Klotho; a deficiency in Klotho plays an important role in the pathogenesis of hyperphosphatemia, renal tubulointerstitial disease, and parathyroid and bone abnormalities. Clinical hyperphosphatemia occurs when these phosphaturic mechanisms cannot counterbalance nephron loss. Hyperphosphatemia is associated with calcific uremic arteriolopathy and uremic cardiomyopathy, which may explain, in part, the epidemiologic connections between phosphate excess and cardiovascular disease. However, no clinical trials have been conducted to establish a causal relationship, and large, randomized trials with hard endpoints are urgently needed to prove or disprove the benefits and risks of therapy. In summary, hyperphosphatemia accelerates renal tubulointerstitial disease, renal osteodystrophy, as well as cardiovascular disease, and it is an important mortality risk factor in patients with chronic kidney disease.
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Affiliation(s)
- Deepashree Gupta
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Columbia, Mo., USA
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