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Ma K, Huang Y, Li M, Li Y, Fan F, Sun Z, Zhang X. Development of Highly Sensitive and Specific and Genetically Encoded Biosensors for Calcifediol and Calcitriol Detection. ACS Sens 2025; 10:3725-3736. [PMID: 40340357 DOI: 10.1021/acssensors.5c00650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
1α,25-Dihydroxyvitamin D3 (calcitriol) and 25-hydroxyvitamin D3 (calcifediol) are essential steroid metabolites that serve as key indicators of vitamin D3 status in the human body. However, conventional detection methods, such as high-performance liquid chromatography (HPLC) and enzyme-linked immunosorbent assay (ELISA), are costly, time-consuming, and labor-intensive, limiting their accessibility for routine analysis. Here, we engineered genetically encoded biosensors by leveraging the human vitamin D receptor (VDR) and retinoid X receptor alpha (RXRA) to enable precise detection of calcitriol and calcifediol in Saccharomyces cerevisiae. The biosensors were designed as two-component modules by fusing the VDR ligand-binding domain to the S. cerevisiae GAL4 DNA-binding domain and RXRA to the VP16 activation domain, facilitating ligand-dependent transcriptional activation. To enhance sensitivity, we increased the copy number of the reporter module and incorporated a transcriptional amplifier, improving the half-maximal effective concentration (EC50) to 23.3 nM for calcitriol and 219.8 nM for calcifediol. Furthermore, biosensor specificity for calcitriol was optimized by screening VDR mutations using a URA3-mediated dual-selection system, yielding the VDRCT mutant, which exhibited no response to 10 μM calcifediol. The biosensors demonstrated high accuracy in measuring calcifediol in dietary supplements and calcitriol in pharmaceutical formulations, showing strong concordance with HPLC results. These findings suggest that the proposed biosensors may provide a cost-effective, rapid, and reliable alternative for food safety inspection and clinical diagnostics.
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Affiliation(s)
- Kang Ma
- College of Biotechnology, Tianjin University of Science and Technology, Tianjin 300457, China
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
| | - Ying Huang
- College of Biotechnology, Tianjin University of Science and Technology, Tianjin 300457, China
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
| | - Mengying Li
- College of Biotechnology, Tianjin University of Science and Technology, Tianjin 300457, China
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
| | - Yixuan Li
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Feiyu Fan
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
- National Center of Technology Innovation for Synthetic Biology, Tianjin 300308, China
| | - Zhe Sun
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
- National Center of Technology Innovation for Synthetic Biology, Tianjin 300308, China
| | - Xueli Zhang
- Key Laboratory of Engineering Biology for Low-carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China
- National Center of Technology Innovation for Synthetic Biology, Tianjin 300308, China
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Zhang J, Xu F, Zhuang P, Xu X, Zou Z, Qing W. Effects of health education based on self-determination theory on hemodialysis knowledge and self-management in maintenance hemodialysis patients. Sci Rep 2025; 15:15982. [PMID: 40341669 PMCID: PMC12062488 DOI: 10.1038/s41598-025-01152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 05/05/2025] [Indexed: 05/10/2025] Open
Abstract
The purpose of this study was to examine the impact of health education based on self-determination theory on hemodialysis knowledge, self-management, interdialytic weight gain and anxiety and depression in maintenance hemodialysis patients. The study is a quasi-randomized control trial, a total of 86 maintenance hemodialysis patients who met the inclusion criteria were included equally in the intervention and control groups. The control group received routine care, and the intervention group received health education based on self-determination theory. Three months after the intervention, the intervention effects were evaluated using the Hemodialysis Related Knowledge Scale, Self-Management Behavior Scale, Interdialytic Weight Gain, and Hospital Anxiety and Depression Scale. Three months after the intervention, the hemodialysis knowledge scores of the intervention group was higher than that of the control group and baseline; the scores of the intervention group in problem solving, partnership, emotional processing, executive self-care dimensions and the total self-management scores were higher than that of the control group and baseline; the interdialytic weight gain of the intervention group was lower than that of the control group and baseline; the anxiety and depression scores of the intervention group were lower than that of the control group and baseline. All these differences were statistically significant (P < 0.05). Health education based on self-determination theory can improve the hemodialysis knowledge level and self-management ability of maintenance hemodialysis patients, and reduce the interdialytic weight gain and anxiety and depression level.
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Affiliation(s)
- Jiquan Zhang
- Department of Nephrology, Deyang People's Hospital, Deyang, 618000, China
| | - Fan Xu
- Department of Nursing, Deyang People's Hospital, Deyang, 618000, China.
| | - Peimin Zhuang
- Department of Nephrology, The First Hospital of Putian City, Putian, 351100, China
| | - Xingying Xu
- Department of Nephrology, Deyang People's Hospital, Deyang, 618000, China
| | - Zhaohua Zou
- Department of Nephrology, Deyang People's Hospital, Deyang, 618000, China
| | - Wei Qing
- Department of Nephrology, Deyang People's Hospital, Deyang, 618000, China.
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Wen Y, Li Y, Zhang D, Liu Z, Liu H, Li X, Wu W, Zeng L, Zou Q, Yi W. Inhibition of MALAT1 facilitates ROS accumulation via the Keap1/HO-1 pathway to enhance photodynamic therapy in secondary hyperparathyroidism. Noncoding RNA Res 2025; 11:249-261. [PMID: 39896343 PMCID: PMC11787669 DOI: 10.1016/j.ncrna.2024.12.001] [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: 09/25/2024] [Revised: 11/05/2024] [Accepted: 12/04/2024] [Indexed: 02/04/2025] Open
Abstract
The prevalence of secondary hyperparathyroidism (SHPT) in advanced chronic kidney disease (CKD) exceeds 80 %. Our previous study indicated that photodynamic therapy (PDT) has potential for treating SHPT. Long noncoding RNA (lncRNA) is involved in various oxidative stress and apoptotic processes, but the molecular mechanism remains unreported. In this study, we found that PDT induced apoptosis in SHPT through reactive oxygen species (ROS) accumulation. The expression of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and heme oxygenase 1 (HO-1) within SHPT was upregulated after PDT. Inhibition of MALAT1 increased PDT-induced ROS, which promoted the apoptosis. Pearson correlation analysis confirmed that there was a positive correlation between MALAT1 and HO-1, and MALAT1 inhibition down-regulated HO-1, whereas concomitant overexpression of HO-1 was able to eliminate the PDT-induced ROS and inhibit apoptosis. The direct binding of MALAT1 to Kelch-like ECH-associated protein 1 (Keap1) protein was confirmed by high-throughput sequencing, RNA pulldown, silver staining and western blotting assays. Si-Keap1 was able to rescue the down-regulation of HO-1 caused by MALAT1 inhibition, restoring the elimination of ROS by HO-1 and attenuating the effect of PDT. In addition, PDT effectively reduced parathyroid hormone (PTH) secretion in SHPT rats, and this effect was further enhanced in combination with MALAT1 inhibitors. Overall, MALAT1 activates downstream HO-1 expression by binding to Keap1, thereby reducing ROS and inhibiting apoptosis, which in turn mediates PDT resistance in SHPT. Inhibition of MALAT1 significantly enhanced the efficacy of PDT, suggesting a potential therapeutic target for improving PDT for SHPT outcomes.
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Affiliation(s)
- Ying Wen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
| | - Yitong Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
- Breast Center, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Danhua Zhang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
| | - Ziru Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
| | - Hong Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xiejia Li
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Wei Wu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Liyun Zeng
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, 410011, China
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Nakanishi M, Mizuno T, Sakai S, Hira D, Koseki T, Matsubara T, Yokoi H, Yanagita M, Terada T, Yamada S, Tsuboi N. Frequency of Acute Kidney Injury After the Initiation of Vitamin D Receptor Activators: A Multicenter Retrospective Observational Study. Clin Drug Investig 2025; 45:191-199. [PMID: 40074969 DOI: 10.1007/s40261-025-01429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND AND OBJECTIVES Vitamin D receptor activators (VDRAs) are widely used in patients with osteoporosis; however, the frequency of acute kidney injury (AKI) due to VDRAs is unclear. This study aimed to investigate whether the incidence of AKI after VDRA initiation differed among patients with different renal functions. METHODS The medical records of Japanese patients who were newly prescribed with VDRAs for osteoporosis at the Fujita Health University Hospital or Kyoto University Hospital between April 2012 and March 2022 were retrospectively reviewed in this study. The RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria were used to assess the incidence of AKI within 7 days after initiation of VDRA therapy. Additionally, the AKI algorithm was used to assess the incidence of AKI from 8 to 365 days after initiation of VDRA therapy. RESULTS The incidence of AKI, as defined by the RIFLE criteria, was significantly higher in patients with normal renal function or end-stage renal failure than in those with mild renal decline (p < 0.05); the incidence of AKI, defined using the AKI algorithm, showed a similar trend. We found that the lack of serum calcium level monitoring before the initiation of VDRAs might be a risk factor for AKI defined by the RIFLE criteria (odds ratio = 2.004, p = 0.096). CONCLUSIONS The incidence of AKI after the initiation of VDRA therapy was high, even if renal function was normal. Thus, our results suggest that monitoring serum calcium levels before the initiation of VDRA therapy is necessary, regardless of renal function.
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Affiliation(s)
- Masanori Nakanishi
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Kutsukakecho Dengakugakubo 1-98, Toyoake, Aichi, 470-1101, Japan
| | - Tomohiro Mizuno
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Kutsukakecho Dengakugakubo 1-98, Toyoake, Aichi, 470-1101, Japan.
| | - Shinya Sakai
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Daiki Hira
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Takenao Koseki
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Kutsukakecho Dengakugakubo 1-98, Toyoake, Aichi, 470-1101, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Yokoi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Terada
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Shigeki Yamada
- Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, Kutsukakecho Dengakugakubo 1-98, Toyoake, Aichi, 470-1101, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Fetene D, Adugnew M, Mamo H, Kedir S, Asmamaw K. Factors affecting knowledge and practices towards prevention of chronic kidney disease among hypertensive patients at public hospital in Bale and East Bale zone, Oromia, Southeast Ethiopia, 2023: A cross-sectional study. Medicine (Baltimore) 2025; 104:e41989. [PMID: 40153756 PMCID: PMC11957632 DOI: 10.1097/md.0000000000041989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 03/09/2025] [Indexed: 03/30/2025] Open
Abstract
Chronic kidney disease (CKD) is a growing health concern worldwide. It is crucial to prevent CKD to mitigate its impact and enhance health results. Recognizing and managing the risk factors of chronic kidney disease at an early stage can aid in stopping its advancement. A cross-sectional study was carried out at a hospital from March 1 to April 30, 2023, involving 422 hypertensive patients. The participants were chosen using systematic random sampling. Data on socio-demographic and clinical factors, as well as knowledge and practices, were gathered through interviews, medical record reviews using structured questionnaires. Descriptive statistics were used to determine the frequency and percentage of variables. The data was entered into Epi-data version 4.6 and analyzed using SPSS version 23 (Chicago). Variables with P-values < .25 were considered for multivariable analysis, and those with P-values < .05 were deemed to be factors associated with knowledge and practices. The study found that 42.2% (178) of hypertensive patients had good knowledge about chronic kidney disease, and 43.6% (184) had good practices. Living in urban areas (with an adjusted odds ratio [AOR] of 3.94 at a 95% confidence interval [CI] of 2.42-6.42) and having a family history of kidney disease (AOR 5.59 at a 95% CI of 3.21-9.75) were factors associated with good knowledge. Being a government employee (AOR 7.29, at 95% CI 1.79-29.58) and maintaining a normal body mass index (AOR 8.03, at 95% CI 3.54-18.19) were linked to good practices. Less than half of the study participants had good knowledge and practices toward prevention of chronic kidney disease. Identifying factors that affect knowledge and practices towards the prevention of chronic kidney disease can offer healthcare providers, governmental and nongovernmental organizations (NGOs), and policymakers' valuable insights for developing strategic interventions and education programs to promote better management of hypertension and CKD.
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Affiliation(s)
- Deriba Fetene
- Department of Nursing, College of Medicine and Health Sciences, School of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Mulugeta Adugnew
- Department of Nursing, College of Medicine and Health Sciences, School of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Hailye Mamo
- Department of Nursing, College of Medicine and Health Sciences, School of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Sana’a Kedir
- Department of Nursing, College of Medicine and Health Sciences, School of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Kidist Asmamaw
- Department of Nursing, College of Medicine and Health Sciences, School of Health Sciences, Madda Walabu University, Robe, Ethiopia
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Prabhahar A, Batta A, Hatwal J, Kumar V, Ramachandran R, Batta A. Endothelial dysfunction in the kidney transplant population: Current evidence and management strategies. World J Transplant 2025; 15:97458. [PMID: 40104196 PMCID: PMC11612885 DOI: 10.5500/wjt.v15.i1.97458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 09/04/2024] [Accepted: 11/04/2024] [Indexed: 11/26/2024] Open
Abstract
The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators. Endothelial dysfunction (ED), characterized by impaired vasodilation, inflammation, and thrombosis, triggers future cardiovascular (CV) diseases. Chronic kidney disease, a state of chronic inflammation caused by oxidative stress, metabolic abnormalities, infection, and uremic toxins damages the endothelium. ED is also associated with a decline in estimated glomerular filtration rate. After kidney transplantation, endothelial functions undergo immediate but partial restoration, promising graft longevity and enhanced CV health. However, the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED, culminating in poor CV health and graft survival. ED in kidney transplant recipients is an under-recognized and poorly studied entity. CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts. ED contributes to the pathogenesis of many of the CV diseases. Various biomarkers and vasoreactivity tests are available to study endothelial functions. With an increasing number of transplants happening every year, and improved graft rejection rates due to the availability of effective immunosuppressants, the focus has now shifted to endothelial protection for the prevention, early recognition, and treatment of CV diseases.
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Affiliation(s)
- Arun Prabhahar
- Department of Telemedicine (Internal Medicine and Nephrology), Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akshey Batta
- Department of Urology and Renal Transplant, Neelam Hospital, Rajpura 140401, Punjab, India
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vivek Kumar
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Raja Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
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Chaiyakittisopon K, Pattanaprateep O, Ponthongmak W, Kunakorntham P, Chuasuwan A, Ingsathit A, Mckay GJ, Attia J, Thakkinstian A. Effectiveness of phosphate binders on mortality and cardiovascular disease in end-stage renal disease patients with hyperphosphatemia: a multicenter real-world cohort study. BMC Nephrol 2025; 26:131. [PMID: 40065267 PMCID: PMC11895186 DOI: 10.1186/s12882-025-04058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/05/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Uncontrolled hyperphosphatemia in end stage renal disease (ESRD) increases the risk of cardiovascular disease (CVD), bone disorders, and premature mortality. Randomized controlled trials show reduced CVD risk of non-calcium-based phosphate-binders (NCBPBs) compared to CBPBs although evidence from real world data is less consistent. This study aimed to compare the effectiveness of NCBPBs, CBPBs, to no phosphate-binder (PB) on mortality and cardiovascular disease in Thai hyperphosphatemic ESRDs. METHODS A retrospective-cohort was conducted by using data from 2 university hospitals between January 2010 and July 2020 (COA. MURA2020/1398 and IRB No.100/63). Primary outcomes were overall survival (OS) and CVD-free time. Secondary outcomes included bone disorders following ESRD. An inverse-probability weighting with regression adjustment was used to assess treatment effects. RESULTS A total of 8,005 patients were included. Initial CBPBs were associated with both longer OS and CVD-free time compared to no-PBs, while initial treatment with aluminum hydroxide was the highest risk of bone disorders. Patients who received CBPBs-NCBPBs had longest OS, followed by aluminum hydroxide, and CBPBs, with average OS of 13.5, 11.0, and 10.9 years, respectively. The average CVD-free time was longest for the CBPBs-NCBPBs, followed by CBPBs-CBPBs compared to no-PBs. However, these comparisons were insignificantly different. CONCLUSIONS initial hyperphosphatemic ESRD treatment with CBPBs provided longer OS and CVD-free time compared to no-PBs, while aluminum hydroxide was the highest risk of bone disorders. CBPBs followed by NCBPBs achieved the longest OS and CVD-free time, although these were statistical non-significance.
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Affiliation(s)
- Kamolpat Chaiyakittisopon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 3rd Floor, Research Center Building, 270 RAMA VI Road. Ratchathewi, Bangkok, 10400, Thailand
- Department of Health Consumer Protection and Pharmacy Administration, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 3rd Floor, Research Center Building, 270 RAMA VI Road. Ratchathewi, Bangkok, 10400, Thailand.
| | - Wanchana Ponthongmak
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 3rd Floor, Research Center Building, 270 RAMA VI Road. Ratchathewi, Bangkok, 10400, Thailand
| | - Patratorn Kunakorntham
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 3rd Floor, Research Center Building, 270 RAMA VI Road. Ratchathewi, Bangkok, 10400, Thailand
- Health Informatics Analyst Data Health for Analysis Informatics Section, Information Technology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anan Chuasuwan
- Nephrology Division, Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Atiporn Ingsathit
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 3rd Floor, Research Center Building, 270 RAMA VI Road. Ratchathewi, Bangkok, 10400, Thailand
| | - Gareth J Mckay
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, New Lambton, NSW, Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 3rd Floor, Research Center Building, 270 RAMA VI Road. Ratchathewi, Bangkok, 10400, Thailand
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Anegkamol W, Bowonsomsarit W, Taweevisit M, Tumwasorn S, Thongsricome T, Kaewwongse M, Pitchyangkura R, Tosukhowong P, Chuaypen N, Dissayabutra T. Synbiotics as a novel therapeutic approach for hyperphosphatemia and hyperparathyroidism in chronic kidney disease rats. Sci Rep 2025; 15:7493. [PMID: 40032932 PMCID: PMC11876653 DOI: 10.1038/s41598-025-91033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Accepted: 02/18/2025] [Indexed: 03/05/2025] Open
Abstract
Hyperphosphatemia and secondary hyperparathyroidism (SHPT) are the common complications found in CKD that lead to severe complications including mineral bone disease (MBD), vascular calcification (VC), and cardiovascular mortality. To mitigate hyperphosphatemia, SHPT and uremic toxemia, we supplemented cisplatin-induced CKD rats with a synbiotic composed of Lactobacillus salivarius LBR228, Bifidobacterium longum BFS309, fructo-oligosaccharide and chitosan oligosaccharide, with Lactobacillus casei as a standard probiotic control. After the 12 weeks experiment, rats supplemented with the synbiotic had lower serum phosphate, calcium-phosphorus product, serum parathyroid hormone, and indoxyl sulfate levels than untreated rats. The expression of type 1 RNA and protein expression were increased in rats treated with the synbiotics. Our result showed that synbiotic treatment alleviates hyperphosphatemia and SHPT, which are the main risks of MBD and VC. The mode of the synbiotic action is hypothesized to associate with the improvement of the tight junction and gut barrier, leading to the suppression of intestinal paracellular phosphate transport. This study demonstrated the beneficial effects of synbiotic treatment in the control of serum phosphate and parathyroid hormone in an animal model with CKD.
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Affiliation(s)
- Weerapat Anegkamol
- Metabolic Disease in Gastrointestinal and Urinary System Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Wirin Bowonsomsarit
- Metabolic Disease in Gastrointestinal and Urinary System Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Mana Taweevisit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Somying Tumwasorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Thana Thongsricome
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Maroot Kaewwongse
- Division of Physiology, School of Medical Sciences, University of Phayao, Phayao, 56000, Thailand
| | - Rath Pitchyangkura
- Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Piyaratana Tosukhowong
- Metabolic Disease in Gastrointestinal and Urinary System Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Natthaya Chuaypen
- Metabolic Disease in Gastrointestinal and Urinary System Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Thasinas Dissayabutra
- Metabolic Disease in Gastrointestinal and Urinary System Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Ren M, Liu Y, Lin B, Zou W, Zhu B, Wu J. The incidence of hyperkalemia in patients with secondary hyperparathyroidism after ultrasound-guided radiofrequency ablation vs. parathyroidectomy. Front Med (Lausanne) 2025; 12:1539652. [PMID: 40041461 PMCID: PMC11876163 DOI: 10.3389/fmed.2025.1539652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 02/03/2025] [Indexed: 03/06/2025] Open
Abstract
Introduction The aim of our study was to compare the incidence of hyperkalemia in maintenance dialysis patients with secondary hyperparathyroidism(SHPT) after parathyroidectomy(PTX) or ultrasound-guided radiofrequency ablation(RFA), and to explore the risk factors and the best preoperative serum potassium threshold. Methods We defined hyperkalemia as serum potassium >5.30 mmol/L. Two operation methods were analyzed in subgroups, and the differences in demographic parameters, operation situation and perioperative laboratory indicators were compared between the two groups. Results A total of 154 maintenance dialysis patients were included, of which 91 patients received PTX and 63 patients received RFA. 53 patients (34.4%) developed postoperative hyperkalemia. Patients in hyperkalemia group had higher preoperative serum potassium, phosphorus, hemoglobin and 25-hydroxyvitamin D level (p < 0.05). It seemed that males were more prone to suffer hyperkalemia than females, but there was no statistically difference (40.9% vs. 25.8%, p = 0.05). The occurrence of hyperkalemia after the operation was obviously higher in hemodialysis patients. Logistic regression analysis showed that preoperative serum potassium level (OR = 3.269, 95%CI 1.638-6.534, p = 0.001) and PTX (OR = 18.119, 95%CI 5.716-57.438, p < 0.01) were independent risk factors for predicting postoperative hyperkalemia. According to ROC curve analysis, the optimal cutoff value for preoperative serum potassium was 4.66 mmol/L, with a sensitivity of 46.8% and a specificity of 86%. Conclusion Hyperkalemia after invasive treatment in patients with severe SHPT was common, and the incidence of hyperkalemia after PTX was significantly higher than that after RFA. Hemodialysis patients were more prone to hyperkalemia, which was related to the preoperative serum potassium level.
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10
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Okafor EN, Ebede SO, Agbo EO. Recent Advances in Nephrology: The Research Gaps and the Need for Greater Emphasis on Incorporating Hard Clinical Endpoints. Niger J Clin Pract 2025; 28:137-144. [PMID: 40326892 DOI: 10.4103/njcp.njcp_867_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/14/2024] [Indexed: 05/07/2025]
Abstract
Current limitations exist in the availability of specific therapies for preventing acute kidney injury (AKI). Managing AKI poses challenges, particularly as interventions are often initiated only after a substantial increase in serum creatinine or a gradual decline in urine output. However, relying on these parameters raises concerns due to their insensitivity to acute changes. The timely detection of patients at risk of kidney disease through the diagnostic utility of biomarkers is essential for the prompt implementation of active interventions. Despite the initial optimism surrounding the discovery of AKI biomarkers, their integration into the routine care of at-risk patients lags behind and is underutilized, even after validations. Therefore, the utilization of biomarkers holds promise in promptly diagnosing AKI and improving patient outcomes. Despite notable technological advancements in various medical subspecialties, survival rates among acute and chronic kidney disease (CKD) patients have not witnessed significant improvement compared to other disciplines. While HIV infection and AIDS were once considered a death sentence, advancements in HIV treatment have allowed for control and longer-acting management. However, a definitive cure for CKD remains elusive. Nephrology research faces challenges, including the imperative to enhance both the quality and quantity of research. The number of randomized controlled trials in nephrology is notably lower compared to other subspecialties, with many yielding negative results. Studies evaluating hard clinical endpoints are also limited. This review provides an overview of recent advances in nephrology and the need for greater emphasis on incorporating hard clinical endpoints that could impact clinical practice.
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Affiliation(s)
- E N Okafor
- Department of Medical Laboratory Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - S O Ebede
- Department of Medical Microbiology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu State, Nigeria
| | - E O Agbo
- Department of Chemical Pathology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, Baze University, Abuja, Nigeria
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11
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Henner DE, Drambarean B, Gerbeling TM, Kendrick JB, Kendrick WT, Koester-Wiedemann L, Nickolas TL, Rastogi A, Rauf AA, Dyson B, Singer MC, Desai P, Fox KM, Cheng S, Goodman W. Practice patterns on the management of secondary hyperparathyroidism in the United States: Results from a modified Delphi panel. PLoS One 2025; 20:e0266281. [PMID: 39888902 PMCID: PMC11785329 DOI: 10.1371/journal.pone.0266281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/17/2022] [Indexed: 02/02/2025] Open
Abstract
BACKGROUND Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD). Many recommendations in the Kidney Disease Improving Global Outcomes (KDIGO) CKD-mineral and bone disorder guidelines are supported by modest evidence and predate the approval of newer agents. Therefore, an expert panel defined consensus SHPT practice patterns in the United States with real-world context from the nephrology community. METHODS Ten US healthcare providers and one patient participated in a modified Delphi method comprising three phases. Consensus was determined via iterative responses to a questionnaire based on the 2009 and 2017 KDIGO guidelines and published literature on the identification, evaluation, monitoring, and interventional strategies for patients with SHPT. The threshold for consensus was 66% agreement. RESULTS Panelists generally agreed with KDIGO recommendations, with some differences. Consensus was reached on 42/105 (40%), 95/105 (90.5%), and 105/105 (100%) questions after phases 1, 2, and 3, respectively. Panelists unanimously agreed that SHPT treatment is often started late. There was a preference for serum phosphate level <4.6 mg/dL, and consensus to maintain serum calcium levels <9.5 mg/dL. There was unanimous agreement for vitamin D analogues as first-line options in patients not on dialysis with severe, progressive SHPT and unanimous preference for intravenous calcimimetic, etelcalcetide, in appropriate in-center dialysis patients. Factors such as formularies, dialysis center protocols, and insurance were recognized to influence therapeutic strategies. CONCLUSIONS Expert consensus was reached on SHPT management, further defining therapeutic strategies and medication use and emphasizing need for treatment early. Despite evidence-based treatment preferences supported by clinical experience, factors other than scientific evidence influence decision making, particularly with medications.
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Affiliation(s)
- David E. Henner
- Division of Nephrology, Berkshire Medical Center, Pittsfield, MA, United States of America
| | - Beatrice Drambarean
- University of Illinois Hospital & Health Sciences System, Chicago, IL, United States of America
| | | | - Jessica B. Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, United States of America
| | | | - Lisa Koester-Wiedemann
- Division of Nephrology, Washington University School of Medicine, St Louis, MO, United States of America
| | - Thomas L. Nickolas
- Division of Nephrology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Anjay Rastogi
- Division of Nephrology, UCLA School of Medicine, Los Angeles, CA, United States of America
| | - Anis A. Rauf
- Nephrology Associates of Northern Illinois, Oakbrook, IL, United States of America
| | | | - Michael C. Singer
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Hospital, Detroit, MI, United States of America
| | - Pooja Desai
- Amgen, Inc., Thousand Oaks, CA, United States of America
| | | | - Sunfa Cheng
- Amgen, Inc., Thousand Oaks, CA, United States of America
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12
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Chen H, Zhou Y, Liu Y, Zhou W, Xu L, Shang D, Ni J, Song Z. Indoxyl sulfate exacerbates alveolar bone loss in chronic kidney disease through ferroptosis. Oral Dis 2025; 31:264-277. [PMID: 38934473 DOI: 10.1111/odi.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES The purpose of this study was to determine whether indoxyl sulfate (IS) is involved in alveolar bone deterioration and to elucidate the mechanism underlying alveolar bone loss in chronic kidney disease (CKD) patients. MATERIALS AND METHODS Mice were divided into the control group, CP group (ligature-induced periodontitis), CKD group (5/6 nephrectomy), and CKD + CP group. The concentration of IS in the gingival crevicular fluid (GCF) was determined by HPLC. The bone microarchitecture was evaluated by micro-CT. MC3T3-E1 cells were stimulated with IS, and changes in mitochondrial morphology and ferroptosis-related factors were detected. RT-PCR, western blotting, alkaline phosphatase activity assays, and alizarin red S staining were utilized to assess how IS affects osteogenic differentiation. RESULTS Compared with that in the other groups, alveolar bone destruction in the CKD + CP group was more severe. IS accumulated in the GCF of mice with CKD. IS activated the aryl hydrocarbon receptor (AhR) in vitro, inhibited MC3T3-E1 cell osteogenic differentiation, caused changes in mitochondrial morphology, and activated the SLC7A11/GPX4 signaling pathway. An AhR inhibitor attenuated the aforementioned changes induced by IS. CONCLUSIONS IS activated the AhR/SLC7A11/GPX4 signaling pathway, inhibited osteogenesis in MC3T3-E1 cells, and participated in alveolar bone resorption in CKD model mice through ferroptosis.
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Affiliation(s)
- Huiwen Chen
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yining Zhou
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yingli Liu
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- Laboratory of Oral Microbiota and Systemic Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Xu
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Dihua Shang
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jing Ni
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhongchen Song
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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Zilberman-Itskovich S, Algamal B, Azar A, Efrati S, Beberashvili I. Nutritional and Inflammatory Aspects of Low Parathyroid Hormone in Maintenance Hemodialysis Patients-A Longitudinal Study. J Ren Nutr 2025; 35:136-145. [PMID: 38848802 DOI: 10.1053/j.jrn.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/11/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Low serum parathyroid hormone (PTH) is an accepted marker for adynamic bone disease which is characterized by increased morbidity and mortality in maintenance hemodialysis (MHD) patients. In light of the known cross-sectional associations between PTH and malnutrition-inflammation syndrome, we aimed to examine the longitudinal associations between PTH with changes in nutritional and inflammatory parameters and clinical outcomes in MHD patients with low PTH. METHODS This historical prospective and longitudinal study analyzed a clinical database at a single hemodialysis center, containing the medical records of 459 MHD patients (mean age of 71.4 ± 12.9 years old, 171 women), treated between the years 2007-2020. Bone turnover, nutritional and inflammatory marker levels were recorded at 0, 6, 12, 18, 24, 30, and 36 months followed by a median of 24 additional months of clinical observations. According to previous use of vitamin D analogs and/or calcium-sensing receptor agonists, the study participants were divided into treatment-related and disease-related groups. A linear mixed effects model was adjusted for baseline demographics and clinical parameters. RESULTS Of 459 MHD patients, 81 (17.6%) had PTH lower than 150pg/mL. Among them, 30 patients had treatment-related and 51 had disease-related low PTH. At baseline, MHD patients with treatment-related low PTH had a higher rate of diabetes compared to the disease-related group. In a linear mixed effects model, increased PTH over time was associated with decreased levels of alkaline phosphatase and C-reactive protein and with increased hemoglobin and albumin, but not the geriatric nutritional risk index at 3-year follow-up. The survival rate did not differ between the groups, with the risk of hospitalizations due to fractures being higher (HR: 4.04 with 95% CI: 1.51-10.8) in the disease-related group. Statistical significance of this association was abolished after adding C-reactive protein or alkaline phosphatase to the multivariate models. CONCLUSIONS Low serum PTH in MHD patients behaves differently depending on its cause, with a higher risk of fractures in the disease-related group. This association is dependent on inflammation. Our results should be verified in larger epidemiological studies.
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Affiliation(s)
- Shani Zilberman-Itskovich
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Baker Algamal
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Ada Azar
- Nutrition Department, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Shai Efrati
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Arora N, Koirala A. Calcium, Magnesium and Phosphate Disorders. ADVANCES IN KIDNEY DISEASE AND HEALTH 2025; 32:50-60. [PMID: 40175030 DOI: 10.1053/j.akdh.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 10/09/2024] [Accepted: 10/15/2024] [Indexed: 04/04/2025]
Abstract
A fundamental understanding of electrolyte disorders is a requisite skill for nephrology practitioners given the vital role kidneys play in maintenance of homeostasis. While disorders of sodium and potassium garner greater attention, calcium, magnesium, and phosphate are similarly essential for a variety of bodily functions. This article reviews the physiology and pathology of calcium, magnesium, and phosphate through a series of clinical vignettes designed to assist nephrologists preparing for boards and practitioners caring for patients with derangements in these electrolytes in clinical practice.
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Affiliation(s)
- Nayan Arora
- Oregon Health and Science University, Portland, OR
| | - Abbal Koirala
- Division of Nephrology, Johns Hopkins University, Baltimore, MD
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15
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Liu Y, Peng CZ, Chai HH, Qian LX, Wu SS, Yu MA, Li SP, Zhang JT, Shan Y, Liu FY, Sun CB, Yang ZW, Zhang R, Che Y, Gao SH, Yu J, Liang P. US-Guided Thermal Ablation for Secondary Hyperparathyroidism: A Prospective Multicenter Study. Radiology 2025; 314:e233104. [PMID: 39772792 DOI: 10.1148/radiol.233104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Background Interest in microwave ablation (MWA) and radiofrequency ablation (RFA) use for treating secondary hyperparathyroidism (SHPT) is rising; however, ablation outcomes in patients with SHPT are not well characterized. Purpose To assess the response of parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels to US-guided parathyroid MWA and RFA and the safety of these treatments in participants with SHPT. Materials and Methods This prospective multicenter cohort study, conducted from September 2017 to March 2022, included participants with SHPT. The primary end point was the proportion of participants achieving the target PTH level (≤585 pg/mL). The secondary end points included PTH, calcium, phosphorus, and ALP levels before ablation and time points for follow-up assessments after ablation (2 hours, 1 day, 1 month, 3 months, and 6 months, and then every 6 months) and complications and technical success rates. Mixed-effects logistic regression models were used to identify factors associated with treatment failure. Results A total of 215 participants (median age, 53 years [IQR, 43-60 years]; 109 [50.7%] male participants) were evaluated, and 183 (85.1%) achieved target PTH levels. Compared with baseline levels, there was an 85.9%, 6.3%, 15.3%, and 37.4% reduction in PTH, calcium, phosphorus, and ALP levels at 24 months after ablation, respectively. For major complications, one (0.5%) participant experienced persistent hoarseness, and severe hypocalcemia (<1.87 mmol/L) was present in 74 (34.4%) participants. After adjustments, predictors associated with treatment failure included the preablation PTH level (adjusted odds ratio [OR], 3.78; 95% CI: 1.19, 12.04; P = .03), maximum tumor volume (adjusted OR, 5.02; 95% CI: 1.74, 14.53; P = .003), and number of glands ablated (adjusted OR, 0.32; 95% CI: 0.11, 0.98; P = .046). The prediction model showed good discrimination ability in the development and validation cohorts (area under the receiver operating characteristic curve, 0.78 [95% CI: 0.66, 0.90] and 0.73 [95% CI: 0.55, 0.91], respectively). Conclusion US-guided thermal ablation techniques were effective and safe treatments in participants with SHPT because they effectively reduced PTH, calcium, phosphorus, and ALP levels. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.
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Affiliation(s)
- Yang Liu
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Cheng-Zhong Peng
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Hui-Hui Chai
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Lin-Xue Qian
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Song-Song Wu
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Ming-An Yu
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Shui-Ping Li
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Jian-Tang Zhang
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Yue Shan
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Fang-Yi Liu
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Chong-Bing Sun
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Zhi-Wei Yang
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Rui Zhang
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Ying Che
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Shu-Hang Gao
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, the Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (Y.L., F.Y.L., J.Y., P.L.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (C.Z.P.); Graduate Department, Bengbu Medical College, Bengbu, Anhui, China (H.H.C.); Department of Ultrasound, Capital Medical University, Beijing Friendship Hospital, Beijing, China (L.X.Q.); Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou, Fujian, China (S.S.W.); Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China (S.P.L., J.T.Z.); Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China (Y.S.); Weifang Peoples Hospital, Weifang, Shandong, China (C.B.S.); Daqing Oilfield General Hospital, Daqing, Liaoning, China (Z.W.Y., R.Z.); and Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (Y.C., S.H.G.)
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Oriol‐Vila E, Rota‐Musoll L, Molina‐Robles E, Roure‐Pujol C, Chiverches‐Pérez E. Educational Interventions for Haemodialysis Patients in the Transplant Process: A Systematic Review. Nurs Open 2024; 11:e70104. [PMID: 39665262 PMCID: PMC11635394 DOI: 10.1002/nop2.70104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/27/2024] [Accepted: 11/13/2024] [Indexed: 12/13/2024] Open
Abstract
AIM To systematically evaluate empirical studies investigating nursing educational interventions for patients with haemodialysis at the different stages of cadaveric kidney transplantation and synthesise these findings. DESIGN A systematic review of clinical interventions. METHODS On clinical trials published in Spanish and English, between January 2005 and July 2022, in the main databases. The number of studies identified is shown in the flowchart of the PRISMA review. For the critical assessment of the scientific quality of the studies, the CASPe checklist and the Cochrane risk of bias assessment tool were applied. RESULTS Eleven studies were obtained in which nursing educational interventions focused on posttransplantations and one that considered care from the person's admission to hospital were evaluated. The results obtained identified four themes: health education, empowerment, quality of life and holistic patient care with the help of different support methods, including individual and personalised support, group format and informational support via an educational brochure, telephone and website. CONCLUSION The reviewed studies suggest that after receiving educational interventions patient dialysis treatment and kidney transplant recipient, have better health outcomes. PATIENT CONTRIBUTION Larger studies are needed to promote a comprehensive and continuous self-care model throughout the kidney transplant process. IMPLICATIONS FOR NURSING HEALTH EDUCATION Nursing educational interventions are necessary throughout the transplantation process for the patient dialysis and the family in a comprehensive and continuous manner. In the future, clinical trial studies are needed at the pretransplantation stage.
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Affiliation(s)
- Ester Oriol‐Vila
- Consorci Hospitalari de Vic, NephrologyBarcelonaSpain
- Faculty of Health and Welfare SciencesUniverstity of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and WelfareCentre for Health and Social Care Research (CESS). University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
| | - Laura Rota‐Musoll
- Faculty of Health and Welfare SciencesUniverstity of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and WelfareCentre for Health and Social Care Research (CESS). University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
| | - Esmeralda Molina‐Robles
- Consorci Hospitalari de Vic, NephrologyBarcelonaSpain
- Faculty of Health and Welfare SciencesUniverstity of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and WelfareCentre for Health and Social Care Research (CESS). University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
| | - Carme Roure‐Pujol
- Faculty of Health and Welfare SciencesUniverstity of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- Department of Social Sciences and Community Health. Faculty of Health and Welfare Sciences. Member of the Research Group ISaMBeS (Innovation in Mental Health and Social Welfare)University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
| | - Emilia Chiverches‐Pérez
- Faculty of Health and Welfare SciencesUniverstity of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and WelfareCentre for Health and Social Care Research (CESS). University of Vic‐Central University of Catalonia (UVIC‐UCC)VicSpain
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Li M, Jiang H, Wang Y, Li F. Efficacy and safety of radiofrequency ablation for secondary hyperparathyroidism: a systematic review and meta-analysis. ASIAN BIOMED 2024; 18:287-296. [PMID: 39697216 PMCID: PMC11650422 DOI: 10.2478/abm-2024-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
Background Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) that affects approximately 90% of end-stage renal disease and poses a significant threat to long-term survival and quality of life in patients. Objectives To assess whether radiofrequency ablation (RFA) is a productive and low-risk treatment for hyperparathyroidism secondary to CKD. Methods Embase, Web of Science, Cochrane Library, and PubMed were searched independently by two authors. The results after RFA and baseline biochemical indicators were compared, and parathyroid hormone (PTH), serum calcium, and serum phosphorus levels were the major outcomes. Results Four retrospective studies were screened out from 147 original literature and involved 118 cases. After RFA, serum PTH levels (1 d standardized mean difference [SMD] = -2.30, 95% confidence interval [CI] = from -3.04 to -1.56, P < 0.0001; 6 months SMD = -2.15, 95% CI = from -3.04 to -1.26, P < 0.0001; 12 months SMD = -2.35, 95% CI = from -3.52 to -1.17, P < 0.0001), serum calcium levels (1 d SMD = -1.49, 95% CI = from -2.18 to -0.81, P = 0.0001; 6 months SMD = -1.09, 95% CI = from -1.51 to -0.68, P < 0.0001), and serum phosphorus levels (1 d SMD = -1.37, 95% CI = from -1.67 to -1.07, P < 0.0001; 6 months SMD = -1.06, 95% CI = from -1.35 to -0.78, P < 0.0001) decreased significantly. Conclusions RFA, the newest thermal ablation technique, can effectively and safely treat hyperparathyroidism secondary to CKD. Hoarseness is the most common complication but is reversed within 6 months.
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Affiliation(s)
- Mengyuan Li
- Department of Ultrasound, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, 471003, China
| | - Hongwei Jiang
- Department of Endocrinology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, 471003, China
| | - Yunchang Wang
- Department of Ultrasound, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, 471003, China
| | - Fujun Li
- Department of Stomatological Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, 471003, China
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18
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Tuey SM, Ghimire A, Guzy S, Prebehalla L, Roque AA, Roda G, West RE, Chonchol MB, Shah N, Nolin TD, Joy MS. Population Pharmacokinetic Model of Vitamin D 3 and Metabolites in Chronic Kidney Disease Patients with Vitamin D Insufficiency and Deficiency. Int J Mol Sci 2024; 25:12279. [PMID: 39596344 PMCID: PMC11595143 DOI: 10.3390/ijms252212279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 11/08/2024] [Accepted: 11/11/2024] [Indexed: 11/28/2024] Open
Abstract
Vitamin D insufficiency and deficiency are highly prevalent in patients with chronic kidney disease (CKD), and their pharmacokinetics are not well described. The primary study objective was to develop a population pharmacokinetic model of oral cholecalciferol (VitD3) and its three major metabolites, 25-hydroxyvitamin D3 (25D3), 1,25-dihydroxyvitamin D3 (1,25D3), and 24,25-dihydroxyvitamin D3 (24,25D3), in CKD patients with vitamin D insufficiency and deficiency. CKD subjects (n = 29) were administered one dose of oral VitD3 (5000 I.U.), and nonlinear mixed effects modeling was used to describe the pharmacokinetics of VitD3 and its metabolites. The simultaneous fit of a two-compartment model for VitD3 and a one-compartment model for each metabolite represented the observed data. A proportional error model explained the residual variability for each compound. No assessed covariate significantly affected the pharmacokinetics of VitD3 and metabolites. Visual predictive plots demonstrated the adequate fit of the pharmacokinetic data of VitD3 and metabolites. This is the first reported population pharmacokinetic modeling of VitD3 and metabolites and has the potential to inform targeted dose individualization strategies for therapy in the CKD population. Based on the simulation, doses of 600 International Unit (I.U.)/day to 1000 I.U./day for 6 months are recommended to obtain the target 25D3 concentration of between 30 and 60 ng/mL. These simulation findings could potentially contribute to the development of personalized dosage regimens for vitamin D treatment in patients with CKD.
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Affiliation(s)
- Stacey M. Tuey
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA (A.G.); (A.-A.R.); (G.R.)
| | - Avisek Ghimire
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA (A.G.); (A.-A.R.); (G.R.)
| | - Serge Guzy
- Pop—Pharm Pharmacometrics Service, Albany, CA 94706, USA;
| | - Linda Prebehalla
- Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA; (L.P.); (T.D.N.)
| | - Amandla-Atilano Roque
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA (A.G.); (A.-A.R.); (G.R.)
| | - Gavriel Roda
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA (A.G.); (A.-A.R.); (G.R.)
| | - Raymond E. West
- Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA; (L.P.); (T.D.N.)
| | - Michel B. Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO 80045, USA;
| | - Nirav Shah
- Department of Medicine Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Thomas D. Nolin
- Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA; (L.P.); (T.D.N.)
| | - Melanie S. Joy
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA (A.G.); (A.-A.R.); (G.R.)
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO 80045, USA;
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Zaimi M, Grapsa E. Current therapeutic approach of chronic kidney disease-mineral and bone disorder. Ther Apher Dial 2024; 28:671-689. [PMID: 38898685 DOI: 10.1111/1744-9987.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/14/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Chronic kidney disease (CKD) has emerged as one of the leading noncommunicable diseases affecting >10% of the population worldwide. Bone and mineral disorders are a common complication among patients with CKD resulting in a poor life quality, high fracture risk, increased morbidity and cardiovascular mortality. According to Kidney Disease: Improving Global Outcomes, renal osteodystrophy refers to changes in bone morphology found in bone biopsy, whereas CKD-mineral and bone disorder (CKD-MBD) defines a complex of disturbances including biochemical and hormonal alterations, disorders of bone and mineral metabolism and extraskeletal calcification. As a result, the management of CKD-MBD should focus on the aforementioned parameters, including the treatment of hyperphosphatemia, hypocalcemia, abnormal PTH and vitamin D levels. Regarding the bone fragility fractures, osteoporosis and renal osteodystrophy, which constitute the bone component of CKD-MBD, anti-osteoporotic agents constitute the mainstay of treatment. However, a thorough elucidation of the CKD-MBD pathogenesis is crucial for the ideal personalized treatment approach. In this paper, we review the pathology and management of CKD-MBD based on the current literature with special attention to recent advances.
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Affiliation(s)
- Maria Zaimi
- National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Eirini Grapsa
- National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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Via Reque Cortes DDP, Drueke TB, Moysés RMA. Persistent uncertainties in optimal treatment approaches of secondary hyperparathyroidism and hyperphosphatemia in patients with chronic kidney disease. Curr Osteoporos Rep 2024; 22:441-457. [PMID: 39158828 DOI: 10.1007/s11914-024-00881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE OF REVIEW This review is a critical analysis of treatment results obtained in clinical trials conducted in patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT), hyperphosphatemia, or both. RECENT FINDINGS Patients with CKD have a high mortality rate. The disorder of mineral and bone metabolism (CKD-MBD), which is commonly present in these patients, is associated with adverse outcomes, including cardiovascular events and mortality. Clinical trials aimed at improving these outcomes by modifying CKD-MBD associated factors have most often resulted in disappointing results. The complexity of CKD-MBD, where many players are closely interconnected, might explain these negative findings. We first present an historical perspective of current knowledge in the field of CKD-MBD and then examine potential flaws of past and ongoing clinical trials targeting SHPT and hyperphosphatemia respectively in patients with CKD.
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Affiliation(s)
| | - Tilman B Drueke
- Inserm Unit 1018, CESP, Hôpital Paul Brousse, Paris-Sud University (UPS) and Versailles Saint-Quentin-en-Yvelines University (Paris-Ile-de-France-Ouest University, UVSQ), Team 5, Villejuif, France
| | - Rosa Maria Affonso Moysés
- Laboratório de Fisiopatologia Renal, Faculdade de Medicina da USP, Nephrology Division, LIM 16, São Paulo, Brazil.
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Hamano T, Koiwa F, Isaka Y, Yokoyama K, Fukagawa M, Inagaki Y, Watanabe YS, Honda D, Akizawa T. Long-Term Efficacy and Safety of Upacicalcet in Japanese Hemodialysis Patients with Secondary Hyperparathyroidism: Open-Label 52-Week Study. Am J Nephrol 2024; 56:70-84. [PMID: 39299219 PMCID: PMC11812589 DOI: 10.1159/000541493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Upacicalcet is a novel injectable calcimimetic. This phase 3 multicenter open-label study aimed to assess the long-term efficacy and safety of upacicalcet in hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT). METHODS Japanese HD patients with serum intact parathyroid hormone (iPTH) levels >240 pg/mL and corrected calcium (cCa) levels ≥8.4 mg/dL were enrolled. Upacicalcet with a dose range of 25-300 µg was administered after each dialysis for 52 weeks. The main efficacy endpoint was the percentage of patients achieving the target iPTH level (60-240 pg/mL). RESULTS A total of 157 patients were enrolled, of whom 138 completed the study. Overall, 94.2% of patients achieved the target serum iPTH level at week 52. Neither symptomatic hypocalcemia nor cCa level <7.5 mg/dL occurred despite the negligible increase of concomitant vitamin D receptor activators and calcium carbonate. Upacicalcet improved the control of serum phosphate (P) and calcium levels regardless of baseline PTH levels and decreased intact fibroblast growth factor-23 levels. The largest parathyroid glands shrank, irrespective of their baseline volume or prior calcimimetic usage. Upacicalcet was well tolerated, with no adverse events requiring dose reduction. CONCLUSION This is the first study to show that a calcimimetic improves serum P and cCa control without inducing severe hypocalcemia in patients with iPTH levels ≤300 pg/mL. Upacicalcet is efficacious in HD patients with mild-to-severe SHPT, with few safety concerns. INTRODUCTION Upacicalcet is a novel injectable calcimimetic. This phase 3 multicenter open-label study aimed to assess the long-term efficacy and safety of upacicalcet in hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT). METHODS Japanese HD patients with serum intact parathyroid hormone (iPTH) levels >240 pg/mL and corrected calcium (cCa) levels ≥8.4 mg/dL were enrolled. Upacicalcet with a dose range of 25-300 µg was administered after each dialysis for 52 weeks. The main efficacy endpoint was the percentage of patients achieving the target iPTH level (60-240 pg/mL). RESULTS A total of 157 patients were enrolled, of whom 138 completed the study. Overall, 94.2% of patients achieved the target serum iPTH level at week 52. Neither symptomatic hypocalcemia nor cCa level <7.5 mg/dL occurred despite the negligible increase of concomitant vitamin D receptor activators and calcium carbonate. Upacicalcet improved the control of serum phosphate (P) and calcium levels regardless of baseline PTH levels and decreased intact fibroblast growth factor-23 levels. The largest parathyroid glands shrank, irrespective of their baseline volume or prior calcimimetic usage. Upacicalcet was well tolerated, with no adverse events requiring dose reduction. CONCLUSION This is the first study to show that a calcimimetic improves serum P and cCa control without inducing severe hypocalcemia in patients with iPTH levels ≤300 pg/mL. Upacicalcet is efficacious in HD patients with mild-to-severe SHPT, with few safety concerns.
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Affiliation(s)
- Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Fumihiko Koiwa
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, The University of Osaka Graduate School of Medicine, Suita, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Shibuya, Japan
| | - Yosuke Inagaki
- Clinical Development Department, Sanwa Kagaku Kenkyusho Co., Ltd., Nagoya, Japan
| | - Yukihisa S Watanabe
- Clinical Development Department, Sanwa Kagaku Kenkyusho Co., Ltd., Nagoya, Japan
| | - Daisuke Honda
- Project Management Department, Sanwa Kagaku Kenkyusho Co., Ltd., Nagoya, Japan,
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Fisler G, Murphy K, Mastroianni F, Schneider JB, Deutschman CS, Leisman DE, Taylor MD. Kidney Blood Flow and Renin-Angiotensin-Aldosterone System Measurements Associated With Kidney and Cardiovascular Dysfunction in Pediatric Shock. Crit Care Explor 2024; 6:e1134. [PMID: 39110074 PMCID: PMC11309640 DOI: 10.1097/cce.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
IMPORTANCE Pediatric acute kidney injury (AKI) is a prevalent and morbid complication of shock. Its pathogenesis and early identification remain elusive. OBJECTIVES We aim to determine whether renal blood flow (RBF) measurements by point-of-care ultrasound (POCUS) and renin-angiotensin-aldosterone system (RAAS) hormones in pediatric shock associate with vasoactive requirements and AKI. DESIGN, SETTING, AND PARTICIPANTS This is a single-center prospective, noninterventional observational cohort study in one tertiary PICU in North American from 2020 to 2022 that enrolled children younger than 18 years with shock without preexisting end-stage renal disease. MAIN OUTCOMES AND MEASURES RBF was measured by POCUS on hospital days 1 and 3 and plasma RAAS hormone levels were measured on day 1. The primary outcome was the presence of AKI by Kidney Disease Improving Global Outcomes criteria at first ultrasound with key secondary outcomes of creatinine, blood urea nitrogen (BUN), Vasoactive-Inotrope Score (VIS), and norepinephrine equivalent dosing (NED) 48 hours after first ultrasound. RESULTS Fifty patients were recruited (20 with AKI, mean age 10.5 yr, 48% female). POCUS RBF showed lower qualitative blood flow (power Doppler ultrasound [PDU] score) and higher regional vascular resistance (renal resistive index [RRI]) in children with AKI (p = 0.017 and p = 0.0007). Renin and aldosterone levels were higher in the AKI cohort (p = 0.003 and p = 0.007). Admission RRI and PDU associated with higher day 3 VIS and NED after adjusting for age, day 1 VIS, and RAAS hormones. Admission renin associated with higher day 3 creatinine and BUN after adjusting for age, day 1 VIS, and the ultrasound parameters. CONCLUSIONS AND RELEVANCE In pediatric shock, kidney blood flow was abnormal and renin and aldosterone were elevated in those with AKI. Kidney blood flow abnormalities are independently associated with future cardiovascular dysfunction; renin elevations are independently associated with future kidney dysfunction. Kidney blood flow by POCUS may identify children who will have persistent as opposed to resolving AKI. RAAS perturbations may drive AKI in pediatric shock.
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Affiliation(s)
- Grace Fisler
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwell, New Hyde Park, NY
- Feinstein Institutes for Medical Research, Northwell, New Hyde Park, NY
| | - Kristina Murphy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwell, New Hyde Park, NY
| | - Fiore Mastroianni
- Division of Pulmonary and Critical Care Medicine, New York University Grossman Long Island School of Medicine, Mineola, NY
| | - James B. Schneider
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwell, New Hyde Park, NY
| | - Clifford S. Deutschman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwell, New Hyde Park, NY
- Feinstein Institutes for Medical Research, Northwell, New Hyde Park, NY
| | - Daniel E. Leisman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Matthew D. Taylor
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwell, New Hyde Park, NY
- Feinstein Institutes for Medical Research, Northwell, New Hyde Park, NY
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Benli S, Yesil E, Tazeoglu D, Ozcan C, Ozcan IT, Dag A. Changes in cardiac functions in patients treated with parathyroidectomy for secondary hyperparathyroidism. Updates Surg 2024; 76:1443-1452. [PMID: 38530609 PMCID: PMC11341577 DOI: 10.1007/s13304-024-01812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024]
Abstract
Our study aims to investigate the changes in cardiac functions, especially myocardial performance index (MPI), in patients who underwent parathyroidectomy for secondary hyperparathyroidism. Patients who underwent parathyroidectomy for secondary hyperparathyroidism between June 2010 and September 2021 were analyzed retrospectively. The patients were divided into two groups: those who underwent total parathyroidectomy (group 1) and those who underwent subtotal parathyroidectomy (group 2). The groups were compared according to the echocardiogram findings performed in the preoperative period and the postoperative sixth month. In addition, cardiac structure, and systolic and diastolic functions, especially myocardial performance index, were evaluated by echocardiography and Doppler imaging. Thirty-seven patients were examined; 16 (43.2%) underwent total parathyroidectomy, and 21 (56.8%) had subtotal parathyroidectomy performed. Group 1's mean left ventricular end-systolic diameter (LVES) decreased from 2.53 ± 0.57 to 2.35 ± 0.37 cm after parathyroidectomy. In Group 1, the postoperative value of LVES and end-systolic volume decreased significantly compared to the preoperative period (p = 0.042, p = 0.008, respectively). EF increased from 59.25 ± 0.05 to 67.81 ± 4.04. In Group 1, EF and EV postoperatively increased significantly compared to the preoperative period (p = 0.023, p = 0.021, respectively). The mean MPI decreased from 0.45 ± 0.07 to 0.39 ± 0.04 after parathyroidectomy in group 1. In group 2, it decreased from 0.46 ± 0.06 to 0.40 ± 0.04 (p < 0.001). The present study provides an improvement in myocardial functions after parathyroidectomy. While LVES, EF, ejection volume, end-systolic volume, and MPI improved in both groups, the MPI improvement was more evident in the total parathyroidectomy group.
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Affiliation(s)
- Sami Benli
- Department of General Surgery, Division of Surgical Oncology, Mersin University Medical Faculty, Mersin, Turkey.
| | - Emrah Yesil
- Department of Cardiology, Mersin University Medical Faculty, Mersin, Turkey
| | - Deniz Tazeoglu
- Department of General Surgery, Division of Surgical Oncology, Mersin University Medical Faculty, Mersin, Turkey
| | - Cumhur Ozcan
- Department of General Surgery, Division of Endocrine Surgery, Mersin University Medical Faculty, Mersin, Turkey
| | | | - Ahmet Dag
- Department of General Surgery, Division of Endocrine Surgery, Mersin University Medical Faculty, Mersin, Turkey
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24
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Siddiqui IA, Masood A, Chandagiri S, Kumar RV, Mir AA. Beyond Numbers: How Biochemical Parameters Can Predict Outcomes in Chronic Kidney Disease Patients on Maintenance Hemodialysis. Cureus 2024; 16:e67349. [PMID: 39310569 PMCID: PMC11413472 DOI: 10.7759/cureus.67349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction The treatment and management of patients undergoing maintenance hemodialysis (MHD) requires constant evaluation through the assessment of biochemical markers. This is necessary for treatment, to prevent progression to complications such as mineral bone disease, and to improve quality of life. We aimed to study the biochemical profile of patients with chronic kidney disease (CKD) grades 4 and 5 on MHD, identify markers altered due to different etiologies, duration of illness, and duration of hemodialysis, and create a panel of markers that can be useful in planning better management. Methods All consecutive patients attending the dialysis unit of ESIC Super Speciality Hospital with CKD grade 4 or grade 5 on MHD between 2019 and 2020 were recruited. A detailed clinical history and demographic profile were taken, and blood samples were collected from the patients during follow-up visits in plain and EDTA (ethylenediamine tetraacetic acid) tubes for analysis. Results A total of 312 patients (22.1% females and 77.9% males.) with a mean age of 49.74 ± 11.49 years were recruited. In the study population, diabetic nephropathy (DN) (17%) and hypertensive nephropathy (48.7%) were the two most prevalent causes of CKD. The majority (64%) of the patients were on MHD three times a week. The range of estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2) at the time of initiation of MHD was 2.9-26.8 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. The mean duration of MHD was 51.58 months, with a mortality rate of 5.9% during the follow-up period (3-108 months). Conclusion Optimal selection and combination of biochemical tests will help in ascertaining the adequacy of management, progress of disease, or complications in MHD patients. This in turn will help guide the clinicians in effectively using these markers in their day-to-day practice.
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Affiliation(s)
- Imran A Siddiqui
- Biochemistry, ESIC Medical College and Superspeciality Hospital, Sanathnagar, Hyderabad, IND
| | - Afshan Masood
- Biochemistry, Obesity Research Centre, College of Medicine, King Saud University, Riyadh, SAU
| | - Sushmita Chandagiri
- Nephrology, ESIC Medical College and Superspeciality Hospital, Sanathnagar, Hyderabad, IND
| | - Raichur V Kumar
- Nephrology, ESIC Medical College and Superspeciality Hospital, Sanathnagar, Hyderabad, IND
| | - Altaf A Mir
- Biochemistry, All India Institute of Medical Sciences, Raebareli, IND
- Biochemistry, ESIC Medical College and Superspeciality Hospital, Sanathnagar, Hyderabad, IND
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25
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Petrakis I, Bacharaki D, Kyriazis P, Balafa O, Dounousi E, Tsirpanlis G, Theodoridis M, Tsotsorou O, Markaki A, Georgoulidou A, Triantafyllis G, Giannikouris I, Kokkalis A, Stavroulopoulos A, Stylianou K. Cardiovascular and All-Cause Mortality Is Affected by Serum Magnesium and Diet Pattern in a Cohort of Dialysis Patients. J Clin Med 2024; 13:4024. [PMID: 39064068 PMCID: PMC11277800 DOI: 10.3390/jcm13144024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Hypomagnesaemia is associated with an increased overall mortality in patients with chronic kidney disease on dialysis (CKD-5D). Mediterranean-style diet (MD), having a high magnesium content, can serve as a form of dietary magnesium supplementation. We examined whether there is a potential link between increased Mediterranean Diet score (MDS) and elevated serum magnesium (sMg) to assess its impact on reducing mortality risk in CKD-5D patients. Methods: In this multi-center prospective observational study, 117 CKD-5D patients (66 on hemodialysis and 51 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied for a median follow-up period of 68 months. After baseline assessment, including measurement of sMg and MDS, all patients were followed up for cardiovascular (CV) and all-cause mortality. Results: Forty deaths occurred, 58% of which were cardiovascular. Patients who were above the median value of sMg (2.2 mg/dL) had a 66% reduction in CV (crude HR, 0.34; 95% CI, 0.11-0.70), and 49% reduction in all-cause (crude HR, 0.51; 95% CI, 0.27-0.96) mortality, even after adjustment for age, malnutrition inflammation score, left ventricular mass index, peripheral vascular disease and diabetes. Similar results were obtained when sMg was analyzed as a continuous variable. sMg was associated directly with MDS (r = 0.230; p = 0.012). Conclusions: Higher sMg levels are strongly and independently associated with reduced CV and all-cause mortality in CKD-5D patients. A strong correlation exists between MDS and sMg. Elevated sMg levels, achieved through MD adherence, can significantly reduce CV mortality, implicating MD as a mediator of the association between sMg and CV mortality.
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Affiliation(s)
- Ioannis Petrakis
- Nephrology Department, University General Hospital of Heraklion, 71500 Heraklion, Greece;
| | - Dimitra Bacharaki
- Nephrology Department, Attikon University Hospital, 12462 Athens, Greece; (D.B.); (O.T.)
| | - Periklis Kyriazis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Olga Balafa
- Nephrology Department, University Hospital of Ioannina, 45500 Ioannina, Greece; (O.B.); (E.D.)
| | - Evangelia Dounousi
- Nephrology Department, University Hospital of Ioannina, 45500 Ioannina, Greece; (O.B.); (E.D.)
| | - George Tsirpanlis
- Nephrology Department, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece;
| | - Marios Theodoridis
- Department of Nephrology, Democritus University of Thrace, 68150 Alexandroupolis, Greece;
| | - Ourania Tsotsorou
- Nephrology Department, Attikon University Hospital, 12462 Athens, Greece; (D.B.); (O.T.)
| | - Anastasia Markaki
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 71410 Heraklion, Greece;
| | | | - George Triantafyllis
- Department of Nephrology, Hemodialysis Unit, Mediterraneo Hospital, 16675 Glyfada, Greece; (G.T.); (I.G.)
| | - Ioannis Giannikouris
- Department of Nephrology, Hemodialysis Unit, Mediterraneo Hospital, 16675 Glyfada, Greece; (G.T.); (I.G.)
| | | | - Aristeides Stavroulopoulos
- Nephrology Department, General Clinic of Kalithea, IASIO Hospital, 17675 Athens, Greece;
- NEPHROEXPERT—Athens Kidney Institute, 17675 Athens, Greece
| | - Kostas Stylianou
- Nephrology Department, University General Hospital of Heraklion, 71500 Heraklion, Greece;
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26
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Staibano P, McKechnie T, Thabane A, Xie M, Zhang H, Gupta MK, Au M, Pasternak JD, Parpia S, Young JEM, Bhandari M. Trends in using intraoperative parathyroid hormone monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons. PLoS One 2024; 19:e0301153. [PMID: 38980868 PMCID: PMC11233005 DOI: 10.1371/journal.pone.0301153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024] Open
Abstract
Hyperparathyroidism is a common endocrine disorder that occurs secondary to abnormal parathyroid gland functioning. Depending on the type of hyperparathyroidism, surgical extirpation of hyperfunctioning parathyroid glands can be considered for disease cure. Intraoperative parathyroid hormone (IOPTH) monitoring improves outcomes in patients undergoing surgery for primary hyperparathyroidism, but studies are needed to characterize its institutional adoption and its role in surgery for secondary and tertiary hyperparathyroidism, as these entities can be difficult to cure. Hence, we will perform a cross-sectional survey study of surgeon rationale, operational details, and barriers associated with IOPTH monitoring adoption across North America. We will utilize a convenience sampling technique to distribute an online survey to head and neck surgeons and endocrine surgeons across North America. This survey will be distributed via email to three North American professional societies (i.e., Canadian Society for Otolaryngologists-Head and Neck Surgeons, American Head and Neck Society, and American Association of Endocrine Surgeons). The survey will consist of 30 multiple choice questions that are divided into three concepts: (1) participant demographics and training details, (2) details of surgical adjuncts during parathyroidectomy, and (3) barriers to adoption of IOPTH. Descriptive analyses and multiple logistic regression will be used to evaluate the impact of demographic, institutional, and training variables on the use of IOPTH monitoring in surgery for all types of hyperparathyroidism and barriers to IOPTH monitoring adoption. Ethics approval was obtained by the Hamilton Integrated Research Ethics Board (2024-17173-GRA). These findings will characterize surgeon and institutional practices with regards to IOPTH monitoring during parathyroid surgery and will inform future trials aimed to optimize the use of IOPTH monitoring in secondary and tertiary hyperparathyroidism.
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Affiliation(s)
- Phillip Staibano
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Xie
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Han Zhang
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael K. Gupta
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Au
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jesse D. Pasternak
- Endocrine Surgery Section Head, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - James Edward Massey Young
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Dabravolskaite V, Makaloski V, Hakovirta H, Kotelis D, Schoenhoff FS, Lescan M. Evaluation of custom-made Relay® stent-grafts for aortic arch landing zones 0 and I: experience from two high-volume aortic centres. Eur J Cardiothorac Surg 2024; 66:ezae241. [PMID: 38991832 DOI: 10.1093/ejcts/ezae241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/28/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES To report experience with a Relay® stent-graft custom-made platform in treating different aortic arch pathology in 2 high-volume aortic centres. METHODS A retrospective analysis of all patients treated between July 2016 and July 2023 with custom-made Relay® stent-graft (custom-made device). Underlying aortic arch pathology was an aneurysm, penetrating aortic ulcer, and dissection. Three custom-made device designs were used: proximal scallop, fenestrations, and inner branches. The endpoints were technical success, perioperative stroke, death, and reintervention rate. RESULTS Thirty-five patients (89% males) with a mean age of 70 ± 11 years were treated.Indication for treatment was penetrating aortic ulcer in 14 patients (40%), aneurysm in 11 patients (31%) and aortic dissection in 10 patients (29%). The technical success rate was 100%. Twenty-eight patients (80%) had proximal sealing in zone 0, and 7 (20%) had proximal sealing in zone 1. Nine patients (25.6%) had proximal scallops, 9 (25.6%) had 1 big fenestration and 17 (48.8%) had a branched device; 1 with single branch, 15 with double branches and 1 with triple branches. Thirty patients (86%) had previous or simultaneous left subclavian artery revascularization. No patient died during 30 days. Two patients (5.7%) had stroke postoperatively; both recovered without disabling deficits. The mean follow-up was 35 ± 26 months. Six patients (17.1%) died during follow-up. One patient required reinforcement of the bridging stent in the left common carotid artery and one additional vascular plugging of the left subclavian artery. Three patients received distal extension. CONCLUSIONS The Relay® stent-graft custom-made platform showed a good performance in our study with a high technical success rate, low perioperative stroke and mortality, and low reintervention rates during the follow-up.
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Affiliation(s)
- Vaiva Dabravolskaite
- Department of Vascular Surgery, University Hospital of Bern, Bern, Switzerland
- Department of Vascular Surgery, University Hospital of Turku, Turku, Finland
- Department of Vascular Surgery, Satakunnan keskussairaala, Pori, Finland
| | - Vladimir Makaloski
- Department of Vascular Surgery, University Hospital of Bern, Bern, Switzerland
| | - Harri Hakovirta
- Department of Vascular Surgery, University Hospital of Turku, Turku, Finland
- Department of Vascular Surgery, Satakunnan keskussairaala, Pori, Finland
| | - Drosos Kotelis
- Department of Vascular Surgery, University Hospital of Bern, Bern, Switzerland
| | | | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Tübingen, Germany
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Wang M, Xiao J, Du Q, Zhang W, Zhang J, Yan Z, Luo J, Yu C, Ye Z, Chen J. Phosphorus balance calculator: an individualized tool for treatment of hyperphosphatemia in hemodialysis patients. Nephrol Dial Transplant 2024; 39:1159-1170. [PMID: 38037501 DOI: 10.1093/ndt/gfad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Lack of evaluations of the dietary phosphorus and dialysis phosphorus removal in daily clinical practice are common obstacles to assessing phosphorus balance and controlling phosphorus in hemodialysis patients. We aimed to investigate whether individualized therapy using a phosphorus balance calculator improves phosphorus control. METHODS A randomized, open-label, multicenter, 4-week clinical trial was conducted. A total of 119 maintenance hemodialysis patients aged 18-85 years old and with serum phosphorus level >1.45 mmol/L from three university teaching hospitals in Shanghai were enrolled. Patients were randomized in a 1:1 ratio to individualized therapy (n = 60) or conventional therapy (n = 59). The primary outcome was the serum phosphorus concentration after 4-week treatment. Secondary outcomes included the serum calcium and parathyroid hormone (PTH) concentrations, changes in serum phosphorus, calcium and PTH concentrations, and the proportion of patients achieving target ranges of serum phosphorus, calcium and PTH after 4-week treatment. RESULTS Among 119 randomized participants [mean age 62 years; 68 male (57%)], 116 completed the trial. Using the phosphorus balance calculator, the individualized group achieved a better phosphorus balance state and significantly reduced serum phosphorus (1.62 ± 0.45 mmol/L versus 1.85 ± 0.45 mmol/L, P = .006), increased the proportions of patients achieving target serum phosphorus range (41% versus 18%, P = .006) and had greater adjusted mean difference in change in serum phosphorus over the 4 weeks (-0.47 versus -0.23 mmol/L, P = .010) when compared with conventional therapy. No significant changes were observed in serum calcium and PTH levels, the proportion of patients achieving target serum calcium or PTH levels, or the adjusted mean difference of serum calcium and PTH levels over the treatment period. CONCLUSION Phosphorus balance calculator was proved to improve serum phosphorus control in patients undergoing maintenance hemodialysis, offering a new tool for managing hyperphosphatemia.
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Affiliation(s)
- Mengjing Wang
- Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Xiao
- Nephrology, Huadong Hospital, Fudan University, Shanghai, China
| | - Qiuna Du
- Nephrology, Tongji Hospital, Tongji University, Shanghai, China
| | - Weichen Zhang
- Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaying Zhang
- Division of Nutrition, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenwen Yan
- Nephrology, Huadong Hospital, Fudan University, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Chen Yu
- Nephrology, Tongji Hospital, Tongji University, Shanghai, China
| | - Zhibin Ye
- Nephrology, Huadong Hospital, Fudan University, Shanghai, China
| | - Jing Chen
- Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Pethő ÁG, Tapolyai M, Csongrádi É, Orosz P. Management of chronic kidney disease: The current novel and forgotten therapies. J Clin Transl Endocrinol 2024; 36:100354. [PMID: 38828402 PMCID: PMC11143912 DOI: 10.1016/j.jcte.2024.100354] [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: 04/18/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive and incurable condition that imposes a significant burden on an aging society. Although the exact prevalence of this disease is unknown, it is estimated to affect at least 800 million people worldwide. Patients with diabetes or hypertension are at a higher risk of developing chronic kidney damage. As the kidneys play a crucial role in vital physiological processes, damage to these organs can disrupt the balance of water and electrolytes, regulation of blood pressure, elimination of toxins, and metabolism of vitamin D. Early diagnosis is paramount to prevent potential complications. Treatment options such as dietary modifications and medications can help slow disease progression. In our narrative review, we have summarized the available therapeutic options to slow the progression of chronic kidney disease. Many new drug treatments have recently become available, offering a beacon of hope and optimism in CKD management. Nonetheless, disease prevention remains the most critical step in disease management. Given the significant impact of CKD on public health, there is a pressing need for further research. With the development of new technologies and advancements in medical knowledge, we hope to find more effective diagnostic tools and treatments for CKD patients.
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Affiliation(s)
- Ákos Géza Pethő
- Faculty of Medicine, Semmelweis University, Department of Internal
Medicine and Oncology, Budapest, Hungary
| | - Mihály Tapolyai
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC,
USA
- Department of Nephrology, Szent Margit Kórhaz, Budapest,
Hungary
| | - Éva Csongrádi
- Faculty of Medicine, University of Debrecen, Debrecen,
Hungary
| | - Petronella Orosz
- Bethesda Children’s Hospital, 1146 Budapest, Hungary
- Department of Pediatrics, Faculty of Medicine, University of Debrecen,
4032 Debrecen, Hungary
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Dabravolskaite V, Meuli L, Yazar O, Bouwmann L, Mufty H, Maleux G, Aho P, Hakovirta H, Venermo M, Makaloski V. Antithrombotic Therapy and Freedom From Bridging Stent Occlusion After Elective Branched Endovascular Repair: A Multicenter International Cohort Study. J Endovasc Ther 2024:15266028241253133. [PMID: 38798060 DOI: 10.1177/15266028241253133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
CLINICAL IMPACT Based on our study, no antithrombotic therapy is significantly associated with bridging stent occlusion, and no evidence of the superiority of other antithrombotic therapy exists. Nevertehless, due to the low number of bridging stent occlusions, this study can neither support nor reject the PRINCE2SS recommendations. Further studies with larger cohorts are needed to determine clear guideliness of the best antithrombotic treatment regimen after complex enfovascular aortic repair.
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Affiliation(s)
- Vaiva Dabravolskaite
- Department of Vascular Surgery, Inselspital, University of Bern, Bern, Switzerland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
- Satasairaala Hospital, Pori, Finland
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Ozan Yazar
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Lee Bouwmann
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Hozan Mufty
- Department of Vascular Surgery, Leuven University Hospital, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, Leuven University Hospital, Leuven, Belgium
| | - Pekka Aho
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Harri Hakovirta
- Department of Vascular Surgery, Inselspital, University of Bern, Bern, Switzerland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Vladimir Makaloski
- Department of Vascular Surgery, Inselspital, University of Bern, Bern, Switzerland
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Sevva C, Divanis D, Tsinari A, Grammenos P, Laskou S, Mantalobas S, Paschou E, Magra V, Kopsidas P, Kesisoglou I, Liakopoulos V, Sapalidis K. Pharmaceutical Management of Secondary Hyperparathyroidism and the Role of Surgery: A 5-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:812. [PMID: 38792994 PMCID: PMC11123390 DOI: 10.3390/medicina60050812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Secondary hyperparathyroidism (SHPT) poses a common condition among patients with chronic kidney disease (CKD) due to the chronic stimulation of the parathyroid glands as a result of persistently low calcium levels. As a first option for medical treatment, vitamin D receptor analogs (VDRAs) and calcimimetic agents are generally used. Apart from cinacalcet, which is orally taken, in recent years, another calcimimetic agent, etelcalcetide, is being administered intravenously during dialysis. Materials and Methods: In a 5-year retrospective study between 2018 and 2023, 52 patients undergoing dialysis were studied. The aim of this study is to highlight the possible effects and/or benefits that intravenously administered calcimimetic agents have on CKD patients. A total of 34 patients (65.4%) received cinacalcet and etelcalcetide while parathormone (PTH) and calcium serum levels were monitored on a monthly basis. Results: A total of 29 out of 33 patients (87.9%) that received treatment with etelcalcetide showed a significant decrease in PTH levels, which rose up to 57% compared to the initial values. None of the included patients needed to undergo parathyroidectomy (PTx) due to either extremely high and persistent PTH levels or severe side effects of the medications. It is generally strongly advised that parathyroidectomies should be performed by an expert surgical team. In recent years, a significant decrease in parathyroidectomies has been recorded globally, a fact that is mainly linked to the constantly wider use of new calcimimetic agents. This decrease in parathyroidectomies has resulted in an important decrease in complications occurring in cervical surgeries (e.g., perioperative hemorrhage and nerve damage). Conslusions: Despite the fact that these surgical complications cannot be easily compared to the pharmaceutical side effects, the recorded decrease in parathyroidectomies is considered to be notable, especially in cases of relapse where a difficult reoperation would be considered based on previously published guidelines.
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Affiliation(s)
- Christina Sevva
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
| | - Dimitrios Divanis
- 2nd Department of Nephrology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (D.D.); (A.T.); (V.L.)
| | - Ariti Tsinari
- 2nd Department of Nephrology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (D.D.); (A.T.); (V.L.)
| | - Petros Grammenos
- Department of Anesthesiology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece;
| | - Styliani Laskou
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
| | - Stylianos Mantalobas
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
| | - Eleni Paschou
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
| | - Vasiliki Magra
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
| | - Periklis Kopsidas
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (D.D.); (A.T.); (V.L.)
| | - Konstantinos Sapalidis
- 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (S.L.); (S.M.); (V.M.); (I.K.); (K.S.)
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Fisher A, Wang JWD, Smith PN. Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes. Int J Clin Pract 2024; 2024:1-26. [DOI: 10.1155/2024/4456803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2025] Open
Abstract
Objective. Although the association between chronic kidney disease (CKD) and osteoporotic fractures is well established, data on CKD combined with hip fracture (HF) are scarce and controversial. We aimed to assess in patients with HF the prevalence of CKD, its impact on hospital mortality and length of stay (LOS) and to determine the prognostic value of CKD to predict hospital outcomes. Methods. Prospectively collected clinical data were analysed in 3623 consecutive HF patients aged ≥65 years (mean age 83.4 ± 7.50 [standard deviation] years; 74.4% females). Results. CKD among older patients with HF is highly prevalent (39.9%), has different clinical characteristics, a 2.5-fold higher mortality rate, and 40% greater risk of prolonged LOS. The strongest risk for a poor outcome was advanced age (>80 years). The risk of death substantially increases in combination with chronic disorders, especially coronary artery disease, anaemia, hyperparathyroidism, and atrial fibrillation; models based only on three variables—CKD stage, age >80, and presence of a specific chronic condition—predicted in-hospital death with good discrimination capability (AUC ≥ 0.700) and reasonable accuracy, the number needed to predict ranged between 5.7 and 14.5. Only 12% of HF patients received osteoporotic drugs prefracture. Conclusion. In HF patients with CKD, the risk of adverse outcomes largely increases in parallel with worsening kidney function and, especially, in combination with comorbidities; models based on three admission variables predict a fatal outcome. Assessment of renal function is essential to preventing osteoporotic fractures.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra 2614, Australia
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra 2614, Australia
- Australian National University Medical School, Canberra 2614, Australia
| | - Jo-Wai Douglas Wang
- Department of Geriatric Medicine, The Canberra Hospital, Canberra 2614, Australia
- Australian National University Medical School, Canberra 2614, Australia
| | - Paul N. Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra 2614, Australia
- Australian National University Medical School, Canberra 2614, Australia
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Sprague SM, Weiner DE, Tietjen DP, Pergola PE, Fishbane S, Block GA, Silva AL, Fadem SZ, Lynn RI, Fadda G, Pagliaro L, Zhao S, Edelstein S, Spiegel DM, Rosenbaum DP. Tenapanor as Therapy for Hyperphosphatemia in Maintenance Dialysis Patients: Results from the OPTIMIZE Study. KIDNEY360 2024; 5:732-742. [PMID: 38323855 PMCID: PMC11146652 DOI: 10.34067/kid.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/01/2024] [Indexed: 02/08/2024]
Abstract
Key Points Tenapanor, a first-in-class local inhibitor of sodium/hydrogen exchanger isoform 3, acts as a phosphate absorption inhibitor by decreasing paracellular phosphate absorption. Tenapanor alone or with phosphate binders achieved P ≤ 5.5 mg/dl over 10 weeks in 34%–38% of patients taking phosphate binders at baseline. Tenapanor can help adults with CKD on maintenance dialysis achieve normal serum phosphate concentrations. Background OPTIMIZE was a randomized, open-label study evaluating different tenapanor initiation methods. OPTIMIZE evaluated tenapanor alone and in combination with phosphate binders (PBs) to achieve target serum phosphate (P) ≤5.5 mg/dl. Methods Patients with inadequately controlled P receiving maintenance dialysis from 42 US locations who were taking PBs with baseline P > 5.5 mg/dl and ≤ 10.0 mg/dl, or were PB-naive with baseline P > 4.5 mg/dl and ≤ 10.0 mg/dl, were included in OPTIMIZE. Participants taking PBs at baseline were randomized to switch from PBs to tenapanor (Straight Switch ; n =151) or reduce PB dosage by ≥50% and add tenapanor (Binder Reduction ; n =152); PB-naive patients started tenapanor alone (Binder-Naive ; n =30). Participants received tenapanor 30 mg twice a day for 10 weeks (part A), followed by an elective, 16-week open-label extension (part B). Outcomes included changes from baseline in P, intact fibroblast growth factor 23, parathyroid hormone, serum calcium, and medication burden; patient-reported outcomes; and safety. Results By part A end point, 34.4% (Straight Switch ), 38.2% (Binder Reduction ), and 63.3% (Binder-Naive ) of patients achieved P ≤ 5.5 mg/dl. Mean P reduction and median pill burden reduction from baseline to part A end point were 0.91±1.7 mg/dl and 4 pills/d for the Straight Switch and 0.99±1.8 mg/dl and 1 pill/d for the Binder Reduction group. The mean P reduction for Binder-Naive patients was 0.87±1.5 mg/dl. Among Straight Switch and Binder Reduction patients who completed patient experience questionnaires, 205 of 243 (84.4%) reported an improved phosphate management routine. Diarrhea was the most common adverse event (133 of 333 [39.9%]). Conclusions Tenapanor as monotherapy or in combination with PBs effectively lowered P toward the target range in patients who were PB-naive or who were not at goal despite PB use. Clinical Trial registration number NCT04549597 .
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Affiliation(s)
- Stuart M. Sprague
- NorthShore University Health System, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | | | | | | | - Steven Fishbane
- Zucker School of Medicine at Hofstra & Northwell Health, Great Neck, New York
| | | | | | - Stephen Z. Fadem
- Kidney Associates, PLLC and Baylor College of Medicine, Houston, Texas
| | | | - George Fadda
- Balboa Nephrology Medical Group, La Mesa, California
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Vergili JM, Proaño GV, Jimenez EY, Moloney L, Papoutsakis C, Steiber A. Academy of Nutrition and Dietetics Commentary on the Phosphorus Recommendation in the KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 Update. J Ren Nutr 2024; 34:192-199. [PMID: 38007185 DOI: 10.1053/j.jrn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023] Open
Abstract
The Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease: 2020 Update recommends adjusting dietary phosphorus to maintain a serum phosphate goal for hemodialysis patients in the normal range (0.81 to 1.45 mmol/L [2.5 to 4.5 mg/dL]). This is lower than the serum phosphate goal used by many dialysis centers (0.97 to 1.78 mmol/L [3.0 and 5.5 mg/dL]). Although context and clinical judgment must always be considered when providing individualized care to patients, a guideline implementation study conducted from December 2020 to December 2022 found that, based on their documentation, registered dietitian nutritionists from two national dialysis chains are almost universally using dialysis center goals instead of the lower phosphate goal recommended by the guideline. This commentary discusses the possible barriers to implementing the Kidney Disease Outcomes Quality Initiative 2020 nutrition guideline's phosphorus recommendation and proposes a systems level approach to promote and support adoption of the recommendation. Calls to action for potential changes in clinician practices, organizational/institutional culture, and government regulations are put forth.
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Affiliation(s)
- Joyce Marcley Vergili
- Registered Dietitian, Board Certified Specialist in Renal Nutrition, Research Consultant, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Gabriela V Proaño
- Senior Research Project Manager, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | - Elizabeth Yakes Jimenez
- Professor and Assistant Dean for Research, College of Population Health and Departments of Pediatrics and Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Lisa Moloney
- Nutrition Researcher, Level 2, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Constantina Papoutsakis
- Senior Director, Data Science Center, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison Steiber
- Chief Science Officer, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
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Jiang Y, Bao X. Systemic immune-inflammatory indicators and bone mineral density in chronic kidney disease patients: A cross-sectional research from NHANES 2011 to 2018. PLoS One 2024; 19:e0302073. [PMID: 38662733 PMCID: PMC11045113 DOI: 10.1371/journal.pone.0302073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The purpose of this study was to look at the relationship between the Systemic Immune Inflammatory Index (SII) and bone mineral density (BMD) in the pelvis, left upper and lower limbs, lumbar spine, thoracic spine, and trunk in a chronic kidney disease (CKD) population in the United States. METHODS The National Health and Nutrition Examination Survey (2011-2016) yielded 2302 people with CKD aged >18 years. CKD was defined as eGFR less than 90 ml/min/1.73 m2 or eGFR greater than 90 ml/min/1.73 m2 with urine ACR greater than 30 mg/L.SII was calculated as PC * (NC / LC) from platelet count (PC), neutrophil count (NC), and lymphocyte count (LC). Multiple logistic regression was used to examine the relationship between BMD and SII at different sites in CKD patients, smoothed curve-fitting and generalized weighting models were used to investigate non-linear relationships, and a two-tailed linear regression model was used to find potential inflection points in the model. RESULTS We discovered a negative correlation between SII and pelvic BMD among 2302 participants after controlling for gender, age, and race [β = -0.008; 95% confidence value -0.008; 95% confidence interval (CI) -0.014, -0.002]. Lower PEBMD was related to increasing SII (trend p = 0.01125). After additional correction, only pelvic BMD remained adversely linked with SII [value -0.006; 95% CI -0.012, -0.000, p = 0.03368]. Smoothed curve fitting revealed a consistent inverse relationship between SII and pelvic BMD. Further stratified analyses revealed a substantial positive negative connection between SII and pelvic BMD in individuals who did not have hypertension, diabetes, a BMI of more than 30 kg/m2, or stage 2 CKD. The connection between SII and PEBMD in people without diabetes revealed a strong inverted U-shaped curve. CONCLUSION In individuals with CKD in the United States, there was a negative connection between the systemic immunoinflammatory index (SII) and pelvic BMD. The SII might be a low-cost and simple test for CKD-related BMD loss.
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Affiliation(s)
- Yuying Jiang
- Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiaorong Bao
- Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, China
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Wang X, Rao J, Chen X, Wang Z, Zhang Y. Identification of Shared Signature Genes and Immune Microenvironment Subtypes for Heart Failure and Chronic Kidney Disease Based on Machine Learning. J Inflamm Res 2024; 17:1873-1895. [PMID: 38533476 PMCID: PMC10964169 DOI: 10.2147/jir.s450736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
Background A complex interrelationship exists between Heart Failure (HF) and chronic kidney disease (CKD). This study aims to clarify the molecular mechanisms of the organ-to-organ interplay between heart failure and CKD, as well as to identify extremely sensitive and specific biomarkers. Methods Differentially expressed tandem genes were identified from HF and CKD microarray datasets and enrichment analyses of tandem perturbation genes were performed to determine their biological functions. Machine learning algorithms are utilized to identify diagnostic biomarkers and evaluate the model by ROC curves. RT-PCR was employed to validate the accuracy of diagnostic biomarkers. Molecular subtypes were identified based on tandem gene expression profiling, and immune cell infiltration of different subtypes was examined. Finally, the ssGSEA score was used to build the ImmuneScore model and to assess the differentiation between subtypes using ROC curves. Results Thirty-three crosstalk genes were associated with inflammatory, immune and metabolism-related signaling pathways. The machine-learning algorithm identified 5 hub genes (PHLDA1, ATP1A1, IFIT2, HLTF, and MPP3) as the optimal shared diagnostic biomarkers. The expression levels of tandem genes were negatively correlated with left ventricular ejection fraction and glomerular filtration rate. The CIBERSORT results indicated the presence of severe immune dysregulation in patients with HF and CKD, which was further validated at the single-cell level. Consensus clustering classified HF and CKD patients into immune and metabolic subtypes. Twelve immune genes associated with immune subtypes were screened based on WGCNA analysis, and an ImmuneScore model was constructed for high and low risk. The model accurately predicted different molecular subtypes of HF or CKD. Conclusion Five crosstalk genes may serve as potential biomarkers for diagnosing HF and CKD and are involved in disease progression. Metabolite disorders causing activation of a large number of immune cells explain the common pathogenesis of HF and CKD.
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Affiliation(s)
- Xuefu Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China
| | - Jin Rao
- Department of Cardiothoracic Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xiangyu Chen
- Department of Cardiothoracic Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yufeng Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China
- Department of Cardiothoracic Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
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Fan Z, Li R, Pan M, Jiang Y, Li Y, Liu L, Li Y. Relationship between serum phosphorus and mortality in non-dialysis chronic kidney disease patients: evidence from NHANES 2001-2018. BMC Nephrol 2024; 25:89. [PMID: 38448815 PMCID: PMC10918918 DOI: 10.1186/s12882-024-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Hyperphosphatemia is common in chronic kidney disease (CKD), associated with higher mortality in dialysis patients. Its impact in non-dialysis patients, especially those with preserved kidney function, remains uncertain. METHODS A prospective cohort study was conducted using data from the National Health and Nutrition Examination Survey (2001-2008). Serum phosphorus was analyzed as a continuous variable, or categorized into three groups: < 3.5 mg/dL, 3.5 to < 4.5 mg/dL, and ≥ 4.5 mg/dL. Cox proportional hazards models were used to analyze the association between phosphorus with all-cause and cardiovascular disease (CVD) mortality, with or without adjustment for age, sex, race, hemoglobin, estimated glomerular filtration rate (eGFR), serum albumin, serum calcium, 25(OH)D, obesity, hypertension, diabetes, and CVD. RESULTS A total of 7694 participants were included in the analysis, representing 28 million CKD patients in the United States. During mean 92 months of follow up, 2708 all-cause deaths (including 969 CVD deaths) were observed. Per 1 mg/dL increase in phosphorus was associated with a 13% and 24% increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95%CI, 1.02-1.24) and CVD mortality (HR, 1.24; 95%CI, 1.07-1.45), respectively. Compared with the < 3.5 mg/dL, phosphorus ≥ 4.5 mg/dL was associated with a 28% and 57% increased risk of all-cause mortality (HR, 1.28; 95%CI, 1.05-1.55) and CVD mortality (HR, 1.57; 95CI, 1.19-2.08), respectively. In participants with eGFR < 60 ml/min/1.73m2, elevated phosphorus (≥ 4.5 mg/ dL) were significantly associated with increased risk of all-cause mortality (HR, 1.36; 95%CI, 1.07-1.72). No significant association was observed in eGFR ≥ 60 ml/min/1.73m2 group (HR, 1.31; 95%CI, 0.86-1.99). This correlation does not differ significantly between subgroups defined by eGFR level (P for interaction = 0.889). CONCLUSION Serum phosphorus above 4.5 mg/dL is significantly associated with a 28% and 57% increased risk of all-cause and CVD death in non-dialysis CKD patients, respectively. This relationship still demonstrated in patients with eGFR < 60 ml/min/1.73m2. However, for population with eGFR ≥ 60 ml/min/1.73m2, further verification is needed.
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Affiliation(s)
- Zhongcheng Fan
- Department of Osteology, Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital, Haikou, China
| | - Rugang Li
- Department of Nephrology, Affiliated Yuebei People's Hospital of Shantou University Medical College, Yuebei, China
| | - Miaoxia Pan
- Department of Osteology, Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital, Haikou, China
| | - Yangyang Jiang
- Department of Nephrology, Affiliated Yuebei People's Hospital of Shantou University Medical College, Yuebei, China
| | - Ying Li
- Department of Nephrology, Affiliated Yuebei People's Hospital of Shantou University Medical College, Yuebei, China
| | - Li Liu
- Department of Nephrology, Affiliated Yuebei People's Hospital of Shantou University Medical College, Yuebei, China
| | - Yang Li
- Department of Nephrology, Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital, 43 Renmin Ave, Haikou, 570208, China.
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Hooshmand Gharabagh L, Shargh A, Mohammad Hosseini Azar MR, Esmaeili A. Comparison between the effect of Empagliflozin and Pioglitazone added to metformin in patients with type 2 diabetes and nonalcoholic fatty liver disease. Clin Res Hepatol Gastroenterol 2024; 48:102279. [PMID: 38159676 DOI: 10.1016/j.clinre.2023.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIMS Non-alcoholic fatty liver disease (NAFLD), defined as the accumulation of >5% fat in the liver, is the most frequently co-exist disease with diabetics up to 70%. Current study was conducted to compare efficacy of combination therapy of empagliflozin (EMPA) or pioglitazone (PGZ) with metformin (MET) in patients with T2DM and NAFLD. METHODS In this open label, prospective clinical trial, sixty patients were randomly assigned to receive EMPA 10 mg/day or PGZ 30 mg/day in combination Metformin (at least 1500 mg) for six months. NAFLD grade and liver stiffness were defined and measured at the beginning and after 6 months. As the secondary outcomes, anthropometric characteristics, lipid profile, plasma glucose test, and liver enzymes test were measured at the baseline and endpoint. RESULTS The results showed that both combination therapy with EMPA+ MET or PGZ+MET significantly reversed fibrosis stage of NAFLD (P<0.05). Significant reduction in lipid profile test, and liver enzymes test were seen in both groups (P<0.05). However, the greater reduction in waist circumference was observed in EMPA groups compared to PGZ (-4.4 ± 2.39 vs -2.05±1.28, p<0.001), meanwhile weight and BMI decreased significantly only in the patients receiving EMPA (-5.78 ± 3.6 kg vs 0.93 ± 0.33 kg and -2.01± 3.19 kg/m2 vs 0.33 ± 0.12 kg/m2, respectively, P<0.001). CONCLUSION combination of EMPA or PGZ with metformin equally improved liver fibrosis stage and stiffness in T2DM patients with NAFLD. The improvements of laboratory tests were observed in the both groups, while, regarding weight reduction, only the regimen containing EMPA was effective.
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Affiliation(s)
- Laya Hooshmand Gharabagh
- Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Imam Khomeini Hospital, Urmia, Iran.
| | - Ali Shargh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Ayda Esmaeili
- Department of Clinical Pharmacy, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran; Experimentaland Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Chang ML, Cheng JS, Chen WT, Hsu CW, Chen KH, Chen YC, Chien RN. Long-term renal function alterations in hepatitis C patients with SVRs: Impacts of therapies and mixed cryoglobulinemia. J Infect Public Health 2024; 17:486-494. [PMID: 38280352 DOI: 10.1016/j.jiph.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND / AIMS Effects of anti-hepatitis C virus (HCV) therapeutic regimens and mixed cryoglobulinemia on long-term renal function of HCV-infected patients with viral clearance have not been determined. METHODS/MATERIALS A prospective 10-year cohort study of 1212 HCV-infected patients (interferon-based therapy, n = 615; direct-acting antiviral (DAA) therapy, n = 434) was conducted. RESULTS At baseline, age, body mass index (BMI), hemoglobin (Hb) and uric acid (UA) levels, and fibrosis-4 score were associated with estimated glomerular filtration rates (eGFRs) in HCV-infected patients. At 24 weeks posttherapy, age, BMI, and Hb and UA levels were associated with eGFRs in patients with a sustained virological response (SVR) (n = 930). Compared with those at baseline, the eGFRs were lower in SVR patients at 24 weeks posttherapy, regardless of the therapeutic regimen. The eGFRs reverted to baseline levels in interferon-treated SVR patients up to 10 years posttherapy but remained decreased in DAA-treated SVR patients up to 4 years posttherapy. Longitudinally, repeated measures analyses with generalized estimating equations showed that the interactions between DAA-based therapy and mixed cryoglobulinemia (OR: 3.291) and Hb levels (1.778) were positively, while DAA-based therapy (0.442), age (0.956), UA levels (0.698), homeostasis model assessment-insulin resistance index (0.961) and complement 4 levels (0.9395) were negatively associated with the eGFR. Among DAA-treated SVR patients, the baseline eGFR (OR: 1.014; 95%CI OR: 1.004-1.023) and high-sensitivity C-reactive protein (HR: 1.082; 95%CI HR: 1.018-1.15) were associated with eGFR reduction at 24 weeks and 4 years posttherapy, respectively. CONCLUSIONS Hepatic fibrosis was an HCV-related factor for renal function. Longitudinally, DAA therapy was negatively, while the interaction between DAA therapy and mixed cryoglobulinemia was positively associated with renal function in SVR patients; deteriorated renal function was recovered in interferon-treated SVR patients. Particularly in DAA-treated SVR patients, baseline renal function and systemic inflammation were associated with short- and long-term reductions in renal function, respectively.
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Affiliation(s)
- Ming-Ling Chang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Jur-Shan Cheng
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Wei Hsu
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Hsing Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Rong-Nan Chien
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wei Y, Zhao ZL, Wu J, Cao SL, Peng LL, Li Y, Yu MA. Complications of microwave ablation in patients with persistent/recurrent hyperparathyroidism after surgical or ablative treatment. Int J Hyperthermia 2024; 41:2308063. [PMID: 38314664 DOI: 10.1080/02656736.2024.2308063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/23/2023] [Accepted: 01/07/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVE To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments. MATERIALS AND METHODS From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors. RESULT Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%). CONCLUSION Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.
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Affiliation(s)
- Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jie Wu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shi-Liang Cao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China
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Miao Y, Wang L, Yin Y, Zhou B, Liao Y. Effect of hemodialysis on left atrial function in patients with end-stage renal failure evaluated by two-dimensional speckle tracking imaging. Echocardiography 2024; 41:e15784. [PMID: 38400659 DOI: 10.1111/echo.15784] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE We sought to evaluate the left atrial (LA) strain parameters of maintenance hemodialysis (MHD) patients before and after dialysis by two dimensional speckle tracking imaging (2D-STI), and to explore the effect of volume load change on LA function. METHODS Seventy-six patients with end stage renal disease (ESRD) on hemodialysis (HD) were enrolled in the study protocol. The median duration of dialysis was 24.0 (7.5, 59.5) months. In addition, 30 healthy subjects were selected as control group. Comprehensive echocardiography was performed immediately before and after hemodialysis to compare the changes in left atrial function. RESULTS Regarding LA strain parameters in patients of pre-HD, the median (25th, 75th) LA reservoir, LA conduit, and LA contractile reserve were 28.0 (23.0, 34.5), -15.5 (-10.0, -21.5), -12.0 (-9.0, -16.0) respectively; the post-HD were 26.0 (21.0, 29.0), -12.0 (-9, -15.5), -12.5 (-9, -15.5) respectively; and controls were 43.0 (36.0, 48.0), -24.0 (-18.0, -32.0), -17.0 (-15.0, -22.0) respectively. The left atrial strain parameters before HD were lower than controls, the differences were statistically significant, the p-value were .000, .025, and .000, respectively. The reservoir function and conduit function of LA strain decreased after hemodialysis, the differences were statistically significant, the p-value were .003 and .006, respectively. Regarding the contraction of LA, the differences between pre- and post-HD were not statistically significant (p = .965). CONCLUSION Hemodialysis removes excess water in human body, while LVGLS and Doppler parameters are greatly affected by reduced preload. New echocardiographic parameters, such as left atrial strain, can quantitatively evaluate the changes in left atrial function before and after hemodialysis in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population.
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Affiliation(s)
- Yunxiang Miao
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Wang
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Yin
- Department of Hemodialysis Center, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bingyuan Zhou
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuping Liao
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China
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Yang Y, Liang W, Gong W, Li S, Chen S, Yang Z, Kuang C, Zhong Y, Yang D, Liu F. Establishment and evaluation of a nomogram prediction model for the risk of vascular calcification in stage 5 chronic kidney disease patients. Sci Rep 2024; 14:1025. [PMID: 38200088 PMCID: PMC10781805 DOI: 10.1038/s41598-023-48275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
Vascular calcification (VC) is a common complication of chronic kidney disease (CKD) that has a detrimental effect on patients' survival and prognosis. The aim of this study was to develop and validate a practical and reliable prediction model for VC in CKD5 patients. The medical records of 544 CKD5 patients were reviewed retrospectively. Multivariate logistic regression analysis was used to identify the independent risk factors for vascular calcification in patients with CKD5 and then created a nomogram prediction model. The area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test, and decision curve analysis (DCA) were used to assess model performance. The patients were split into groups with normal and high serum uric acid levels, and the factors influencing these levels were investigated. Age, BUN, SUA, P and TG were independent risk factors for vascular calcification in CKD5 patients in the modeling group (P < 0.05). In the internal validation, the results of model showed that the AUC was 0.917. No significant divergence between the predicted probability of the nomogram and the actual incidence rate (x2 = 5.406, P = 0.753) was revealed by the calibration plot and HL test, thus confirming that the calibration was satisfactory. The external validation also showed good discrimination (AUC = 0.973). The calibration chart and HL test also demonstrated good consistency. Besides, the correlation analysis of serum uric acid levels in all CKD5 patients revealed that elevated uric acid levels may be related to gender, BUN, P, and TG.
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Affiliation(s)
- Yan Yang
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
- Department of General Practice, Puning People's Hospital, Puning, 515300, Guangdong, China
| | - Wenxue Liang
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Wenyu Gong
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Shishi Li
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Sining Chen
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Zhiqian Yang
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Chaoying Kuang
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Yuzhen Zhong
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China
| | - Demao Yang
- Department of General Practice, Puning People's Hospital, Puning, 515300, Guangdong, China.
| | - Fanna Liu
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, 613 W. Huangpu Avenue, Guangzhou, 510632, Guangdong, China.
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Fusaro M, Barbuto S, Gallieni M, Cossettini A, Re Sartò GV, Cosmai L, Cianciolo G, La Manna G, Nickolas T, Ferrari S, Bover J, Haarhaus M, Marino C, Mereu MC, Ravera M, Plebani M, Zaninotto M, Cozzolino M, Bianchi S, Messa P, Gregorini M, Gasperoni L, Agosto C, Aghi A, Tripepi G. Real-world usage of Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) biomarkers in nephrology practices. Clin Kidney J 2024; 17:sfad290. [PMID: 38223338 PMCID: PMC10784916 DOI: 10.1093/ckj/sfad290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Indexed: 01/16/2024] Open
Abstract
Background Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications, and increase cardiovascular (CV) risk. Nephrologists' awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice. Methods A national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice. Results One hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10%. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1%) of both PTH and alkaline phosphatase (ALP), 100 (94.3%) of 25(OH)D, and 61 (57.5%) of 1.25(OH)2D; while most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7% and c-terminal: 93.4%), Klotho (95.3%; soluble form: 97.2%), tartrate-resistant acid phosphatase 5b (TRAP-5b) (92.5%), C-terminal telopeptide (CTX) (71.7%), and pro-collagen type 1 N-terminal pro-peptide (P1NP) (88.7%). As interesting data regarding Italian nephrologists' behavior to start treatment of secondary hyperparathyroidism (sHPT), the majority of clinicians used KDOQI guidelines (n = 55, 51.9%). In contrast, only 40 nephrologists (37.7%) relied on KDIGO guidelines, which recommended referring to values of PTH between two and nine times the upper limit of the normal range. Conclusion Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Simona Barbuto
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, Milano, Italy
- Post-Graduate School of Specialization in Nephrology, University of Milano, Milano, Italy
- Division of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Althea Cossettini
- Post-Graduate School of Specialization in Nephrology, University of Milano, Milano, Italy
| | | | - Laura Cosmai
- Division of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Thomas Nickolas
- Department of Medicine, Division of Nephrology, Columbia University, New York, NY, USA
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, Geneva, Switzerland
| | - Jordi Bover
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Mathias Haarhaus
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carmela Marino
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
| | | | - Maura Ravera
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefano Bianchi
- Department of Internal Medicine, Nephrology and Dialysis Complex Operative Unit, Livorno, Italy
| | - Piergiorgio Messa
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lorenzo Gasperoni
- Nephrology and Dialysis Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Caterina Agosto
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | | | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
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Molina P, Molina MD, Carrero JJ, Escudero V, Torralba J, Castro-Alonso C, Beltrán S, Vizcaíno B, González-Moya M, Kanter J, Sancho-Calabuig A, Bover J, Górriz JL. Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis. J Clin Med 2023; 12:7631. [PMID: 38137700 PMCID: PMC10743559 DOI: 10.3390/jcm12247631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/27/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Study design: Our research is presented in a prospective cohort study. Setting and participants: A total of 966 participants with NDD-CKD stages 4-5 were enrolled in the PECERA study from 12 centers in Spain. Exposure: The participants were treated with sevelamer. Outcome: This study yielded all-cause and cardiovascular mortality outcomes. Analytical approach: We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. Results: After a median follow-up of 29 months (IQR: 13-36 months), death occurred in 181 participants (19%), with cardiovascular (n = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Limitations: Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. Conclusions: In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Mariola D. Molina
- Department of Mathematics, Universidad de Alicante, 03690 Sant Vicent del Raspeig, Spain;
| | - Juan J. Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden;
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Javier Torralba
- Department of Nephrology, Hospital General Universitario, 03010 Alicante, Spain;
| | - Cristina Castro-Alonso
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Sandra Beltrán
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Belén Vizcaíno
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Mercedes González-Moya
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Julia Kanter
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
| | - Asunción Sancho-Calabuig
- Department of Nephrology, Hospital Universitari Dr. Peset, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, 46017 Valencia, Spain; (V.E.); (C.C.-A.); (S.B.); (B.V.); (M.G.-M.); (J.K.); (A.S.-C.)
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | - José L. Górriz
- Department of Medicine, Universitat de València, 46010 Valencia, Spain;
- Department of Nephrology, Hospital Clínico Universitario, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana, 46010 Valencia, Spain
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Capossela L, Ferretti S, D’Alonzo S, Di Sarno L, Pansini V, Curatola A, Chiaretti A, Gatto A. Bone Disorders in Pediatric Chronic Kidney Disease: A Literature Review. BIOLOGY 2023; 12:1395. [PMID: 37997994 PMCID: PMC10669025 DOI: 10.3390/biology12111395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Intense changes in mineral and bone metabolism are frequent in chronic kidney disease (CKD) and represent an important cause of morbidity and reduced quality of life. These disorders have conventionally been defined as renal osteodystrophy and classified based on bone biopsy, but due to a lack of bone biopsy data and validated radiological methods to evaluate bone morphology in children, it has been challenging to effectively assess renal osteodystrophy in pediatric CKD; the consequence has been the suboptimal management of bone disorders in children. CKD-mineral and bone disorder (CKD-MBD) is a new expression used to describe a systemic disorder of mineral and bone metabolism as a result of CKD. CKD-MBD is a triad of biochemical imbalances in calcium, phosphate, parathyroid hormone, and vitamin D; bone deformities and soft tissue calcification. This literature review aims to explore the pathogenesis, diagnostic approach, and treatment of CKD-MBD in children and the effects of renal osteodystrophy on growing skeleton, with a specific focus on the biological basis of this peculiar condition.
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Affiliation(s)
- Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Silvia D’Alonzo
- Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy;
| | - Lorenzo Di Sarno
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.F.); (L.D.S.); (A.C.)
| | - Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (V.P.); (A.C.); (A.G.)
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Silva AL, Chertow GM, Hernandez GT, Lynn RI, Tietjen DP, Rosenbaum DP, Yang Y, Edelstein S. Tenapanor Improves Long-Term Control of Hyperphosphatemia in Patients Receiving Maintenance Dialysis: the NORMALIZE Study. KIDNEY360 2023; 4:1580-1589. [PMID: 37853560 PMCID: PMC10695649 DOI: 10.34067/kid.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
Key Points Tenapanor is a first-in-class, minimally systemic sodium–hydrogen exchanger 3 inhibitor with a mechanism of action distinct from phosphate binders. Tenapanor alone or with phosphate binders led to 35%–49% of patients achieving serum phosphate ≤4.5 mg/dl over an 18-month period versus 22% at baseline. Tenapanor alone or with phosphate binders may help adults with CKD on maintenance dialysis achieve normal serum phosphate concentrations. Background Most patients with ESKD and hyperphosphatemia have difficulty controlling serum phosphate (sP) concentrations despite maintenance dialysis, dietary restriction, and phosphate binder treatment. NORMALIZE evaluated the efficacy and safety of tenapanor 30 mg twice daily alone or in combination with phosphate binders to achieve sP within the adult population reference range (2.5–4.5 mg/dl). Methods Patients who completed the Phase 3 PHREEDOM study could enroll in NORMALIZE. Patients enrolled in NORMALIZE who had received tenapanor during the PHREEDOM study (n =111) added sevelamer carbonate if sP was >4.5 mg/dl. Patients who had received sevelamer carbonate during the PHREEDOM study (n =61) added tenapanor and decreased sevelamer carbonate if sP was ≤4.5 mg/dl, per protocol titration schedule. Patients were followed in NORMALIZE for up to 18 months. We assessed efficacy in the full analysis set, defined as patients who received ≥1 dose of study drug and had ≥1 post-treatment sP measurement (n =171). We assessed safety in all patients who received ≥1 dose of study drug (n =172). Results At the end point visit, 57 of 171 patients (33%) in the full analysis set achieved sP between 2.5 and 4.5 mg/dl. Eight of 23 patients (35%) who were on tenapanor alone at the end point visit achieved sP between 2.5 and 4.5 mg/dl. The mean reduction from PHREEDOM baseline to end of NORMALIZE in sP was 2.0 mg/dl. Serum intact fibroblast growth factor-23 was significantly reduced; serum intact parathyroid hormone was significantly reduced among patients with intact parathyroid hormone ≥300 pg/ml at PHREEDOM baseline. The most commonly reported treatment-emergent adverse event was diarrhea in 38 of 172 patients (22%), which led to tenapanor discontinuation in four patients (2%). Conclusions Tenapanor alone or in combination with phosphate binders helped adult patients on maintenance dialysis achieve normal sP concentrations. Safety was consistent with previous studies of tenapanor. Clinical trial registry name and registration number A Long-Term Study to Evaluate the Ability of Tenapanor Alone or in Combination With Sevelamer to Treat to Goal Serum Phosphorus in Patients With ESKD on Dialysis (NORMALIZE), NCT03988920 .
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Affiliation(s)
| | - Glenn M. Chertow
- Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | - Yang Yang
- Ardelyx, Inc., Waltham, Massachusetts
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Chen T, Chao W, Zou Y, Di J, Zhou X, Zong Y, Zhang M, Yang M. Personality traits and peritoneal dialysis patients' prognosis. Ren Fail 2023; 45:2264935. [PMID: 37846973 PMCID: PMC10583605 DOI: 10.1080/0886022x.2023.2264935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
Objective: Peritoneal dialysis (PD) requires high patient conscientiousness. Therefore, we aimed to investigate the relationship between conscientiousness score and prognosis in PD patients.Methods: The ten-item Big Five Personality Inventory's Chinese version was used to assess the conscientiousness score. Basic clinical information, prior medical history, hematological examination results, the occurrence of the first peritonitis and catheter-related infection, the start of hemodialysis, and the time of renal transplantation were collected. The patients were split into two groups, high and low conscientiousness groups, based on the mean value of the conscientiousness score. The differences in prognostic indicators were compared between groups, and the association between conscientiousness score and prognostic indicators in PD patients was assessed.Results: Enrolled PD patients were divided into low conscientiousness group 103 and high conscientiousness group 98. There were significant differences in serum albumin (p = 0.021) and iPTH (p = 0.045) between the two groups. Multivariate Cox regression analysis identified conscientiousness score as an independent risk factor for the development of first peritonitis (HR = 0.558, 95% CI 0.400-0.779, p = 0.001) and first catheter-related infection (HR = 0.544, 95% CI 0.308-0.962, p = 0.036) in PD patients. Conscientiousness score (HR = 2.377, 95% CI 1.109-5.095, p = 0.026) was independently associated with renal transplantation.Conclusion: Conscientiousness personality is closely related to the prognosis of PD patients.
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Affiliation(s)
- Tianlei Chen
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Wenying Chao
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Yun Zou
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Jia Di
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Xin Zhou
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Yin Zong
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Mengyu Zhang
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Min Yang
- Department of Nephrology, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
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Shigematsu T, Koiwa F, Isaka Y, Fukagawa M, Hagita K, Watanabe YS, Honda D, Akizawa T. Efficacy and Safety of Upacicalcet in Hemodialysis Patients with Secondary Hyperparathyroidism: A Randomized Placebo-Controlled Trial. Clin J Am Soc Nephrol 2023; 18:1300-1309. [PMID: 37696667 PMCID: PMC10578632 DOI: 10.2215/cjn.0000000000000253] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Secondary hyperparathyroidism is a major complication of patients undergoing hemodialysis (HD). Upacicalcet, a new injectable calcimimetic, acts on calcium-sensing receptors to suppress parathyroid hormone (PTH) secretion. We examined the efficacy and safety of upacicalcet in patients with secondary hyperparathyroidism receiving HD. METHODS In this phase 3, double-blind, placebo-controlled study, we randomized Japanese patients undergoing HD with serum intact PTH (iPTH) concentrations >240 pg/ml and corrected calcium concentrations ≥8.4 mg/dl. Either upacicalcet or placebo was administered after each HD session for 24 weeks. The primary outcome was the percentage of participants achieving the target mean serum iPTH concentration (60-240 pg/ml) at weeks 22-24. RESULTS A total of 103 participants received upacicalcet, and 50 participants received the placebo. The percentage of participants achieving mean serum iPTH concentrations of 60-240 pg/ml during the evaluation period was 67% (69/103) in the upacicalcet group and 8% (4/50) in the placebo group. The difference between the two groups was 59% (95% confidence interval, 48% to 71%). Upacicalcet also decreased serum fibroblast growth factor-23, bone-specific alkaline phosphatase, total type 1 procollagen-N-propeptide, and tartrate-resistant acid phosphatase-5b concentrations. Adverse events were reported in 85% (88/103) and 72% (36/50) participants in the upacicalcet and placebo groups, respectively. The incidence of upper gastrointestinal adverse events, such as nausea and vomiting, was similar between the two groups. Serum corrected calcium concentrations <7.5 mg/dl were observed in 2% of participants in the upacicalcet group and no participants in the placebo group. CONCLUSIONS Upacicalcet, a novel injectable calcimimetic, is effective and safe for secondary hyperparathyroidism patients receiving HD. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Phase 3 Study of SK-1403, NCT03801980 .
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Affiliation(s)
| | - Fumihiko Koiwa
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Keiko Hagita
- Clinical Development Department, Sanwa Kagaku Kenkyusho Co., Ltd., Nagoya, Japan
| | - Yukihisa S. Watanabe
- Clinical Development Department, Sanwa Kagaku Kenkyusho Co., Ltd., Nagoya, Japan
| | - Daisuke Honda
- Project Management Department, Sanwa Kagaku Kenkyusho Co., Ltd., Nagoya, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Maggio MC, Miniaci A, Gallizzi R, Civino A. "Neuroimmunoendocrinology" in Children with Rheumatic Diseases: How Glucocorticoids Are the Orchestra Director. Int J Mol Sci 2023; 24:13192. [PMID: 37685999 PMCID: PMC10487400 DOI: 10.3390/ijms241713192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
The neural, the endocrine, and the immune systems are studied as distinct districts in physiological and pathological settings. However, these systems must be investigated with an integrative approach, while also considering that therapeutic agents, such as glucocorticoids, can induce a reversible or irreversible change of this homeostasis. Children and adolescents affected by rheumatic diseases frequently need treatment with corticosteroids, and the treatment must sometimes be continued for a long time. In the biological era, the treat-to-target strategy allowed a real revolution in treatment, with significant steroid dose sparing or, in many patients, steroid treatment withdrawal. In this review, the impact of glucocorticoids on endocrine, immune, and neurologic targets is analyzed, and the crosstalk between these systems is highlighted. In this narrative review, we explore the reasoning as to why glucocorticoids can disrupt this homeostasis, we summarize some of the key results supporting the impact of glucocorticoids treatment on endocrine, immune, and neurologic systems, and we discuss the data reported in the international literature.
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Affiliation(s)
- Maria Cristina Maggio
- University Department PROMISE “G. D’Alessandro”, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy;
| | - Angela Miniaci
- Paediatric Rheumatology, UOC of Paediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Romina Gallizzi
- Paediatric Unit, Department of Health Science, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Adele Civino
- Paediatric Rheumatology and Immunology, Vito Fazzi Hospital, 73100 Lecce, Italy;
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Qiu W, Zhou G. Observation of the efficacy of parathyroidectomy for secondary hyperparathyroidism in hemodialysis patients: a retrospective study. BMC Surg 2023; 23:234. [PMID: 37568150 PMCID: PMC10422825 DOI: 10.1186/s12893-023-02143-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Parathyroidectomy (PTX) is commonly performed as a treatment for secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease (ESRD). We aimed to evaluate the efficacy of PTX in patients with SHPT who underwent hemodialysis. METHODS This retrospective study analyzed the clinical treatment of 80 hemodialysis patients with SHPT who underwent either total PTX with forearm auto transplantation (TPTX + AT) or subtotal parathyroidectomy (SPTX). We compared the changes in biochemical indices before and after surgery as well as the attenuation of intact parathyroid hormone (iPTH) in the TPTX and SPTX groups. We also evaluated clinical symptoms and quality of life using the Visual Analog Scale (VAS) and the Short Form-36 Questionnaire (SF-36) before and at 3, 6, and 12 months after surgery. RESULTS Serum iPTH and serum phosphorus levels decreased significantly after surgery in 80 patients with SHPT (P < 0.05). Within one month of surgery, there was a difference in iPTH levels between the TPTX + AT and SPTH groups, but there was no difference over time. Patients experienced significant improvement in their clinical symptoms of restless leg syndrome, skin itching, bone pain, and joint pain at 1 week post operation (P < 0.001). Quality of life significantly improved after surgery, as assessed by SF-36 scores (P < 0.05). Hypocalcemia was the most common postoperative complication, occurring in 35% of patients. Within the first 12 months post surgery, 5 patients had a recurrence. CONCLUSION PTX is effective in rapidly reducing iPTH levels, improving calcium and phosphorus metabolism disorders, and enhancing patients' quality of life by safely and effectively relieving clinical symptoms.
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Affiliation(s)
- Wenqiang Qiu
- Department of General Surgery, Jinzhou Medical University Postgraduate Training Base (Liaoyang Central Hospital), Liaoyang, 111000, China
| | - Ge Zhou
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China.
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