1
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Bover J, Massó E, Gifre L, Alfieri C, Soler-Majoral J, Fusaro M, Calabia J, Rodríguez-Pena R, Rodríguez-Chitiva N, López-Báez V, Sánchez-Baya M, da Silva I, Aguilar A, Bustos MC, Rodrigues N, Chávez-Iñiguez JS, Romero-González G, Valdivielso JM, Molina P, Górriz JL. Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines. Nutrients 2023; 15:nu15071576. [PMID: 37049415 PMCID: PMC10097233 DOI: 10.3390/nu15071576] [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: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.
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Affiliation(s)
- Jordi Bover
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Elisabet Massó
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Laia Gifre
- Rheumatology Service, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Carlo Alfieri
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Jordi Soler-Majoral
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Maria Fusaro
- National Research Council (CNR), 56124 Pisa, Italy
- Department of Medicine, University of Padua, 35128 Padova, Italy
| | - Jordi Calabia
- Department of Nephrology, University Hospital Josep Trueta, 17007 Girona, Spain
| | - Rosely Rodríguez-Pena
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Néstor Rodríguez-Chitiva
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Víctor López-Báez
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Maya Sánchez-Baya
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Iara da Silva
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - Armando Aguilar
- Department of Nephrology, Instituto Mexicano del Seguro Social, Hospital General de Zona No. 2, Tuxtla Gutiérrez 29000, Mexico
| | - Misael C Bustos
- Department of Nephrology, Pontificia Catholic University of Chile, Santiago 8331150, Chile
| | - Natacha Rodrigues
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Jonathan S Chávez-Iñiguez
- Department of Nephrology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico
- Centro Universitario de Ciencias de la Salud CUCS, Guadalajara University, Guadalajara 44340, Mexico
| | - Gregorio Romero-González
- Department of Nephrology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- REMAR-IGTP Group, Research Institute Germans Trias i Pujol, Can Ruti Campus, 08916 Badalona, Spain
| | - José Manuel Valdivielso
- Grupo de Investigación Traslacional Vascular y Renal, Instituto de Investigación Biomédica IRBlleida, 25198 Lleida, Spain
| | - Pablo Molina
- Department of Nephrology, Hospital Universitario Dr Peset, Universitat de València Fisabio, 46017 Valencia, Spain
| | - José L Górriz
- Department of Nephrology, University Hospital Clínico, INCLIVA, Valencia University, 46010 Valencia, Spain
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2
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Rios P, Silvariño R, Sola L, Ferreiro A, Lamadrid V, Fajardo L, Gadola L. Mineral and bone disorder and longterm survival in a chronic kidney disease grade 3b-4cohort. Ren Fail 2022; 44:1356-1367. [PMID: 35946486 PMCID: PMC9373789 DOI: 10.1080/0886022x.2022.2107543] [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] [Indexed: 11/13/2022] Open
Abstract
Mineral and bone disorder biomarkers ‘normal ranges’ are controversial. The aim of the study was to evaluate the association between serum calcium (Ca), phosphate (P), intact parathyroid hormone (iPTH), and 25(OH) vitamin D levels and mortality risk, in a chronic kidney disease (CKD) grade (G) 3b-4 cohort. The Uruguayan National Renal Healthcare Program (NRHP-UY) CKD patients’ cohort, included between 1 October 2004 and 1 March 2020 and followed-up until 1 March 2021, was analyzed with the Ethics Committee approval. A total of 6473 patients were analyzed: 56% men, median age 73 (65–79) years, 55% on CKD G3b. At the end of the follow-up, 2459 (37.7%) patients had died (6.4/100 patient–year). There were iPTH data on 2013 patients (younger, with lower estimated glomerular filtration rate (eGFR) and lesser comorbidities). By bivariate Cox analysis the lowest death risk was observed with mean Ca between 9.01 and 10.25 mg/dl, P between 2.76 and 4.0 mg/dl, iPTH ≤ 105 pg/ml, and 25(OH) vitamin D >10 ng/ml. The multivariate Cox regression mortality risk adjusted to age, sex, CKD etiology, diabetes, smoking, cardiovascular comorbidity, blood pressure, proteinuria, eGFR, renin-angiotensin system blockers and vitamin D treatments, serum Ca, P, iPTH, and 25(OH) vitamin D (n = 964) showed that a higher mortality risk was associated with p > 4.00 mg/dl (HR 1.668, CI 95%: 1.201–2.317), iPTH >105 pg/ml (HR 1.386, CI 95%: 1.012–1.989), and 25(OH) vitamin D ≤ 10 ng/ml (HR 1.958, CI 95%: 1.238–3.098) and a lower mortality risk with 1,25(OH)2 vitamin D treatment (HR 0.639, CI 95%: 0.451–0.906). These data may contribute to the precise G3b-4 CKD-MBD biomarkers levels definition.
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Affiliation(s)
- Pablo Rios
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Ricardo Silvariño
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay.,Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Laura Sola
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Alejandro Ferreiro
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay.,Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Verónica Lamadrid
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay
| | - Laura Fajardo
- Sociedad Uruguaya de Nefrología, Montevideo, Uruguay
| | - Liliana Gadola
- Comisión Asesora Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay.,Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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3
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Bover J, Bosch R, Luis Górriz J, Ureña P, Ortiz A, daSilva I, García-Trabanino RA, Hueso M, Trinidad P, Jara A, Furlano M, Gelpi R, Vila-Santandreu A, Restrepo CA, Sánchez-Baya M, Arana C, Goicoechea M, Coll V, Segura J, Gutiérrez O, Kalantar-Zadeh K, Sánchez E, Ferreiro A, García-Maset R. Kidneys also speak Spanish: Initiatives towards standardisation of our nephrology nomenclature. Nefrologia 2022; 42:223-232. [PMID: 36167667 DOI: 10.1016/j.nefroe.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 06/16/2023] Open
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain.
| | - Ricardo Bosch
- Departamento de Biología de Sistemas, Unidad de Fisiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Pablo Ureña
- AURA Nord Saint Ouen, Saint Ouen, Francia y Department of Renal Physiology, Necker Hospital, University of Paris Descartes, París, France
| | - Alberto Ortiz
- Servicio de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Iara daSilva
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma, Badalona, Spain
| | - Ramón A García-Trabanino
- Centro de Hemodiálisis de San Salvador, Fondo Social de Emergencia para la Salud de Tierra Blanca, El Salvador, Spain
| | - Miguel Hueso
- Servicio de Nefrología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de trabajo sobre BigData e Inteligencia Artificial (BigSEN) de la Sociedad Española de Nefrología, Barcelona, Spain
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI, IMSS, Ciudad de México, Mexico
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mónica Furlano
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Rosana Gelpi
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain; Servicio de Nefrología, Hospital de Caldas, Universidad de Caldas, Manizales, Colombia
| | - Ana Vila-Santandreu
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain
| | - César A Restrepo
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Maya Sánchez-Baya
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Marián Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, Spain; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain
| | - Julián Segura
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension and Kidney Transplantation, Orange, University of California Los Angeles, Los Angeles, CA, USA
| | - Emilio Sánchez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Alejandro Ferreiro
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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4
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Xu A, Prasad V. The use and meaning of the parachute metaphor in biomedicine: a citation analysis of a systematic review and a randomized trial of the parachute for freefall. J Comp Eff Res 2022; 11:383-390. [PMID: 35189694 DOI: 10.2217/cer-2021-0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Numerous authors have used the 'parachute' analogy to comment on the importance of and need for randomized, controlled trials (RCTs) in the hierarchy of medical evidence. Methods: The authors completed a retrospective literature analysis examining publications citing the 2003 parachute paper by Smith and Pell and a 2018 RCT of a parachute by Yeh et al. For all of the articles that directly analogized a medical intervention to a parachute, the authors identified the desired outcome of the practice and searched PubMed for relevant RCTs. Results: Authors citing the parachute analogy are often critical of RCTs and often draw comparisons to interventions that are not parachutes.
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Affiliation(s)
- Alexander Xu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19103, USA
| | - Vinay Prasad
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics; San Francisco General Hospital, Hematology Oncology; University of California, San Francisco, CA, USA
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5
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Torres PU, Troya MI, Dauverge M, Bover J. Independent effects of parathyroid hormone and phosphate levels on hard outcomes in non-dialysis patients: food for thought. Nephrol Dial Transplant 2021; 37:613-616. [PMID: 34718751 DOI: 10.1093/ndt/gfab308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Pablo Ureña Torres
- AURA Nord Saint Ouen Dialysis Service. Saint Ouen, France and Service d'Explorations Fonctionnelles Rénales, Hôpital Necker, Université Paris V, René Descartes, Paris, France
| | - María Isabel Troya
- Nephrology Department, University Hospital Germans Trias I Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
| | - Maxime Dauverge
- AURA Nord Saint Ouen Dialysis Service. Saint Ouen, France and Service d'Explorations Fonctionnelles Rénales, Hôpital Necker, Université Paris V, René Descartes, Paris, France
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias I Pujol, RICORS, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
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6
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Rodrigues FG, Ormanji MS, Heilberg IP, Bakker SJL, de Borst MH. Interplay between gut microbiota, bone health and vascular calcification in chronic kidney disease. Eur J Clin Invest 2021; 51:e13588. [PMID: 33948936 PMCID: PMC8459296 DOI: 10.1111/eci.13588] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 02/06/2023]
Abstract
Deregulations in gut microbiota may play a role in vascular and bone disease in chronic kidney disease (CKD). As glomerular filtration rate declines, the colon becomes more important as a site of excretion of urea and uric acid, and an increased bacterial proteolytic fermentation alters the gut microbial balance. A diet with limited amounts of fibre, as well as certain medications (eg phosphate binders, iron supplementation, antibiotics) further contribute to changes in gut microbiota composition among CKD patients. At the same time, both vascular calcification and bone disease are common in patients with advanced kidney disease. This narrative review describes emerging evidence on gut dysbiosis, vascular calcification, bone demineralization and their interrelationship termed the 'gut-bone-vascular axis' in progressive CKD. The role of diet, gut microbial metabolites (ie indoxyl sulphate, p-cresyl sulphate, trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFA)), vitamin K deficiency, inflammatory cytokines and their impact on both bone health and vascular calcification are discussed. This framework may open up novel preventive and therapeutic approaches targeting the microbiome in an attempt to improve cardiovascular and bone health in CKD.
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Affiliation(s)
- Fernanda G Rodrigues
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Nutrition Post-Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Milene S Ormanji
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ita P Heilberg
- Nutrition Post-Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil.,Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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7
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Bover J, Arana C, Ureña P, Torres A, Martín-Malo A, Fayos L, Coll V, Lloret MJ, Ochoa J, Almadén Y, Guirado L, Rodríguez M. Hyporesponsiveness or resistance to the action of parathyroid hormone in chronic kidney disease. Nefrologia 2021; 41:514-528. [PMID: 36165134 DOI: 10.1016/j.nefroe.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/20/2020] [Indexed: 06/16/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is an integral component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). Many factors have been associated with the development and progression of SHPT but the presence of skeletal or calcemic resistance to the action of PTH in CKD has often gone unnoticed. The term hyporesponsiveness to PTH is currently preferred and, in this chapter, we will not only review the scientific timeline but also some of the molecular mechanisms behind. Moreover, the presence of resistance to the biological action of PTH is not unique in CKD since resistance to other hormones has also been described ("uremia as a receptor disease"). This hyporesponsiveness carries out important clinical implications since it explains, at least partially, not only the progressive nature of the pathogenesis of CKD-related PTH hypersecretion and parathyroid hyperplasia but also the increasing prevalence of adynamic bone disease in the CKD population. Therefore, we underline the importance of PTH control in all CKD stages, but not aiming to completely normalize PTH levels since a certain degree of SHPT may represent an adaptive clinical response. Future studies at the molecular level, i.e. on uremia or the recent description of the calcium-sensing receptor as a phosphate sensor, may become of great value beyond their significance to explain just the hyporesponsiveness to PTH in CKD.
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Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain.
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain
| | - Pablo Ureña
- AURA Nord Saint Ouen y Departamento de Fisiología Renal, Hospital Necker, Universidad de París Descartes, Paris, France
| | - Armando Torres
- Servicio de Nefrología, Hospital Universitario de Canarias, REDinREN, Universidad de La Laguna, Tenerife, Spain
| | - Alejandro Martín-Malo
- Unidad de Gestión Clinica Nefrología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Red Nacional de Investigación en Nefrología (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Leonor Fayos
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain
| | - Jackson Ochoa
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain
| | - Yolanda Almadén
- Unidad de Gestión Clínica Medicina Interna, Lipid and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Guirado
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, Spain
| | - Mariano Rodríguez
- Unidad de Gestión Clinica Nefrología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Red Nacional de Investigación en Nefrología (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
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8
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Bover J, Bosch R, Górriz JL, Ureña P, Ortiz A, daSilva I, García-Trabanino RA, Hueso M, Trinidad P, Jara A, Furlano M, Gelpi R, Vila-Santandreu A, Restrepo CA, Sánchez-Baya M, Arana C, Goicoechea M, Coll V, Segura J, Gutiérrez O, Kalantar-Zadeh K, Sánchez E, Ferreiro A, García-Maset R. Kidneys also speak Spanish: Initiatives towards standardisation of our nephrology nomenclature. Nefrologia 2021; 42:S0211-6995(21)00157-0. [PMID: 34452777 DOI: 10.1016/j.nefro.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España.
| | - Ricardo Bosch
- Departamento de Biología de Sistemas, Unidad de Fisiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario. INCLIVA. Universidad de Valencia, Valencia, España
| | - Pablo Ureña
- AURA Nord Saint Ouen. Saint Ouen, Francia y Department of Renal Physiology. Necker Hospital, University of Paris Descartes, París, Francia
| | - Alberto Ortiz
- Servicio de Nefrología e Hipertensión. IIS-Fundación Jiménez Díaz-UAM, Madrid, España
| | - Iara daSilva
- Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma, Badalona, España
| | - Ramón A García-Trabanino
- Centro de Hemodiálisis de San Salvador, Fondo Social de Emergencia para la Salud de Tierra Blanca, El Salvador, España
| | - Miguel Hueso
- Servicio de Nefrología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Grupo de trabajo sobre BigData e Inteligencia Artificial (BigSEN) de la Sociedad Española de Nefrología, Barcelona, España
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI. IMSS, Ciudad de México, México
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mónica Furlano
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Rosana Gelpi
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Hospital de Caldas, Universidad de Caldas, Manizales, Colombia
| | - Ana Vila-Santandreu
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España
| | - César A Restrepo
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Maya Sánchez-Baya
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Marián Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, REDinREN, Barcelona, España; Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España
| | - Julián Segura
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine. University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension and Kidney Transplantation, Orange. University of California Los Angeles, Los Angeles, California, USA
| | - Emilio Sánchez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, España
| | - Alejandro Ferreiro
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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9
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Cozzolino M, Galassi A, Ciceri P. Phosphate binders in dialysis: better satisfied than sorry. Clin Kidney J 2021; 14:1859-1860. [PMID: 34345407 PMCID: PMC8323148 DOI: 10.1093/ckj/sfab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/11/2022] Open
Abstract
High serum phosphate levels have been associated with increased morbidity and mortality in dialysis patients. Nephrologists routinely counteract the positive phosphate balance in dialysis patients through nutritional counselling, stronger phosphate removal by dialysis and prescription of phosphate binders. An individualized choice of phosphate binders is a desirable option to improve the poor adherence with these medications' prescription that has been associated with hyperphosphataemia.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea Galassi
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Paola Ciceri
- Renal Research Laboratory, Department of Nephrology, Dialysis and Renal Transplant, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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10
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Ketteler M, Ambühl P. Where are we now? Emerging opportunities and challenges in the management of secondary hyperparathyroidism in patients with non-dialysis chronic kidney disease. J Nephrol 2021; 34:1405-1418. [PMID: 34170509 PMCID: PMC8494658 DOI: 10.1007/s40620-021-01082-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022]
Abstract
Abstract Rising levels of parathyroid hormone (PTH) are common in patients with chronic kidney disease (CKD) not on dialysis and are associated with an elevated risk of morbidity (including progression to dialysis) and mortality. However, there are several challenges for the clinical management of secondary hyperparathyroidism (SHPT) in this population. While no recognised target level for PTH currently exists, it is accepted that patients with non-dialysis CKD should receive early and regular monitoring of PTH from CKD stage G3a. However, studies indicate that adherence to monitoring recommendations in non-dialysis CKD may be suboptimal. SHPT is linked to vitamin D [25(OH)D] insufficiency in non-dialysis CKD, and correction of low 25(OH)D levels is a recognised management approach. A second challenge is that target 25(OH)D levels are unclear in this population, with recent evidence suggesting that the level of 25(OH)D above which suppression of PTH progressively diminishes may be considerably higher than that recommended for the general population. Few therapeutic agents are licensed for use in non-dialysis CKD patients with SHPT and optimal management remains controversial. Novel approaches include the development of calcifediol in an extended-release formulation, which has been shown to increase 25(OH)D gradually and provide a physiologically-regulated increase in 1,25(OH)2D that can reliably lower PTH in CKD stage G3–G4 without clinically meaningful increases in serum calcium and phosphate levels. Additional studies would be beneficial to assess the comparative effects of available treatments, and to more clearly elucidate the overall benefits of lowering PTH in non-dialysis CKD, particularly in terms of hard clinical outcomes. Graphic abstract ![]()
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Affiliation(s)
- Markus Ketteler
- Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
| | - Patrice Ambühl
- Institut für Nephrologie, Stadtspital Waid und Triemli Zürich, Zurich, Switzerland
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11
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Bover J, Arana C, Ureña P, Torres A, Martín-Malo A, Fayos L, Coll V, Lloret MJ, Ochoa J, Almadén Y, Guirado L, Rodríguez M. Hyporesponsiveness or resistance to the action of parathyroid hormone in chronic kidney disease. Nefrologia 2021. [PMID: 33985858 DOI: 10.1016/j.nefro.2020.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT) is an integral component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). Many factors have been associated with the development and progression of SHPT but the presence of skeletal or calcemic resistance to the action of PTH in CKD has often gone unnoticed. The term hyporesponsiveness to PTH is currently preferred and, in this chapter, we will not only review the scientific timeline but also some of the molecular mechanisms behind. Moreover, the presence of resistance to the biological action of PTH is not unique in CKD since resistance to other hormones has also been described ("uremia as a receptor disease"). This hyporesponsiveness carries out important clinical implications since it explains, at least partially, not only the progressive nature of the pathogenesis of CKD-related PTH hypersecretion and parathyroid hyperplasia but also the increasing prevalence of adynamic bone disease in the CKD population. Therefore, we underline the importance of PTH control in all CKD stages, but not aiming to completely normalize PTH levels since a certain degree of SHPT may represent an adaptive clinical response. Future studies at the molecular level, i.e. on uremia, or the recent description of the calcium-sensing receptor as a phosphate sensor, may become of great value beyond their significance to explain just the hyporesponsiveness to PTH in CKD.
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Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España.
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España
| | - Pablo Ureña
- AURA Nord Saint Ouen y Departamento de Fisiología Renal, Hospital Necker, Universidad de París Descartes, París, Francia
| | - Armando Torres
- Servicio de Nefrología, Hospital Universitario de Canarias, REDinREN, Universidad de La Laguna, Tenerife, España
| | - Alejandro Martín-Malo
- Unidad de Gestión Clínica Nefrología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; Red Nacional de Investigación en Nefrología (REDinREN), Instituto de Salud Carlos III, Madrid, España
| | - Leonor Fayos
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España
| | - María Jesús Lloret
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España
| | - Jackson Ochoa
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España
| | - Yolanda Almadén
- Unidad de Gestión Clínica Medicina Interna, Lipid and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - Lluis Guirado
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, REDinREN, Barcelona, España
| | - Mariano Rodríguez
- Unidad de Gestión Clínica Nefrología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; Red Nacional de Investigación en Nefrología (REDinREN), Instituto de Salud Carlos III, Madrid, España
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12
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Phosphate, Microbiota and CKD. Nutrients 2021; 13:nu13041273. [PMID: 33924419 PMCID: PMC8070653 DOI: 10.3390/nu13041273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023] Open
Abstract
Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney disease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventually, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identified a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented filamentous bacteria. Furthermore, the microbiota was required for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial production of the short-chain fatty acid butyrate. We review current knowledge on the relationship between phosphate, microbiota and CKD-MBD. Topics include microbial bioactive compounds of special interest in CKD, the impact of dietary phosphate and phosphate binders on the gut microbiota, the modulation of CKD-MBD by the microbiota and the potential therapeutic use of microbiota to treat CKD-MBD through the clinical translation of concepts from other fields of science such as the optimization of phosphorus utilization and the use of phosphate-accumulating organisms.
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13
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Bover J, Ureña-Torres P, Cozzolino M, Rodríguez-García M, Gómez-Alonso C. The Non-invasive Diagnosis of Bone Disorders in CKD. Calcif Tissue Int 2021; 108:512-527. [PMID: 33398414 DOI: 10.1007/s00223-020-00781-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Abnormal bone metabolism is an integral part of the chronic kidney disease-mineral bone disorder (CKD-MBD). For several reasons, the difficult bone compartment was neglected for some time, but there has been renewed interest as a result of the conception of bone as a new endocrine organ, the increasing recognition of the cross-talk between bone and vessels, and, especially, the very high risk of osteoporotic fractures (and associated mortality) demonstrated in patients with CKD. Therefore, it has been acknowledged in different guidelines that action is needed in respect of fracture risk assessment and the diagnosis and treatment of osteoporosis in the context of CKD and CKD-MBD, even beyond renal osteodystrophy. These updated guidelines clearly underline the need to improve a non-invasive approach to these bone disorders in order to guide treatment decisions aimed at not only controlling CKD-MBD but also decreasing the risk of fracture. In this report, we review the current role of the most often clinically used or promising biochemical circulating biomarkers such as parathyroid hormone, alkaline phosphatases, and other biochemical markers of bone activity as alternatives to some aspects of bone histomorphometry. We also mention the potential role of classic and new imaging techniques for CKD patients. Information on many aspects is still scarce and heterogeneous, but many of us consider that it is indeed time for action, recognizing our definitely limited ability to base certain treatment decisions only on our current non-comprehensive knowledge.
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Affiliation(s)
- Jordi Bover
- Department of Nephrology, Fundació Puigvert and Universitat Autònoma, IIB Sant Pau, REDinREN, C. Cartagena 340-350, 08025, Barcelona, Catalonia, Spain.
| | - Pablo Ureña-Torres
- Department of Dialysis, AURA Nord Saint Ouen and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Mario Cozzolino
- Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Minerva Rodríguez-García
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, REDinREN, Universidad de Oviedo, Oviedo, Spain
| | - Carlos Gómez-Alonso
- Unidad de Gestión Clínica de Metabolismo Óseo y Mineral, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Spain
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14
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Kritmetapak K, Losbanos L, Berent TE, Ashrafzadeh-Kian SL, Algeciras-Schimnich A, Hines JM, Singh RJ, Kumar R. Hyperphosphatemia with elevated serum PTH and FGF23, reduced 1,25(OH) 2D and normal FGF7 concentrations characterize patients with CKD. BMC Nephrol 2021; 22:114. [PMID: 33784965 PMCID: PMC8011073 DOI: 10.1186/s12882-021-02311-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/12/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hyperphosphatemia confers adverse cardiovascular outcomes, and commonly occurs in late-stage CKD. Fibroblast growth factor 7 (FGF7) is a phosphaturic peptide which decreases renal phosphate transport in vitro and in vivo. Serum FGF7 concentrations are reduced in hyperphosphatemic patients with hypophosphatasia and are elevated in some hypophosphatemic patients with tumor-induced osteomalacia. No data, however, are available on whether circulating FGF7 concentrations increase to compensate for phosphate retention in CKD patients. METHODS This was a cross-sectional study performed among 85 adult patients with varying estimated glomerular filtration rates (eGFR). We measured serum intact FGF7 (iFGF7) concentration using an iFGF7 immunoassay and determined its associated factors. Relationships between eGFR and mineral metabolism biomarkers [phosphate, iFGF7, iFGF23, parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D (1,25(OH)2D)] were explored. RESULTS For eGFRs of ≥ 60 (n = 31), 45-59 (n = 16), 30-44 (n = 11), 15-29 (n = 15), and < 15 mL/min/1.73 m2 (n = 12), median (IQ25-75) iFGF7 concentrations were 46.1 (39.2-56.9), 43.1 (39.0-51.5), 47.3 (38.3-66.5), 47.7 (37.7-55.8), and 49.6 (42.5-65.6) pg/mL, respectively (P = 0.62). Significant increases in serum iFGF23, PTH, and phosphate were observed at eGFRs of < 33 (95 % CI, 26.40-40.05), < 29 (95 % CI, 22.51-35.36), and < 22 mL/min/1.73 m2 (95 % CI, 19.25-25.51), respectively, while significant decreases in serum 1,25(OH)2D were observed at an eGFR of < 52 mL/min/1.73 m2 (95 % CI, 42.57-61.43). No significant correlation was found between serum iFGF7 and phosphate, iFGF23, PTH or 1,25(OH)2D. In multivariable analyses, body mass index (per 5 kg/m2 increase) was independently associated with the highest quartile of serum iFGF7 concentration (OR, 1.20; 95 % CI, 1.12-1.55). CONCLUSIONS Compensatory decreases in circulating 1,25(OH)2D and increases in circulating iFGF23 and PTH, but not iFGF7, facilitate normalization of serum phosphate concentration in early stages of CKD. Whether other circulating phosphaturic peptides change in response to phosphate retention in CKD patients deserves further study.
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Affiliation(s)
- Kittrawee Kritmetapak
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, MN, 55905, Rochester, USA.,Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Louis Losbanos
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, MN, 55905, Rochester, USA
| | - Taylor E Berent
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, MN, 55905, Rochester, USA
| | | | - Alicia Algeciras-Schimnich
- Clinical Immunoassay Laboratory, Mayo Clinic, MN, Rochester, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, Rochester, USA
| | - Jolaine M Hines
- Immunochemical Core Laboratory, Mayo Clinic, MN, Rochester, USA
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, Rochester, USA
| | - Rajiv Kumar
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, MN, 55905, Rochester, USA. .,Department of Biochemistry and Molecular Biology, Mayo Clinic, MN, Rochester, USA.
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15
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Santos IDS, Araújo MJCLN, Jorgetti V, Elias RM, Bover J. Kidneys also "speak Portuguese". J Bras Nefrol 2021; 43:608-609. [PMID: 33704349 PMCID: PMC8940108 DOI: 10.1590/2175-8239-jbn-2020-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/18/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Rosilene Motta Elias
- Hospital Nove de Julho, São Paulo, SP, Brasil.,Hospital das Clínicas, São Paulo, SP, Brasil
| | - Jordi Bover
- Universitat Autònoma de Barcelona, Fundació Puigvert, Barcelona, España
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16
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Bover J, Bosch R, Ureña P, Trinidad P, Jara A, Górriz JL, Furlano M, García-Trabanino RA, Gelpi R, Ortiz A, Restrepo CA, Sánchez-Baya M, Arana C, Goicoechea M, Coll V, Segura J, Gutiérrez O, Sánchez E, Ferreiro A, García-Maset R. Kidneys also speak Spanish. Nefrologia 2021; 41:224-226. [PMID: 36166212 DOI: 10.1016/j.nefroe.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/07/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain.
| | - Ricardo Bosch
- Graduado en la Universidad Nacional de la Plata, Buenos Aires, Argentina; Departamento de Biología de Sistemas, Unidad de Fisiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Pablo Ureña
- Graduado en la Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana, AURA Nord Saint Ouen, Saint Ouen, Francia, Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI, IMSS, Ciudad de México, Mexico
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Mónica Furlano
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain; Graduada en la Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Rosana Gelpi
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain; Graduada en la Universidad de la República, Montevideo, Uruguay
| | - Alberto Ortiz
- Servicio de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - César A Restrepo
- Servicio de Nefrología, Hospital de Caldas, Universidad de Caldas, Manizales, Colombia
| | - Maya Sánchez-Baya
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain; Graduada en la Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain; Graduada en la Universidad Privada Antenor Orrego, Trujillo, Peru
| | - Marián Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, Spain; Graduada en la Universidad Central de Venezuela, Caracas, Venezuela
| | - Julián Segura
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Emilio Sánchez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Alejandro Ferreiro
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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17
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Bover J, Bosch R, Ureña P, Trinidad P, Jara A, Górriz JL, Furlano M, García-Trabanino RA, Gelpi R, Ortiz A, Restrepo CA, Sánchez-Baya M, Arana C, Goicoechea M, Coll V, Segura J, Gutiérrez O, Sánchez E, Ferreiro A, García-Maset R. Kidneys also speak Spanish. Nefrologia 2021; 41:225-226. [PMID: 33288346 DOI: 10.1016/j.nefro.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/07/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Jordi Bover
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España.
| | - Ricardo Bosch
- Graduado en la Universidad Nacional de La Plata, Buenos Aires, Argentina; Departamento de Biología de Sistemas, Unidad de Fisiología, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - Pablo Ureña
- Graduado en la Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana. AURA Nord Saint Ouen, Saint Ouen, Francia. Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, Francia
| | - Pedro Trinidad
- Departamento de Nefrología, HECMN siglo XXI, IMSS, Ciudad de México, México
| | - Aquiles Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Luis Górriz
- Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, España
| | - Mónica Furlano
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España; Graduada en la Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Rosana Gelpi
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España; Graduada en la Universidad de la República, Montevideo, Uruguay
| | - Alberto Ortiz
- Servicio de Nefrología e Hipertensión, IIS-Fundación Jiménez Díaz-UAM, Madrid, España
| | - César A Restrepo
- Servicio de Nefrología, Hospital de Caldas, Universidad de Caldas, Manizales, Colombia
| | - Maya Sánchez-Baya
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España; Graduada en la Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Carolt Arana
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España; Graduada en la Universidad Privada Antenor Orrego, Trujillo, Perú
| | - Marián Goicoechea
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Verónica Coll
- Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma, Barcelona, España; Graduada en la Universidad Central de Venezuela, Caracas, Venezuela
| | - Julián Segura
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Orlando Gutiérrez
- Division of Nephrology, Department of Medicine. University of Alabama at Birmingham, Birmingham, Alabama, Estados Unidos
| | - Emilio Sánchez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - Alejandro Ferreiro
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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18
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Molina P, Molina MD, Pallardó LM, Torralba J, Escudero V, Álvarez L, Peris A, Sánchez-Pérez P, González-Rico M, Puchades MJ, Fernández-Nájera JE, Giménez-Civera E, D'Marco L, Carrero JJ, Górriz JL. Disorders in bone-mineral parameters and the risk of death in persons with chronic kidney disease stages 4 and 5: the PECERA study. J Nephrol 2021; 34:1189-1199. [PMID: 33394344 DOI: 10.1007/s40620-020-00916-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/11/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Abnormalities of bone mineral parameters are associated with increased mortality in patients on dialysis, but their effects and the optimal range of these biomarkers are less well characterized in non-dialysis chronic kidney disease (CKD). METHODS PECERA (Collaborative Study Project in Patients with Advanced CKD) is a 3-year, prospective multicenter, open-cohort study of 966 adult patients with non-dialyzed CKD stages 4-5 enrolled from 12 centers in Spain. Associations between levels of serum calcium (Ca) (corrected for albumin), phosphate (P), and intact parathyroid hormone (iPTH) with all-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were examined using time-dependent Cox proportional hazards models and penalized splines analysis adjusted by demographics and comorbidities, treatments and biochemical values collected every 6 months for 3 years. RESULTS After a median follow-up of 29 months (IQR: 13-36 months) there were 181 deaths (19%). The association of calcium with all-cause mortality was J-shaped, with an increased risk for all-cause mortality at levels > 10.5 mg/dL. For phosphate and iPTH levels, the association was U-shaped. The serum values associated with the minimum risk of mortality were 3.8 mg/dL for phosphate and 70 pg/mL for iPTH, being the lowest risk ranges between 2.8 and 5.0 mg/dL, and between 38 and 112 pg/mL for phosphate and iPTH, respectively. CONCLUSIONS Our study provides evidence on the non-linear association of serum calcium, phosphate and iPTH levels with mortality in stage 4 and 5 CKD patients, and suggests potential survival benefits for controlling bone mineral parameters in this population, as previously reported for dialysis patients.
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Affiliation(s)
- Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain.
- Department of Medicine, Universitat de València, Valencia, Spain.
| | - Mariola D Molina
- Department of Mathematics, Universidad de Alicante, Alicante, Spain
| | - Luis M Pallardó
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Javier Torralba
- Department of Nephrology, Hospital General Universitario, Alicante, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr Peset, FISABIO, Avda. Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Luis Álvarez
- Section of Nephrology, Hospital Virgen de Los Lirios, Alcoi, Spain
| | - Ana Peris
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Sánchez-Pérez
- Department of Nephrology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel González-Rico
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - María J Puchades
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | | | - Elena Giménez-Civera
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Luis D'Marco
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - José L Górriz
- Department of Medicine, Universitat de València, Valencia, Spain
- Department of Nephrology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
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English–Latin nomenclature conundrum: should we use kidneylogy, kidneylogist? Kidney Int 2020; 98:1352-1353. [DOI: 10.1016/j.kint.2020.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
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