scholarly journals Raloxifene in the Treatment of Osteoporosis in Postmenopausal Women with End-Stage Renal Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 53 (11) ◽  
pp. 730-737
Author(s):  
Hao-Yang Ma ◽  
Shuang Chen ◽  
Ling-Ling Lu ◽  
Wei Gong ◽  
Ai-Hua Zhang
Keyword(s):  
Lumbar Spine ◽  
Renal Disease ◽  
Postmenopausal Women ◽  
End Stage Renal Disease ◽  
Control Group ◽  
Mineral Density ◽  
Treatment Of Osteoporosis ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

AbstractAs a selective estrogen receptor modulator (SERM), raloxifene is used in healthy postmenopausal women to prevent bone loss and reduce fractures. However, the benefit of raloxifene is uncertain in the treatment of osteoporosis among patients with end-stage renal disease (ESRD) or those who require maintenance dialysis. We assessed the safety and efficacy of raloxifene in this particular population. Studies were selected from PubMed, Springer, CNKI (Chinese National Knowledge Infrastructure) and Wanfang Database. Randomized controlled trials (RCTs) and prospective studies with control/placebo groups were included. Five studies were included with a total of 244 participants (121 patients in the raloxifene group and 123 patients in the placebo/control group). The median duration of treatment was 12 months. The incidence rate of side effects of raloxifene was 0/121 (0%). There was a significant improvement of lumbar spine bone mineral density (BMD) levels in the raloxifene group compared with the placebo group (MD: 33.88, 95% CI: 10.93, 56.84, p=0.004). There was no significant difference concerning the improvement of femoral neck BMD (MD: 8.42, 95% CI: –10.21, 27.04, p=0.38), intact parathyroid hormone (iPTH) (MD: –12.62, 95% CI: –35.36, 10.13, p=0.28), calcium (MD: -0.08, 95% CI: –0.61, 0.44, p=0.76), phosphorus (MD: 0.18, 95% CI: –0.12, 0.48, p=0.23) or bone alkaline phosphatase (BAP) (MD: –4.33, 95% CI: –14.44, 5.79, p=0.40). Raloxifene seems to be effective in improving the lumbar spine BMD in postmenopausal women with ESRD. More large RCTs are necessary to evaluate the long-term safety of raloxifene in uremic patients.

scholarly journals Experience With Anti-Sclerostin Antibody for Osteoporosis Patient With End-Stage Renal Disease on Hemodialysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A192-A192
Author(s):  
Mona Al Mukaddam ◽  
Christopher Hvisdas ◽  
Anisa Sulaj ◽  
Kruti Patel ◽  
Richie Tran
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Side Effects ◽  
Femoral Neck ◽  
Bone Formation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Mineral Density ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: Romosozumab is a sclerostin inhibitor indicated for treatment of postmenopausal osteoporosis. Sclerostin inhibits Wnt/Beta-catenin signaling pathway. When sclerostin is inhibited, stimulation of this pathway leads to increased bone formation and production of osteoprotegerin, which also decreases bone resorption. Patients with chronic kidney disease (CKD) demonstrate increased levels of sclerostin that negatively correlates with the rate of bone formation; however, data is lacking for use of romosozumab in this patient population. The report herein details the experience of use of romosozumab in a patient with end-stage renal disease (ESRD) on hemodialysis (HD). Clinical Case: A 37-year-old old African American male was referred after multiple rib fractures and severe non-traumatic T8 compression fracture with nerve compression. His past medical history includes lupus nephritis and cerebritis, ESRD on HD since age 22 status post (s/p) failed renal transplant, and tertiary hyperparathyroidism complicated with fracture in iliac brown tumor and mediastinal parathyromatosis s/p three parathyroid surgeries. Bone mineral density by DXA (g/cm2, Z-score) were as follows: lumbar spine (0.700, -4.0) femoral neck (0.676, -3.8), total hip (0.628,-4.0), 1/3 radius(0.443,-6.2). No prior exposure to antiresorptive or osteoanabolic agents. Pertinent labs included serum calcium 8.5 mg/dL (nl 8.9–10.3 mg/dl), albumin 4.2 g/dL, alkaline phosphatase 319 U/L (nl 38–126), Phosphorus 3.1 mg/dL (2.4–4.7), Creatinine 5.62 mg/dl, 25-OH Vitamin D 31 ng/mL (nl 25 - 80), intact parathyroid hormone 17.9 pmol/L (nl 1.6–6.9). Patient was in excruciating pain and not a surgical candidate due to poor bone quality. Osteoanabolic therapy was recommended given the severity of osteoporosis; however, teriparatide and abaloparaitde were contraindicated given comorbidities. The patient was offered off-label use of Romosozumab with clear understanding that the drug is not approved for this indication and safety/efficacy data in ESRD is not known. The boxed warning regarding increased risk of stroke, myocardial infarction and death were discussed and patient was willing to proceed. Repeat DXA after eleven monthly doses of Romosozumab resulted in a remarkable improvement in bone mineral density at all sites: lumbar spine (+47%), femoral neck (+41%), total hip (+28%), 1/3 radius (+20%). Patient tolerated medication with no side effects or fractures. Serum calcium was monitored prior to initiation and before every dose. No doses were held due to abnormal laboratory values or side effects. Conclusion: This case report summarizes successful experience with the use of Romosozumab in one patient with ESRD on HD with favorable outcomes.

Effects of Kidney Transplantation on Cognitive Performance in a Pediatric Population

PEDIATRICS ◽  
1984 ◽  
Vol 74 (2) ◽  
pp. 273-278 ◽  
Author(s):  
Robert S. Fennell ◽  
Wiley C. Rasbury ◽  
Eileen B. Fennell ◽  
Mary K. Morris
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
Cognitive Performance ◽  
End Stage Renal Disease ◽  
Pediatric Population ◽  
Control Group ◽  
Memory And Attention ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

The cognitive functioning of 20 children and adolescents with end-stage renal disease was assessed 1 to 3 weeks prior to the onset of hemodialysis, and at 1 month and 1 year after successful kidney transplantation, and results were compared with those of a matched control group. A battery of intelligence, achievement, problem solving, learning, memory, and attention tasks were administered. Both groups had significantly improved scores over time on most measures. The group with renal disease exhibited significantly greater improvement than the control group from initial testing to 1 month after transplantation on the performance IQ and full-scale IQ as well as in mathematics achievement. This significant difference was not maintained, however, at 1 year after transplantation. Cognitive performance was less impaired the later the onset of renal failure or the fewer the years in end-stage renal disease. BUN nitrogen, serum creatinine levels, and BP did not consistently correlate with any of the cognitive or academic achievement measures.

scholarly journals Frail phenotype might herald bone health worsening among end-stage renal disease patients

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3542 ◽  
Author(s):  
Chia-Ter Chao ◽  
Jenq-Wen Huang ◽  
Ding-Cheng Chan ◽  
Keyword(s):  
Lumbar Spine ◽  
Renal Disease ◽  
Bone Health ◽  
End Stage Renal Disease ◽  
Mineral Density ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background Frailty exhibits a high prevalence in end-stage renal disease (ESRD) patients and is associated with adverse health-related outcomes, including falls and fractures. Available studies do not address whether frailty is associated with temporal changes in BMD. We evaluated this issue by analyzing the follow-up dual energy X-ray absorptiometry (DXA) results in an ESRD cohort. Methods In 2015, we enrolled forty-three ESRD patients, divided into frail, pre-frail, and robust ones based on a validated simple FRAIL scale, all receiving DXA at baseline. After one year of follow-up, survivors received another DXA, and we calculated the absolute and percentage changes in area, bone mineral density (BMD), T-, and Z-scores of lumbar spine and femoral neck (FN) between baseline and follow-up examinations. Results Among all, frail individuals with ESRD had significantly lower average lumbar spine area, lower L4, FN, and total BMD and T-scores, lower FN and total Z-scores than non-frail ones, without differences in gender, body mass index, dialysis duration, and comorbidities. Furthermore, we discovered frail ESRD patients had significantly more prominent decrease in average lumbar spine area, percentage changes in L1 Z-scores and average lumbar spine area, and a trend toward more prominent decrease in L4 area than non-frail ones after one year of follow-up. Conclusions Baseline frailty might be associated with deteriorating bone health, including shrinking L-spine areas and a more rapid decrease in L-spine Z scores, among ESRD patients. This frailty-bone association should be highlighted during our care of frail individuals with ESRD.

scholarly journals Effects of Heparin on Early Patency of Arteriovenous Fistula in Angioaccess Surgery of Patients with End-Stage Renal Disease

2018 ◽  
Vol 3 (1) ◽  
pp. 36
Author(s):  
Mohamamd Mozafar ◽  
Fatemeh Hoseinzadegan ◽  
Saran Lotfollahzadeh ◽  
Maryam Baikpour ◽  
Razie Amraei ◽  
...  
Keyword(s):  
Renal Disease ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
End Stage Renal Disease ◽  
Control Group ◽  
Post Surgery ◽  
Significant Difference ◽  
Systemic Anticoagulation ◽  
Stage Renal Disease ◽  
End Stage

Background: Arteriovenous fistula (AVF) is now the optimal method of obtaining vascular access for dialysis. Measures such as systemic anticoagulation have been proposed as means of increasing patency rates but enough evidence does not exist to support their application. We aimed to evaluate the efficacy of preoperative heparin injection on patency of AVF during the first 24 hours after surgery and to determine whether such measure can be used to prevent early thrombosis of the vascular access.Methods: The study was carried out on 150 patients admitted to Shohada-e-Tajrish hospital for permanent vascular access placement during 2011-2012. 75 patients were randomly assigned to receive 100 units/kg of heparin intraoperatively and at 24 hours post-surgery AVF patency rate was assessed and compared to the control group. Results: All the 75 patients who had received heparin intraoperatively had a patent arteriovenous fistula 24 hours post-surgery which showed a statistically significant difference compared to the control group among which only 69 (92%) patients had a functioning AV fistula (p-value= 0.028).Conclusions: Our results show that systemic anticoagulation with heparin can be considered as an effective option in preventing vascular access failure. However, considering the contradictory data on the usefulness of heparin injection, larger trials are needed to evaluate efficacy and adverse effects of systemic intraoperative anticoagulation in End-Stage Renal Disease (ESRD) patients before qualifying it as a method of increasing AVF patency in these patients

scholarly journals The Profile of Timing Dialysis Initiation in Patients with End-stage Renal Disease in China: A Cohort Study

2020 ◽  
Vol 45 (2) ◽  
pp. 180-193
Author(s):  
Ying Liu ◽  
Luping Wang ◽  
Xianfeng Han ◽  
Yang Wang ◽  
Xuefeng Sun ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Cox Regression ◽  
Mainland China ◽  
Dialysis Initiation ◽  
Significant Difference ◽  
Initiation Of Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Relationship

Background: Hemodialysis is the main approach for renal replacement therapy in patients with end-stage renal disease (ESRD) in China. The timing of dialysis initiation is one of the key factors influencing patient survival and prognosis. Over the past decade, the relationship between the timing of dialysis initiation and mortality has remained unclear in patients with ESRD in China. Methods: Patients who commenced maintenance hemodialysis from 2009 to 2014 from 24 hemodialysis centers in Mainland China were enrolled in the study (n = 1,674). Patients were divided into 2 groups based on the year they started hemodialysis (patients who started hemodialysis from 2009 to 2011, and patients who started hemodialysis from 2012 to 2014). Analysis of the yearly change in the estimated glomerular filtration rate (eGFR) at the initiation of dialysis was performed for the 2 groups. Meanwhile, the patients were divided into 3 groups based on their eGFR at the initiation of dialysis (<4, 4–8, and >8 mL/min/1.73 m2). For these 3 groups, the relationship between the eGFR at the start of dialysis and mortality were analyzed. Results: The average eGFRs were 5.68 and 5.94 mL/min/1.73 m2 for 2009–2011 and 2012–2014, respectively. Compared with the 2009–2011 group, the proportion of patients with diabetes in 2012–2014 increased from 26.7 to 37.7%. The prognosis of patients with different eGFRs at the start of dialysis was analyzed using Kaplan-Meier survival curves. After adjusting for confounding factors through a Cox regression model, no significant difference was demonstrated among the 3 groups (<4 mL/min/1.73 m2 was used as the reference, in comparison with 4–8 mL/min/1.73 m2 [p = 0.681] and >8 mL/min/1.73 m2 [p = 0.403]). Conclusion: In Mainland China, the eGFR at the start of dialysis did not change significantly over time from 2008 to 2014 and had no association with the mortality of patients with ESRD.

The role of VEGF rs699947 polymorphism in End-Stage Renal Disease: A preliminary study

2021 ◽  
pp. 19-23
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Protective Factor ◽  
Public Health Problem ◽  
Turkish Population ◽  
Control Group ◽  
Case Group ◽  
Important Public Health Problem ◽  
Stage Renal Disease ◽  
End Stage

Aim: End-Stage Renal Disease (ESRD) is an important public health problem worldwide with an increasing incidence and prevalence. There are many environmental and genetic factors which contribute to the development of ESRD. Vascular endothelial growth factor (VEGF) has been suggested to play an important role in renal pathophysiology. The aim of this study was to determine the probable relation between ESRD and VEGF gene rs699947 polymorphism in Turkish population. Material and Method: Genotyping of rs699947 was carried out in 50 ESRD patients on dialysis treatment and 30 healthy controls, using a Kompetitive Allelic-Specific PCR (KASP) method following DNA isolation. Demographic and clinical characteristics of the patients were recorded. Results: The prevalance of rs699947 AA genotype was found to be higher in the control group, but it was not statistically significant (p>0.05) . Conclusion: Although statistically insignificant, the frequency of AA genotype was higher in the control group compared to the case group, therefore we concluded that AA genotype may be a protective factor for ESRD in Turkish population. However, this conclusion needs to be further verified by future studies performed in larger study groups.

scholarly journals Analysis of Endocan Levels in Hypertensive Patients as Risk Factors of Chronic Kidney Disease

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Suryani Jamal ◽  
Uleng Bahrun ◽  
Ibrahim Abdul Samad ◽  
Fitriani Mangarengi ◽  
Hasyim Kasim ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Ii ◽  
University Hospital ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Elisa Method ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

This study aimed to analyze endocan levels as a marker of endothelial dysfunction in the control group, patients withstage I hypertension, stage II hypertension, and patients with end-stage renal disease. Endocan levels were measured withESM-1 (endocan) kit by Enzyme-Linked Immunosorbent Assay (ELISA) method. This study used a cross-sectional methodand was conducted in Dr. Wahidin Sudirohusodo Hospital, Makassar and Hasanuddin University Hospital from Septemberto October 2017. There were 83 samples in this study, consisting of 12 samples in the control group, 22 samples of stage Ihypertension, 28 samples of stage II hypertension, and 21 samples of end-stage renal disease aged 20-90 years old. Thisstudy showed significantly higher endocan levels in patients with stage II hypertension and end-stage renal disease(p< 0.05). Endocan levels were significantly higher (p<0.05) in patients with end-stage renal disease compared with thecontrol group and patients with stage I hypertension; but not significantly higher (p > 0.05) compared to patients with stageII hypertension. Also, the median of endocan levels in patients with the end-stage renal disease was higher (309,850 ng/L)compared to patients with stage II hypertension (273,050 ng/L).

Podocalyxin as an early marker predicting diabetic nephropathy and its correlation with stages of diabetic nephropathy in type two diabetic patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salah El-Din A Shelbaya ◽  
Hanan M Ali ◽  
Rana H Ibrahim ◽  
Nourhan Safwat Sawirs
Keyword(s):  
Diabetic Nephropathy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Control Group ◽  
Diabetic Patients ◽  
Type 2 Dm ◽  
Stage Renal Disease ◽  
End Stage ◽  
Positive Significant Correlation

Abstract Background Nephropathy, a major complication of diabetes, is the leading cause of end-stage renal disease. Early identification of nephropathy in diabetes patients is crucial because it creates opportunity for preventing the incidence of DN and/or even slows down the process of end-stage renal disease attributed to diabetes. Human podocytes (Pods) have been demonstrated to be functionally and structurally injured in the natural history of diabetic nephropathy. Aim of the Work To evaluate the possible association between the urinary podocalyxin levels and severity and grade of diabetic nephropathy and to use urinary podocalyxin as a non-invasive marker for early stage of diabetic nephropathy in type 2 DM. Patients and Methods We collected 60 known clinically and biochemically type 2 diabetic patients.20 diabetic patients with no evidence of diabetic nephropathy, 20 patients diagnosed as diabetic nephropathy in microalbuminuria stages and 20 patients diagnosed as diabetic nephropathy in macroalbuminuria stages from Ain Shams University hospitals between April and December 2018 and 20 apparently healthy volunteers will included as a control group. Results Urinary PCX was significantly higher in patients group compared to control group. Urinary PCX was significantly higher in microalbuminuric group than in normoalbuminuric group and higher in macroalbuminuric group than in microalbuminuric group. There was a positive significant correlation between FBS, 2HrPP, HBA1C and urinary PCX. There was a positive significant correlation between s.create and urinary PCX. There was a positive significant correlation between ACR and urinary PCX. Conclusion Urinary podocalyxin seems to be beneficial as an early marker for early stages of diabetic nephropathy in type 2 DM patients.

scholarly journals P1541HEMODIALYSIS IN END-STAGE RENAL DISEASE PATIENTS OVER 75 YEARS OLD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tasnim Mesbahi ◽  
Barbouch Samia ◽  
Fattoum Safa ◽  
Najjar Mariem ◽  
Jebali Hela ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Older Patients ◽  
Cox Model ◽  
Dialysis Initiation ◽  
First Year ◽  
Younger Patients ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Over the last decade, the age of dialysis patients has been increasing steadily worldwide. The benefits of dialysis in older people with end stage renal disease (ESRD) are not clear. We will try to evaluate whether dialysis in older has survival advantage compared to younger people. Method It is a prospective descriptive and analytic study including 229 patients who initiated chronic hemodialysis during the period between January and June 2017. Patients were classified into two groups by age at dialysis initiation. Patients above 75 years of age were considered old (old group OG). Patients aged less then 75 years old were considered young (young group YG). Primary outcome was old patient’s survival during the first 3 and 12 months from the dialysis initiation. Results Among a total of 229 new patients who began dialysis treatment, 41 (17,9%) ESRD were above 75 years of age.The sex ratio was 0,95 and 1,54 in respectively in OG and YG (p = 0,167). Diabetes was present in 56% of the elderly and in 59% of the younger group (p = 0,72) and was more frequently the cause of ESRD in the two groups. The average of modified Charlson Comorbidity Index was 6,7 ± 2,3 and 3,9 ± 2,6 respectively in OG and YG(p = 10-3). Younger patients had been referred earlier to nephrologists than the older ones. In fact, glomerular filtration rate at the beginning of the follow up was 18,7 ± 8,9 ml/min/1,73 in OG and 25,4 ± 16,2 in YG (p = 0,004). There was no statically significant difference between the two groups in the frequency of the use of temporary catheters at dialysis initiation (p = 0,778) and the urgent or planned initiation of dialysis (p = 0,298). Younger patients required hospitalization to organize dialysis initiation more than older patients (51,6% VS 26,8%; p = 0,005). Compared with the group of younger patients, Cox model showed an incremental increase in mortality associated with older patients’ group during the first year of HD (p = 0,036). However, there was no difference between OG and YG in the mortality rate during the first 3 months of HD (p = 0,102). Conclusion We may conclude that life expectancy of patients who began dialysis above 75 years is significantly shorter than younger patients in the first year of HD. In the other hand, the difference between the 2 groups wasn’t significant regarding the conditions of dialysis initiation.

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