scholarly journals SO070THE SPECTRUM OF RENAL OSTEODYSTROPHY IN PREVALENT PERITONEAL DIALYSIS PATIENTS IN 21ST CENTURY - A HISTOMORPHOMETRIC ANALYSIS OF BONE BIOPSIES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Luciano Pereira ◽  
Juliana Magalhães ◽  
Luís Mendonça ◽  
Hugo Diniz ◽  
Maria João Sousa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Calcification ◽  
Renal Osteodystrophy ◽  
Frequent Pattern ◽  
Diabetic Patients ◽  
Histomorphometric Analysis ◽  
Bone Formation Rate ◽  
Susceptible Population ◽  
X Ray ◽  
Bone Biopsies

Abstract Background and Aims The spectrum of renal osteodystrophy (ROD) in peritoneal dialysis (PD) patients remains to be clarified. Most studies are old and the results inconsistent. Also there were changes in clinical practice that may have influenced the bone histology in PD patients. Method In order to characterize ROD in prevalent PD population, we performed tetracycline-labelled bone biopsies in 49 PD patients with histomorphometric analysis according KDIGO guidelines. Exclusion criteria: history of kidney transplant, hemodialysis, treatment with agents interfering in bone metabolism (for example bisphosphonates). Hands and pelvis x-ray were performed to evaluate vascular calcification (VC) and to calculate the Adragão score. All patients were treated with biocompatible PD solutions, with calcium concentration of 1.25 mmol/L. Results Forty-nine patients participated in the study, with 32 biopsies analyzed so far. Mean age was 52.4±10.9 years, 16 male, 6 with diabetes mellitus, 23 on manual PD, median time on PD was 22.1 (3-61) months. Mean calcium, phosphate and PTH were 9.2±0.5 mg/dL, 4.9±1.0 mg/dL and 489.87±227.8 pg/mL, respectively. Vascular calcification was detected in 29% of patients and mean Adragão score was 1.13. Essential histomorphometric and selected data is represented in table 1: Bone volume (BV) tended to be lower in diabetics - 17.1% (10.1-23.1) compared with non-diabetics – 22.6% (12.7-41.4) (p=0.07). Median bone formation rate (BFR) tended to be lower - 21.39 µm3/µm2/y (8.2-53.2) in diabetic patients than in non-diabetics - 28.63 µm3/µm2/y (3.5-89.77) (p=0.80). PTH levels also tended to be lower in diabetics – 384.8 pg/mL compared to non-diabetics – 514.1 pg/mL (p=0.14). BV tended to be lower in patients with VC – 19.1% (10.1-27) compared with patients without VC - 22.6% (12.7-41.4) (p=0.23). VC was detected on x-ray in all 6 patients with diabetes and only in 11.5% (3 in 26) of non-diabetic patients. Conclusion Similar to previous reports, the most frequent ROD pattern was ABD. However, PD patients with ABD had mean PTH of 405 pg/mL, a value well within the recommended KDIGO targets. This reinforces PTH as a far from ideal marker of bone turnover and suggests different targets for PTH levels in this seemingly highly susceptible population to ABD even when treated with low calcium dialysate. The proportion of patients with normal bone was higher than previously published. This finding can be explained by differences in the classification of ROD and prescription of biocompatible PD solutions in all patients. Diabetic patients tended to have lower BV and BFR. This finding is not surprising considering osteoblastic toxicity caused by advanced glycation end products. Also diabetic patients have a state of relative hypoparathyroidism. In conclusion, the most frequent pattern was ABD. Diabetic patients on PD may be a different subgroup.

Effects of Continuous Ambulatory Peritoneal Dialysis (CAPD) on Renal Osteodystrophy

1985 ◽  
Vol 5 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Carmelo Loschiavo ◽  
Antonia Fabris ◽  
Silvano Adami ◽  
Luciana Tomelleri ◽  
Nicola Tessitore ◽  
...  
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Renal Osteodystrophy ◽  
Bone Lesions ◽  
Vitamin D Metabolites ◽  
Vitamin D Metabolism ◽  
Mean Values ◽  
Bone Biopsies ◽  
Normal Mean

The authors performed a metabolic and morphologic investigation of calcium metabolism in 22 patients on continuous ambulatory peritoneal dialysis (CAPD), selected as the first procedure. The patients were kept on a diet containing about 30 Kcal/ kg, 1 g/kg of protein, 950 mg of phosphate and 1500 mg of calcium per day. They showed normal mean values of serum calcium, phosphate, alkaline phosphatase, total protein and albumin at the start and after six, 12 and 21 months of CAPD. Serum PTH levels showed a progressive decrease over 21 months. Serum 25-OH-D3 were low at start and showed a further decrease after 12 months of CAPD. Before and during CAPD, serum 1,25 (OH)2D3 levels were undetectable. The bone mineral content was within normal range at start and showed a slight decrease after 12 months of CAPD. In 64% of the patients, bone biopsies, obtained from the iliac crest at the start showed osteomalacia, either isolated or associated with hyperparathyroidism. After 12 months, osteomalacia was still evident in 71% of this group. The authors concluded that dietary restriction of phosphate is important in preventing secondary hyperparathyroidism in patients on CAPD. However, prevalence of osteomalacia is due to defective vitamin D metabolism and its management requires administration of vitamin D metabolites. In its morphological aspects and clinical features, renal osteodystrophy (RO) may differ significantly between patients on CAPD and those on hemodialysis (1–3). In addition, workers have reported conflicting opinions concerning the incidence and severity of bone lesions in CAPD patients (4–6). We undertook this investigation in order to evaluate the evolution and clinical, biochemical and morphologic aspects of RO in 22 ESRD patients treated with CAPD after long-term restriction of dietary protein and phosphate.

Bone Metabolism and Peritoneal Membrane Transport in Children on Chronic Peritoneal Dialysis

2003 ◽  
Vol 23 (5) ◽  
pp. 487-492 ◽  
Author(s):  
Helena Ziólkowska ◽  
Malgorzata Pańczyk-Tomaszewska ◽  
Andrzej Debiński ◽  
Andrzej Sawicki ◽  
Maria Roszkowska-Blaim
Keyword(s):  
Peritoneal Dialysis ◽  
Bone Metabolism ◽  
Glucose Concentration ◽  
Test Group ◽  
Peritoneal Membrane ◽  
Bone Formation Rate ◽  
Peritoneal Transport ◽  
Group I ◽  
Bone Biopsies ◽  
Group Ii

Objective The aim of the study was to assess the influence of peritoneal membrane permeability on bone metabolism in dialyzed children. Patients and Methods 24 children with end-stage renal failure and being treated with peritoneal dialysis (PD) were studied. The children were divided into two groups based on the results of a standard peritoneal equilibration test: group I, high peritoneal transport [ratio of dialysate glucose concentration at 4 hours to dialysate glucose concentration at 0 hours (D/D0) < 0.26, dialysate-to-serum ratio of creatinine concentration at 4 hours (D/P) > 0.81], 10 children aged 9.9 ± 2.9 years; group II, other peritoneal transport types (D/D0 > 0.26, D/P < 0.81), 14 children aged 11.4± 2.7 years. Serum levels of calcium (sCa), phosphorus (sP), protein, albumin, alkaline phosphatase (AP), and parathormone (PTH) were measured, and bone biopsies were performed in all children. Alfacalcidol and calcium carbonate doses were adjusted to sCa, sP, and PTH levels in all patients. Results No statistically significant differences (NS) between the two groups were found in age, duration of PD, sCa, sP, AP, PTH, protein, or albumin levels. The mean alfacalcidol dose was 0.055 ± 0.057 μg/kg body weight/week in group I and 0.099 ± 0.065 μg/kg/week in group II ( p = NS). In group I, the high peritoneal transport group, significantly lower osteoclast surface (OcS/BS) and bone formation rate (BFR/TV) were found compared with group II (3.1% ± 1.7% vs 4.6% ± 2.0%, and 483.5 ± 329.2 μm3/mm2/day vs 913.9 ± 558.3 μm3/mm2/day, respectively, p < 0.05). We also found significant positive correlation between D/D0 and BFR/TV and OcS/BS ( r = 0.45, p < 0.05). Conclusion Bone turnover in children treated with PD may depend on peritoneal permeability.

SO074VASCULAR CALCIFICATION IN PREVALENT PERITONEAL DIALYSIS PATIENTS AND ITS RELATIONSHIP WITH CLINICAL AND BONE HISTOMORFOMETRIC PARAMETERS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Luciano Pereira ◽  
Juliana Magalhães ◽  
Ricardo Neto ◽  
Ana Oliveira ◽  
Ana Beco ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Calcium Phosphate ◽  
Sedimentation Rate ◽  
Bone Disease ◽  
Bone Biopsy ◽  
Bone Volume ◽  
Phosphate Binders ◽  
Diabetic Patients ◽  
X Ray ◽  
The Relationship

Abstract Background and Aims Vascular calcification (VC) is associated to morbidity and mortality in chronic kidney patients. However, it remains to clarify the relationship between VC and renal osteodystrophy (ROD) evaluated by bone biopsy in peritoneal dialysis (PD) patients. Method In order to characterize the relationship between VC and ROD in prevalent PD population, we performed tetracycline-labelled bone biopsies with histomorphometric analysis according KDIGO guidelines. Hands and pelvis x-ray were performed to evaluate VC and to calculate Adragão Score. Exclusion criteria: previous kidney transplant, hemodialysis, treatment with agents interfering in bone metabolism (for example bisphosphonates). All patients were treated with biocompatible PD solutions, with calcium concentration of 1.25 mmol/L. Results Thirty-one patients participated in the study. Mean age was 52.32±11.09 years, 16 male, 6 with diabetes mellitus (DM), 22 on manual PD, median time on PD was 12 (3-61) months. Mean calcium, phosphate and PTH were 9.2±0.5 mg/dL, 4.9±1.0 mg/dL and 486.0±230.5 pg/mL, respectively. Most frequent diagnosed ROD pattern was adynamic bone disease (44.4%) followed by hiperparathyroid bone disease (33.3%) and normal bone (14.8%). VC was detected in 29% of patients and mean Adragão score was 1.13. However, 100% of diabetics had VC on x-ray compared to 12% of non-diabetics. Clinical, analytical and histomorphometric essential data is represented in table 1: Also no significant differences were observed between the patients with or without VC in ROD patterns on bone biopsy, glucose load in PD solutions, prescribed phosphate binders namely calcium-based binders, active vitamin D or calcimimetics. In diabetic patients, bone volume tended to be lower (17.26% vs 22.54%; p=0.072) comparing to non-diabetics. Bone formation rate was similar in diabetics and non-diabetics (25.39 vs 27.71µm3/µm2/y) as mineralization lag time (18.7 vs 20.1 days). Conclusion ROD evaluated by bone biopsy and the proportion of PD patients with VC on x-ray were similar to previous reports. However, in the present study a striking difference in VC was detected in diabetics – all diabetic patients had VC demonstrated radiographically. This finding was not explained by differences in calcium, phosphate, PTH levels or other studied factors. So DM could be a strong risk factor to VC in this population. Also, patients with VC were older, with higher sedimentation rate and lower total KT/V. It is possible that diabetic patients represent a different subgroup, particularly prone to lower bone volume and specially VC. They might benefit from higher dialysis dose and aggressive approaches to prevent or retard VC. This remains to be proved in properly designed prospective studies. In conclusion, age, sedimentation rate, total KT/V and presence of diabetes were associated to VC in prevalent PD patients. Diabetics may be a subgroup of PD patients with very high risk of VC.

MO568STATIC PARAMETERS OF HISTOMORPHOMETRY FOR THE EVALUATION OF BONE TURNOVER IN RENAL OSTEODYSTROPHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hanne Skou Jørgensen ◽  
Geert Behets ◽  
Patrick D'Haese ◽  
Pieter Evenepoel
Keyword(s):  
Bone Turnover ◽  
Diagnostic Accuracy ◽  
Renal Osteodystrophy ◽  
Bone Biopsy ◽  
Bone Formation Rate ◽  
Suitable Alternative ◽  
Predictive Values ◽  
Bone Biopsies ◽  
Low Bone Turnover ◽  
Tetracycline Labeling

Abstract Background and Aims A full histomorphometric analysis of a transiliac bone biopsy with prior tetracycline labeling remains the gold standard to diagnose renal osteodystrophy. Bone turnover is primarly evaluated by the dynamic parameter bone formation rate, calculated from the incorporation of tetracycline in bone. In cases of failed tetracycline labels, however, an evaluation of bone turnover based on static parameters is warranted. This study investigates the diagnostic accuracy of static histomorphometric parameters for the diagnosis of high and low bone turnover. Method Bone biopsies with prior tetracycline labeling of sufficient quality for a full histomorpometric analysis were included (n = 205). Mean age of participants was 56±13 years, 67% were men, and 22% had diabetes mellitus. Diagnostic accuracy of static histomorphometric parameters for bone turnover was evaluated by area under the receiver operator characteristics curve (AUC) statistics, against the full set of static and dynamic histomorphometric parameters. The cohort was randomly split to allow calculation of optimal diagnostic cutoffs in an exploration cohort (n=105), with subsequent validation in a separate subset of patients (n=100). Results All histomorphometric parameters were significantly different across categories of low (24%), normal (60%), and high (16%) bone turnover (p &lt; 0.01), and all were significant predictors of both high and low bone turnover (Figure 1). Calculated optimal cutoffs and their sensitivities and specificities in the validation cohort are shown in Table 1. Diagnostic accuracy was very good for high turnover, as the combination of presence of fibrosis with ObPm&gt;5.4%, OcPm&gt;1.5%, and OAr&gt;2.4% provided a correct diagnosis in 94% of patients, with positive (PPV) and negative (NPV) predictive values of 80% and 96%, respectively. Using the same predefined combination, an accuracy of 80% was achieved for low turnover (no fibrosis, ObPm≤1.9% OcPm≤0.9% and OAr≤1.6%), with a PPV of 71% and a NPV of 82%. Conclusion Static histomorphometric parameters provide an acceptable alternative for the diagnosis of high and low bone turnover. In the absence of successful tetracycline labeling, the proposed cutoffs may provide a suitable alternative for the evaluation of bone turnover in renal osteodystrophy.

scholarly journals Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258284
Author(s):  
Ricardo Neto ◽  
Luciano Pereira ◽  
Juliana Magalhães ◽  
Janete Quelhas-Santos ◽  
João Frazão
Keyword(s):  
Bone Formation ◽  
Bone Turnover ◽  
Vascular Calcification ◽  
Formation Rate ◽  
Common Finding ◽  
Multivariable Logistic Regression Analysis ◽  
Bone Formation Rate ◽  
X Ray ◽  
Cardiovascular Morbidity And Mortality ◽  
Low Bone Turnover

Background Vascular calcification (VC) is a common finding in chronic kidney disease (CKD) patients and predicts subsequent cardiovascular morbidity and mortality in this population. Vascular calcification is linked to disordered mineral metabolism and has been associated with bone histomorphometry changes in CKD. However, data on predialysis patients is scarce. Methods A cross-sectional study was conducted on a cohort of 56 CKD patients not yet on dialysis, who underwent a transiliac bone biopsy for histomorphometric evaluation after double tetracycline labeling. Patients had no previous exposure to calcium salts, vitamin D agents, steroids or bisphosphonates. Vascular calcification was assessed at the time of biopsy, using Kauppila (plain X-ray of the lateral lumbar spine) and Adragão (plain X-ray of the pelvis and hands) scores. Results Vascular calcification was seen in two-thirds of the cohort. Subjects with VC were more likely to be male and have diabetes, and had significantly higher sclerostin and osteoprotegerin circulating levels than those without VC. The histomorphometric analysis showed that bone formation rate was significantly lower in VC compared to non-VC patients. In the multivariable logistic regression analysis, bone formation rate was independently associated with the presence of VC. Conclusions Vascular calcification is highly prevalent in predialysis patients, especially in those with diabetes. The independent association between bone formation rate and VC provides evidence of an important interaction between bone and vessel in CKD. Our results suggest that low bone turnover is a non-traditional risk factor for cardiovascular disease in predialysis patients.

scholarly journals Relationship between Vascular Calcification, Protein-Energy Wasting Syndrome, and Sarcopenia in Maintenance Automated Peritoneal Dialysis

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 666
Author(s):  
Gustavo Leal-Alegre ◽  
Claudia Lerma ◽  
Gabriela Leal-Escobar ◽  
Bernardo Moguel-González ◽  
Karen Belén Martínez-Vázquez ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Vascular Calcification ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Wasting Syndrome ◽  
Protein Energy ◽  
Inflammation Score

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

scholarly journals Low plasma magnesium concentration and future abdominal aortic calcifications in moderate chronic kidney disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anique D. ter Braake ◽  
◽  
Larissa P. Govers ◽  
Mieke J. Peeters ◽  
Arjan D. van Zuilen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Disease Risk ◽  
Statistical Significance ◽  
Cardiovascular Disease Risk ◽  
Magnesium Concentration ◽  
X Ray ◽  
Abdominal Aortic ◽  
Plasma Magnesium

Abstract Background Higher plasma magnesium concentrations are associated with reduced cardiovascular disease risk in chronic kidney disease (CKD) patients. The importance of plasma magnesium concentration for vascular calcification in earlier stages of CKD remains underexplored. This study investigated whether plasma magnesium is a determinant for the presence and severity of vascular calcification in moderate CKD. Methods Retrospective analysis was performed using abdominal aortic calcification (AAC) scores in 280 patients with stage 3 and 4 CKD enrolled in the MASTERPLAN trial. Lateral abdominal X-ray was used to evaluate AAC. Plasma magnesium concentration were measured over time. A zero-inflated Poisson model determined the association between plasma magnesium concentration and AAC. Results 79 out of 280 patients did not have AAC, and in patients with AAC the median calcification score was 3.5 (interquartile range: 0.0–8.6). The mean plasma magnesium concentration was 0.76 ± 0.10 mmol/L at baseline. A 0.1 mmol/L higher plasma magnesium concentration was associated with lower AAC of 0.07 point (95% CI -0.28 – 0.14). A 0.1 mmol/L higher plasma magnesium lowered the odds of detecting any AAC by 30% (OR = 0.63; 95% CI 0.29–1.37). After 1 year and 4 years (at time of X-ray) of follow-up this association was attenuated (OR = 0.93; 95% CI 0.61–1.43 and 0.93; 95% CI 0.60–1.45, respectively). None of these associations reached statistical significance. Conclusions Plasma magnesium concentration at baseline is not associated with the risk for future AAC. Interventions increasing magnesium to avoid vascular calcification may have greatest potential in early CKD stages prior to onset of vascular calcification.

Comparative study of quantitative ultrasonography and dual-energy X-ray absorptiometry for evaluating renal osteodystrophy in children with chronic kidney disease

2010 ◽  
Vol 29 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Athanasios Christoforidis ◽  
Nikoleta Printza ◽  
Chrysa Gkogka ◽  
Ekaterini Siomou ◽  
Anna Challa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Comparative Study ◽  
Renal Osteodystrophy ◽  
Dual Energy ◽  
X Ray ◽  
Quantitative Ultrasonography
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