MO574MINERAL AND BONE DISORDERS CHANGES IN RENAL TRANSPLANTED PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ana Carina Ferreira ◽  
Marco Mendes ◽  
Cecília Silva ◽  
Patrícia Cotovio ◽  
Inês Aires ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Bone Biopsy ◽  
Serum Levels ◽  
Agatston Score ◽  
Vascular Calcifications ◽  
Bone Disorders ◽  
X Ray ◽  
Bone Disorder ◽  
Echocardiographic Findings

Abstract Background and Aims Successful renal transplant restores many physiologic abnormalities, including improvement of chronic kidney disease- mineral and bone disorder (CKD-MBD) syndrome. The primary aims of this study were: analyse the changes and evolution of the 3 components of CKD-MBD pre and 1 year post renal transplantation: the mineral abnormalities, the bone disorders and the vascular calcifications; and to correlate fibroblast grow factor 23 (FGF23), klotho and sclerostin serum levels with bone histomorphometric parameters and CV disease. The secondary aims were to study the evolution of other bone related parameters and correlate those with bone biopsies data, as well as to validate Adragão vascular calcification score in a population of renal transplant patients. Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (for Adragão score) and echocardiographic findings were recorded. All patients were submitted to a bone biopsy and laboratorial evaluation at baseline (time 0 – T0). Patients were followed for 12 months (time 1 – T1), after which performed laboratorial evaluation, a 2nd bone biopsy, echocardiogram, X-ray of pelvis and hands, bone densitometry and non-contrast cardiac CT (Agatston score). Continuous variables are presented as medians and categorical variables as frequencies. Differences between T0 and T1 were accessed by Wilcoxon matched-pairs test and paired McNemar test. Correlations between bone histomorphometric findings and severity of vascular calcifications with demographic and laboratorial parameters were obtained with Wilcoxon rank-sum test or Kruskall Wallis test. STATA software was used and p < 0.05 was considered statistically significant. Results We recruited 84 patients in a 28 month-period. At the end of 12 months, 69 patients performed a 2nd evaluation. Median age 53 years, 48 men, 53 caucasian, median dialysis vintage 55 months. We observe a significant reduction on phosphorus, magnesium, PTH, calcitonin, sclerostin, bone alkaline phosphatase and FGF23. Both calcium and alpha-klotho serum levels increase, with no significant changes in vitamin D levels. 68% of the patients presented renal osteodystrophy at the 2nd bone biopsy, and we observed a significant increase in the development of low turnover bone disorder, with no major changes in volume or mineralization. Changes in alpha-klotho, bAP and sclerostin (from T0 to T1) were important determinants of changes in turnover, mineralization and volume, respectively. Despite not being statistically significant, we were able to observe an improvement in the cortical bone porosity. Vascular calcifications and echocardiographic findings weren’t different comparing to the baseline (Median Adragão score was 1 in both evaluations, and valve calcifications were present in 22% and 23% of patients, with no changes in LVMI). The median Agatston score was 48.5, being the median adjusted percentile of 82%. FGF23 and sclerostin were found to be independent risk factors for extra-osseous calcifications, as well as low bone volume, cortical porosity and osteoid volume. Adragão score and valve calcifications correlated well with the increased severity of coronary calcifications determined by Agatston score (absolute and percentile). Conclusion In conclusion, renal transplantation improves two of the three components of CKD-MBD (biochemical and bone disorders), slowing the progression of vascular calcifications. FGF23, sclerostin and bAP seemed to be key parameters in understanding the bone changes observed in post transplant period, and these hormones also interfere with extra osseous calcification severity. Adragão score seems to be a good tool to access vascular calcifications in renal transplanted patients.

scholarly journals P1675BONE DENSITOMETRY IN RENAL TRANSPLANTED PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Carina Ferreira ◽  
Marco Mendes ◽  
Cecília Silva ◽  
Patrícia Cotovio ◽  
Inês Aires ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Negative Correlation ◽  
Bone Biopsy ◽  
Agatston Score ◽  
Z Score ◽  
Vascular Calcifications ◽  
X Ray ◽  
T Score ◽  
Neck Fracture ◽  
Z Scores

Abstract Background and Aims Renal transplant and associated immunosuppression can influence bone volume. Presently, the data is conflicting with older studies showing bone loss after transplant, while recent ones didn’t conclude the same. The aim of this study was to analyse the relations between bone-related molecules [phosphorus (Pi), Calcium (Ca), Magnesium (Mg), parathyroid hormone (PTH), bone alkaline phosphatase (bAP), calcitonin, vitamin D (vitD), alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] and bone densitometry findings in renal transplanted patients. Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (Adragão score) and echocardiographic findings were recorded. All patients were submitted to a laboratorial evaluation and a bone biopsy at baseline (time 0). Patients were followed for 12 months, after which performed laboratorial evaluation, 2nd bone biopsy, echocardiogram, X-ray of pelvis and hands, bone densitometry (DXA) and non-contrast cardiac CT for Agatston score (time 1). Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon matched-pairs test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant. Results We recruited 85 patients from 1st October 2015 to 1st March 2018. At the end of 12 months, 6 patients refuse to perform the 2nd evaluation, 5 had primary non-function of the kidney graft, 1 had no 1st bone biopsy sample in time 0 and 4 patients died. We performed a 2nd evaluation in 69 patients and included those in this study. Mean age 50.2±12.4 years, 48 men, 53 caucasian (78.8%), median BMI 24.5 (22.7 – 27.8), median dialysis vintage 55 months (42 – 84). Patients had a median cumulative steroid dose of 5692.5 (5260 – 7250) mg. At 12 months, the median FRAX value for osteoporotic fracture was 3.5 (2.2 – 6.2) and for femoral neck fracture was 0.8 (0.2 – 2.7). The DXA findings are shown in Table 1. We found a negative correlation between vascular calcifications (Agatston Score and respective calcium percentile) and T and Z score of femoral neck (p=0.04), but not with the other DXA variables. Total femur variables (DMO, T-score, Z-score) were correlated with sclerostin values in time 1 (p<0.01), and there was a trend for correlation between the spine DXA variables (DMO, T-score, Z-score) and sclerostin in time 1 (p=0.08, p=0.07, p=0.04). Spine DXA variables were negatively associated with alpha-klotho in time 0 (p=0.04, p=0.05, p=0.06). We didn’t found correlations with Pi, Ca or bAP. There was a negative correlation between FRAX osteoporotic and femoral neck fracture values and alpha-klotho in time 1 (p=0.002; p=0.003). Conclusion We found an inverse correlation between T and Z scores of femoral neck and coronary vascular calcifications. Regarding bone-derived hormones, Spine T and Z scores and FRAX values negatively correlated with alfa-klotho. Sclerostin seems to be associated with high mineral density.

scholarly journals P1696VASCULAR CALCIFICATION IN RENAL TRANSPLANTED PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Carina Ferreira ◽  
Marco Mendes ◽  
Cecília Silva ◽  
Patrícia Cotovio ◽  
Inês Aires ◽  
...  
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Bone Biopsy ◽  
Vascular Calcifications ◽  
X Ray ◽  
Time Points ◽  
Progression Of Vascular Calcifications

Abstract Background and Aims Chronic kidney disease – mineral and bone disorder (CKD-MBD) is a well-known syndrome in end stage renal disease. Vascular calcifications are one of its components. Renal transplantation seemed to halt the progression of vascular calcifications. The aim of this study was to analyse the progression of vascular calcifications in a cohort of renal transplanted patients, and the associations of those with the old and new bone-derived hormones. Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. All patients were submitted to a bone biopsy and laboratorial evaluation at baseline (time 0) including measurements of calcium (Ca), phosphorus (Pi), magnesium (Mg), vitamin D (vitD), calcitonin, parathyroid hormone (PTH), bone alkaline phosphatase (bAP) and total alkaline phosphatase (tAP), alpha-klotho, fibroblast grow-factor 23 (FGF23) and sclerostin. Patients were followed for 12 months, after which performed a second bone biopsy and laboratorial evaluation (time 1). At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (Adragão score) and echocardiographic findings were recorded. At the end of the study, echocardiogram, X-ray of pelvis and hands, bone densitometry and non-contrast cardiac CT (Agatston score) were performed. Immunosuppression included induction therapy followed by tacrolimus, mycophenolate mofetil and prednisolone. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant. Results We recruited 85 patients from 1st October 2015 to 1st March 2018. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%), median BMI 25.1±3.4. At the end of 12 months, 6 patients refuse to perform the 2nd evaluation, 5 had primary non-function of the kidney graft, 1 had no sample on bone biopsy in time 0 and 4 patients died. We performed a 2nd evaluation in 69 patients and included those in this study. The median baseline and 12 months Adragão score had no differences [1 (0 – 2)]. The median coronary artery calcium score was 48.5 (0 – 535) and median percentile was 80 (0 – 92.5). Valvular calcifications were present in 15 and 16 patients at baseline and after 1 year respectively, with no statistical difference between the two time points. Coronary artery calcium scores were correlated with age (p<0.001), two time points Adragão score (p<0.001), presence of valvular calcification in time 1 evaluation (p=0.004), baseline calcium (p=0.02), baseline and 1-year sclerostin (p=0.01; p=0.04). Coronary artery calcium scores were higher in patients with highest values of FGF23 at baseline (p=0.04). Using a pairwise correlation, vitamin D levels (r=0.4, p=0.0004), iPTH (r=0.6, p<0.001) and total cholesterol levels (r=-0.3, p=0.01) were correlated with the score. Coronary calcium Percentile (adjusted for age, gender and race) was correlated with Adragão score in the two time points (p=0.0001; p=0.002), with presence of valvular calcifications in time 1 evaluation (p=0.02), baseline and 1-year calcium serum levels (p=0.004; p=0.02) and baseline sclerostin (p=0.01). Conclusion In conclusion, vascular calcifications stabilize after renal transplant. Adragão score, that is a less expensive exam than cardiac CT, can assess vascular calcifications in renal transplanted patients. Only calcium and sclerostin correlated with both Agatston scores and coronary calcium percentiles.

scholarly journals P1418BONE-DERIVED HORMONES, MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT OUTCOME IN END-STAGE RENAL PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Carina Ferreira ◽  
Marco Mendes ◽  
Cecília Silva ◽  
Patrícia Cotovio ◽  
Inês Aires ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Mineral Metabolism ◽  
Bone Biopsy ◽  
Left Ventricular ◽  
Categorical Variables ◽  
Vascular Calcifications ◽  
Mineral And Bone Disorder ◽  
Dialysis Vintage ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease ESRD (ESRD) patients, increasing morbid-mortality. The aim of this study was to analyse the associations between the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] and the usual markers of the disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)], as well echocardiographic findings [left ventricular mass index (LVMI) measured by Devereux formula, valvular calcifications], vascular calcifications and patients outcomes. Method We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation, bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant. Results We included 85 patients. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%). The median LVMI was 108.5 (92 – 129) g/m2, with 32 patients presenting LVH and 19 valvular calcifications. Median Adragão score was 1 (0 – 2). At the end of 12 months, 4 patients died and 5 had graft failure (non-primary function). Alpha-klotho correlated with bAP (p=0.0006) and marginally with PTH and absence of valvular calcifications (p=0.05). FGF23 correlated with Pi (p<0.001), Ca (p=0.004), PTH (p=0.003), Mg (p=0.002), and inversely with bAP (p=0.003). There was a marginal association with Adragão score (p=0.06). We didn’t found correlations between FGF23 and alpha-klotho or dialysis vintage or echocardiographic characteristics. Sclerostin correlated negatively with bAP (p=0.007) and PTH (p=0.04). The 3rd sclerostin tertile was associated with high scores of vascular calcifications (p=0.02). Lower levels of sclerostin were associated with patient survival at the end of 12 months (p=0.02). Conclusion From these 3 new bone-derived hormones, sclerostin, a bone formation inhibitor, seems to act as a risk factor for vascular calcifications and worse outcomes.

P1680MINERAL METABOLISM CHANGES AFTER RENAL TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Carina Ferreira ◽  
Marco Mendes ◽  
Cecília Silva ◽  
Patrícia Cotovio ◽  
Inês Aires ◽  
...  
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Negative Correlation ◽  
Bone Biopsy ◽  
Serum Levels ◽  
Bone Alkaline Phosphatase ◽  
X Ray ◽  
Time Points ◽  
Post Transplant ◽  
Vitamin D Levels

Abstract Background and Aims Successful renal transplant restores many physiologic abnormalities, including improvement of chronic kidney disease-mineral and bone disorder (CKD-MBD) syndrome, and modifications of bone-related molecules in disease and health can help to understand pathophysiology of this syndrome. The aim of this study was to analyse the evolution of some of the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] pre and post transplantation and the associations between those and the usual markers of the CKD-MBD disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), calcitonin, vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)] pre and post transplant. We also looked at the differences between values in the two time-points (delta). Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (for Adragão score) and echocardiographic findings were recorded. All patients were submitted to a bone biopsy and laboratorial evaluation at baseline (time 0). Patients were followed for 12 months (time 1), after which performed laboratorial evaluation, a second bone biopsy, echocardiogram, X-ray of pelvis and hands, bone densitometry and non-contrast cardiac CT (Agatston score). Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon matched-pairs test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant. Results We recruited 85 patients from 1st October 2015 to 1st March 2018. At the end of 12 months, 6 patients refuse to perform the 2nd evaluation, 5 had primary non-function of the kidney graft, 1 had no sample on bone biopsy in time 0 and 4 patients died. We performed a 2nd evaluation in 69 patients and included those in this study. Mean age 50.2±12.4 years, 48 men, 53 caucasian (78.8%), median BMI 24.5 (22.7 – 27.8), median dialysis vintage 55 (42 – 84). We observe a significant reduction on phosphorus (delta: -1.1 mg/dl), magnesium (delta: -0.5 mg/dl), PTH (delta: -297.7 pg/ml), Calcitonin (delta: -0.9 ng/L), sclerostin (delta: -1.1 ng/ml), bone alkaline phosphatase (delta: -11.5 U/L) and FGF23 (delta: -1656.5 RU/ml). Both calcium (delta: 0.7 mg/dl) and alpha-klotho (delta: 265.7 pg/ml) serum levels increase, with no significant changes in vitamin D levels. With restoring renal health (time 1) and comparing with time 0, PTH maintain the negative correlation with sclerostin (p=0.02) and the positive correlation with FGF23 (p=0.0002) as in time 0; modify the correlation with Pi, becoming a negative correlation instead of positive (p=0.001) and gain new correlations with Ca (p=0.001) and vitamin D levels (p=0.03). Also, PTH correlated with the delta FGF23 (rho=-0.4, p=0.003) and sclerostin correlated with delta PTH (p=0.01). FGF23 didn’t associate with delta PTH, neither PTH associated with delta sclerostin. FGF23 didn’t reveal statistical association with Pi or Ca levels after transplant, contrasting with positive associations in pre transplant (p=0.002, p<0.0001). On the contrary, sclerostin developed a new correlation with Pi (p=0.0004) and a negative correlation with Ca (p=0.01). We didn’t find correlations between these molecules and alpha-klotho. Conclusion In conclusion, it seems that sclerostin influences PTH levels and that PTH is the stimulus for the increase or decrease of FGF23 serum levels (as we found a positive association between those two molecules in both time-points and a negative association between PTH and the difference of FGF23 pre and post transplant). Levels of Ca and Pi seemed to be directly influenced by the level of PTH in post transplant, and those minerals seemed to be key factors for sclerostin secretion.

scholarly journals Small bowel obstruction due to retroperitoneal hernia following renal transplant: a case report

2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
Atta Nawabi ◽  
Adam C Kahle ◽  
Clay D King ◽  
Perwaiz Nawabi
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Common Type ◽  
Postoperative Phase ◽  
Oral Contrast ◽  
Large Defect ◽  
Retroperitoneal Dissection ◽  
Unclear Etiology

Abstract Para duodenal hernias, the most common type of retroperitoneal hernias, are thought to occur naturally from abnormal gut rotation because of fusion folds within the peritoneum. Retroperitoneal hernias are a rare postoperative complication and have not been described after renal transplantation via a retroperitoneal approach. This case report presents a 48-year-old male with intestinal obstruction after renal transplant due to herniation into the retroperitoneum via an incidentally created peritoneal defect. We suggest computed tomography with oral contrast be used in the early postoperative phase to assess for obstruction in patients with prolonged ileus of unclear etiology who have undergone retroperitoneal dissection. Small peritoneal defects should be closed during dissection. Larger, or multiple peritoneal defects should be extended to make a single, large defect to decrease the possibility of bowel herniating and becoming incarcerated.

Possibilities and limits of X-ray microtomography for in vivo and ex vivo detection of vascular calcifications

2009 ◽  
Vol 25 (6) ◽  
pp. 615-624 ◽  
Author(s):  
A. A. Postnov ◽  
P. C. D’Haese ◽  
E. Neven ◽  
N. M. De Clerck ◽  
V. P. Persy
Keyword(s):  
Ex Vivo ◽  
Vascular Calcifications ◽  
X Ray

Bicêtre hospital experience with sirolimus-based therapy in human renal transplantation: the sirolimus European renal transplant study

2003 ◽  
Vol 35 (3) ◽  
pp. S58-S61 ◽  
Author(s):  
B Charpentier ◽  
C.G Groth ◽  
L Bäckman ◽  
J.-M Morales ◽  
R Calne ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Hospital Experience

scholarly journals Effects of the Use of Non-Calcium Phosphate Binders in the Control and Outcome of Vascular Calcifications: A Review of Clinical Trials on CKD Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Piergiorgio Bolasco
Keyword(s):  
Calcium Phosphate ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Phosphate Binders ◽  
Vascular Calcifications ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Advanced Stages ◽  
The Impact ◽  
Specific Contribution

Vascular calcifications produce a high impact on morbidity and mortality rates in patients affected by chronic kidney disease and mineral bone disorder (CKD-MBD). Effects are manifested from the more advanced stages of CKD (stages 3-4), particularly in patients undergoing dialysis (CKD5D). In recent years, a large number of therapeutic options have been successfully used in the treatment of secondary hyperparathyroidism (SHPT), despite eliciting less marked effects on nonbone calcifications associated with CKD-MBD. In addition to the use of Vitamin D and analogues, more recently treatment with calcimimetic drugs has also been undertaken. The present paper aims to analyze comparative and efficacy studies undertaken to assess particularly the impact on morbidity and mortality rates of non-calcium phosphate binders. Moreover, the mechanism of action underlying the depositing of calcium and phosphate along blood vessel walls, irrespective of the specific contribution provided in reducing the typical phosphate levels observed in CKD largely at more advanced stages of the disease, will be investigated. The aim of this paper therefore is to evaluate which phosphate binders are characterised by the above action and the mechanisms through which these are manifested.

MO580HYPOPROTEIC DIET SUPPLEMENTED WITH KETOANALOGUES IN PATIENTS WITH ADVANCED DIABETIC KIDNEY DISEASE – EFFECTS ON MINERAL BONE DISORDERS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Liliana Garneata ◽  
Carmen-Antonia Mocanu ◽  
Tudor Petrisor Simionescu ◽  
Andreea Elena Mocanu ◽  
Gabriel Mircescu
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Serum Levels ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Diabetic Patients ◽  
Bone Disorders ◽  
Diabetic Kidney ◽  
Low Protein ◽  
Ckd Stage

Abstract Background and Aims Dietary protein restriction is rediscussed as mainstay approach in advanced Chronic Kidney Disease (CKD), both in diabetics and non-diabetics to defer renal replacement therapy (RRT), mainly by better metabolic control; improvements in mineral bone disorders (MBD) were also suggested, but less studied in Diabetic Kidney Disease (DKD). An unicentric prospective interventional trial aimed to assess the effects of ketoanalogue-supplemented low protein diet (sLPD) on proteinuria and CKD progression (data already presented). The parameters of MBD were also evaluated. Method Adult diabetic patients (452) with stable CKD stage 4+, proteinuria>3g/g creatininuria and SGA A were enrolled in a run-in phase (3 mo), with LPD (0.6g/kg dry ideal bw). Those who proved adherent (92, 64% males, median age 55.7 yrs, 65% on insulin) received sLPD (Ketosteril®, 1 tablet/10kg) for 12mo. Monitoring and treatment followed the Best Practice Guidelines. The primary endpoint was proteinuria during intervention as compared to pre-enrolment. Serum levels of calcium, phosphates and iPTH were considered to assess MBD. Nutrition, inflammation (SGA, BMI, serum albumin, CRP) and compliance were safety parameters. Results In patients with advanced DKD and severe proteinuria, sLPD was associated with a 69 (63; 82) % reduction in proteinuria (data presented). Significant amelioration in MBD was noted: serum levels of calcium and phosphates were significantly ameliorated at the end of the study as compared to enrolment - 4.3 (4.2-4.9) vs 3.2 (3.1-3.5) mg/dL and 5.4 (4.9-6.1) vs 8.2 (7.8-8.9) mg/dL, respectively. Serum iPTH significantly decreased: 185 (168-212) vs 375 (354-585) pg/mL. The need for calcium supplementation decreased: 6.5 (6.0-6.7) vs 7.0 (6.8-7.3) g/day. Vitamin D was required by only 35% vs 65% of patients. Nutritional status was preserved and dietary compliance was very good throughout the study. Conclusion In patients with advanced DKD ketoanalogue supplemented low protein diet seems to be effective and safe as part of MBD management.

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