MO944BONE DISEASE AFTER KIDNEY TRANSPLANTATION - (SUBTOTAL) PARATHYROIDECTOMY REDUCES FRACTURE RISK

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ulrich Jehn ◽  
Anja Kortenhorn ◽  
Katharina Schütte-Nütgen ◽  
Markus Strauss ◽  
Hermann Josef Pavenstädt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Fracture Risk ◽  
Protective Factor ◽  
Active Vitamin ◽  
Pathological Fractures ◽  
Subtotal Parathyroidectomy ◽  
Active Vitamin D ◽  
Mineral Bone Disorder ◽  
Bone Disorder

Abstract Background and Aims Kidney transplant recipients can be considered as high-risk collective for pathological fractures, since diverse risk factors leading to mineral bone disorder (MBD) and osteoporosis accumulate in this setting. (Subtotal) parathyroidectomy (PTX) is indicated for ESRD patients with secondary hyperparathyroidism (sHPT) who do not respond to drug therapy adequately. This study aims to identify influencable factors that are associated with pathological fractures and bone disease in KTX recipients. Method We conducted a retrospective study involving 722 adult patients with a total of 4686 patient-years who were transplanted at our center between January 2007 and June 2015. The clinical patient data was extracted from the patients’ electronic files. Different laboratory and clinical parameters for mineral bone disorder and osteoporosis including medication were evaluated. As primary endpoint we chose fracture events that were not related to malignancies or adequate trauma. Results 47 (6,5%) of the patients suffered from pathologic fracture events during the follow-up period. 124 of the patients (17.2%) underwent PTX. In 112 of these patients (90.3%), PTX was performed prior to kidney transplantation (KTx), in 12 patients PTX took place after KTx. Median time for PTX in relation to KTx was 3.7 years prior to KTx (IQR 5.43). Only 1 (2,2%) of the patients with fracture events has received PTX beforehand compared to 124 (19,2%) of the patients without fractures. Adjusted for the well-known fracture risk factors for mineral bone disease and osteoporosis which include female sex, age and dialysis vintage, PTX remains a significant protective factor against fractures after KTx in multivariable Cox regression analysis (HR 0.124, p=0.041) and in Kaplan-Meier analysis (Figure 1). Serum calcium levels were significantly lower in patients after PTX (p<0.001). Active Vitamin D was applicated in patients after PTX more frequently (40.0% vs. 22.7%, p<0.001) Conclusion Our study reveals PTX as a protective factor regarding pathological fractures after KTx. As these patients show lower serum calcium levels, one explanation for this finding could be a more generous supplementation of these patients with active vitamin D, which is known to increase bone mineral density and to reduce fracture risk. Therefore, considering that hypoprathyroidism following PTX after KTx and low plasma-PTH levels correlate with significant decrease of renal function, patients on conservative sHPT therapy should be treated with active vitamin D preparations more generously and special attention should be paid on bone metabolism.

scholarly journals Chronic KidneY Disease-Mineral Bone Disorder in the Elderly Peritoneal Dialysis Patient

2015 ◽  
Vol 35 (6) ◽  
pp. 640-644 ◽  
Author(s):  
James Goya Heaf
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Fracture Risk ◽  
Dialysis Patient ◽  
The Elderly ◽  
Active Vitamin ◽  
Mineral Bone Disorder ◽  
Bone Disorder

Purpose The purpose of this paper was to review the literature concerning the treatment of chronic kidney disease-mineral bone disorder (CKD-MBD) in the elderly peritoneal dialysis (PD) patient. Results Chronic kidney disease-mineral bone disorder is a major problem in the elderly PD patient, with its associated increased fracture risk, vascular calcification, and accelerated mortality fracture risk. Peritoneal dialysis, however, bears a lower risk than hemodialysis (HD). The approach to CKD-MBD prophylaxis and treatment in the elderly PD patient is similar to other CKD patients, with some important differences. Avoidance of hypercalcemia, hyperphosphatemia, and hyperparathyroidism is important, as in other CKD groups, and is generally easier to attain. Calcium-free phosphate binders are recommended for normocalcemic and hypercalcemic patients. Normalization of vitamin D levels to > 75 nmol/L (> 30 pg/L) and low-dose active vitamin D therapy is recommended for all patients. Hyperparathryoidism is to be avoided by using active vitamin D and cinacalcet. Particular attention should be paid to treating protein malnutrition. Fracture prophylaxis (exercise, use of walkers, dwelling modifications) are important. Hypomagnesemia is common in PD and can be treated with magnesium supplements. Vitamin K deficiency is also common and has been identified as a cause of vascular calcification. Accordingly, warfarin treatment for this age group is problematic. Conclusion While treatment principles are similar to other dialysis patient groups, physicians should be aware of the special problems of the elderly group.

Risk Factors for Peritoneal Dialysis–Associated Peritonitis: The Role of Oral Active Vitamin D

2010 ◽  
Vol 30 (5) ◽  
pp. 541-548 ◽  
Author(s):  
Michael Rudnicki ◽  
Julia Kerschbaum ◽  
Johann Hausdorfer ◽  
Gert Mayer ◽  
Paul König
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Concomitant Medication ◽  
Mortality Data ◽  
Active Vitamin ◽  
Baseline Serum ◽  
Laboratory Parameters ◽  
Active Vitamin D

BackgroundPeritonitis is a major complication of peritoneal dialysis (PD), being associated with hospitalization, catheter loss, technique failure, and increased mortality. Data on various risk factors for peritonitis are inconsistent, and no association with concomitant therapy has been shown.MethodsWe performed a retrospective analysis of all incident and prevalent PD patients ( n = 55) treated in Innsbruck, Austria, between 2000 and 2007. Data consisted of 1291 patient–months and 55 episodes of peritonitis. Patient demographic data, comorbidities, concomitant medication, laboratory parameters, and microbiology results were obtained from the medical records and from the hospital's electronic database.ResultsThe mean peritonitis incidence rate was 0.51 episodes/patient–year (range: 0.24 – 0.73 episodes/patient–year) or 1 episode every 23.5 months (range: 16 – 50 months). In a primary analysis including demographic characteristics, comorbidities, laboratory parameters, and concomitant medication, only treatment with oral active vitamin D was associated with a significantly lower risk of peritonitis. Adjusted for time on PD and baseline serum albumin, oral active vitamin D therapy was associated with an 80% reduced relative risk of peritonitis [hazard ratio (HR): 0.20; 95% confidence interval (CI): 0.06 to 0.64; p = 0.007)]. The risk reduction was comparable in patients who received 0.25 μg or more of vitamin D daily (HR: 0.18; 95% CI: 0.05 to 0.65; p = 0.008) and in those who received less than 0.25 μg vitamin D daily (HR: 0.21; 95% CI: 0.06 to 0.77; p = 0.018).ConclusionsTreatment with oral active vitamin D might be associated with a lower risk of peritonitis in PD patients.

scholarly journals Active vitamin D supplementation and COVID-19 infections: review

2021 ◽  
Author(s):  
Nakhoul Farid ◽  
Nakhoul Rola ◽  
Elias A. T. Koch ◽  
Nakhoul Nakhoul
Keyword(s):  
Vitamin D ◽  
Vitamin D Supplementation ◽  
Active Vitamin ◽  
Active Vitamin D

Design and synthesis of active vitamin D analogs

2010 ◽  
Vol 121 (1-2) ◽  
pp. 7-12 ◽  
Author(s):  
Silvina Eduardo-Canosa ◽  
Ramón Fraga ◽  
Rita Sigüeiro ◽  
Maria Marco ◽  
Natacha Rochel ◽  
...  
Keyword(s):  
Vitamin D ◽  
Active Vitamin ◽  
Vitamin D Analogs ◽  
Design And Synthesis ◽  
Active Vitamin D

MO792CONTEMPORARY MINERAL AND BONE DISORDER MARKERS AND TREATMENT AMONG HEMODIALYSIS PATIENTS IN THE EUROPEAN DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS)*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Brian Bieber ◽  
Indranil Dasgupta ◽  
Pieter Evenepoel ◽  
Stefan H Jacobson ◽  
Piergiorgio Messa ◽  
...  
Keyword(s):  
Vitamin D ◽  
Practice Patterns ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Active Vitamin ◽  
Mineral And Bone Disorder ◽  
Bone Disorder ◽  
Country Differences ◽  
Dialysis Outcomes ◽  
The Uk

Abstract Background and Aims Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients. Method DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing. Results The % of patients with a high PTH (>600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices. Conclusion CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.

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