Association between Biomarkers of Mineral and Bone Metabolism and Removal of Calcium and Phosphate in Hemodialysis

2019 ◽  
Vol 49 (1-2) ◽  
pp. 71-78 ◽  
Author(s):  
Malgorzata Debowska ◽  
Lu Dai ◽  
Alicja Wojcik-Zaluska ◽  
Jan Poleszczuk ◽  
Wojciech Zaluska ◽  
...  
Keyword(s):  
Bone Metabolism ◽  
Serum Phosphate ◽  
Phosphate Removal ◽  
Ionized Calcium ◽  
Serum Osteocalcin ◽  
Intact Osteocalcin ◽  
Calcium Kinetics ◽  
Hemodialysis Session ◽  
Calcium Removal ◽  
Serum Pth

Background: A significant drop of serum phosphate and calcium removal or loading during hemodialysis induce reactions in mineral and bone remodeling that may inversely affect phosphate and calcium removal during dialysis. Objectives: We aimed to analyze the interdependencies between biomarkers of mineral and bone metabolism and removal of phosphate and calcium during hemodialysis, as this complex relationship is not fully understood. Methods: Three subsequent hemodialysis sessions during a 1-week treatment cycle with interdialytic periods of 2–2-3 days were monitored in 25 anuric patients. Calcium and phosphate concentrations were measured in serum before, at 1, 2, and 3 h, at the end, and 45 min after each session and in the outlet dialysate every 30 min. Biomarkers associated with mineral and bone metabolism: parathyroid hormone (PTH 1–34 and PTH 1–84), calcitonin, 25(OH)-vitamin D, fetuin-A, osteopontin, osteocalcin 1–43/49, and intact osteocalcin were assayed once in each patient before the midweek hemodialysis session. Results: Post-dialytic and intra-dialytic serum phosphate of midweek hemodialysis session and phosphate mass removed within 1 week correlated positively with serum PTH (0.40 < rho <0.46, p value <0.05). Higher concentration of serum PTH was associated with an increased level of osteocalcin. Pre-dialytic, post-dialytic, average for treatment time and average weekly concentrations of ionized calcium in serum correlated positively with serum osteocalcin. Serum osteocalcin and osteopontin levels were associated with the masses of total and ionized calcium, respectively, removed during 3 hemodialysis sessions. Conclusions: During hemodialysis, phosphate removal was associated with serum PTH, whereas calcium kinetics was influenced by serum osteocalcin and osteopontin. These results demonstrate that active processes involving biomarkers of mineral and bone metabolism are affected by the phosphate and calcium kinetics already within 4 h hemodialysis sessions.

scholarly journals Phosphate kinetics during high-flux hemodialysis.

1993 ◽  
Vol 4 (5) ◽  
pp. 1214-1218
Author(s):  
C A DeSoi ◽  
J G Umans
Keyword(s):  
Extracellular Fluid ◽  
Compartment Model ◽  
Chronic Hemodialysis ◽  
Serum Phosphate ◽  
Phosphate Removal ◽  
Ionized Calcium ◽  
Dietary Phosphate ◽  
Phosphate Mobilization ◽  
Serum Pth ◽  
Relationship Of

Phosphate clearance by polysulfone (PS) and cuprophane (CU) membranes and the relationship of peridialytic changes in serum phosphate with those of serum-ionized calcium, parathyroid hormone (PTH), and insulin were studied in six stable patients undergoing chronic hemodialysis (HD). Dietary phosphate intake was 25.7 mmol/day, and total dose of elemental calcium was 3.2 g/day. Patients were dialyzed for 2 to 4 h, once with each membrane. Serum phosphate levels fell precipitously during the first hour of HD with both dialyzers, from 1.42 and 1.49 mM to nadirs of 0.53 and 0.69 mM for PS and CU, respectively. Phosphate levels began to increase either late in HD or at the end of HD and, by 4 h post-HD, did not differ from predialysis values. Total mass transfer of phosphate was greater during the first hour (3.4 and 3.2 mmol for PS and CU, respectively) than during the remainder of HD (2.4 and 2.6 mmol/h). There were no significant differences in intradialytic serum phosphate changes, postdialytic phosphate rebound, or total phosphate removal between the two dialyzers. Ionized calcium increased by 0.11 mM, and PTH was suppressed to 40 to 50% of baseline values during dialysis with either membrane. Although phosphate removal continued for the duration of dialysis, serum phosphate did not continue to decrease, either reaching an apparent steady state or beginning to rebound, even during dialysis. This suggests active phosphate mobilization from a pool other than the extracellular fluid and demonstrates the inadequacy of a one-compartment model to explain these data. Further, these data do not support the regulation of intradialytic phosphate mobilization by serum PTH or insulin.(ABSTRACT TRUNCATED AT 250 WORDS)

Relations between diurnal variations in serum osteocalcin, cortisol, parathyroid hormone, and ionized calcium in normal individuals

1991 ◽  
Vol 124 (4) ◽  
pp. 391-398 ◽  
Author(s):  
Henning Kaspersen Nielsen ◽  
Peter Laurberg ◽  
Kim Brixen ◽  
Leif Mosekilde
Keyword(s):  
Parathyroid Hormone ◽  
Diurnal Rhythm ◽  
Time Course ◽  
Serum Cortisol ◽  
Early Morning ◽  
Ionized Calcium ◽  
Serum Osteocalcin ◽  
Serum Concentrations ◽  
Normal Individuals ◽  
Serum Pth

Abstract. Serum osteocalcin varies in a diurnal rhythm, with peak values during the night and minimum levels before noon, but the factors controlling this rhythm are unknown. In this study, we evaluated the temporal relations between the osteocalcin rhythm and variations in serum concentrations of cortisol, intact parathyroid hormone (PTH(1-84)), and ionized calcium (Ca2+) in 15 normal volunteers, aged 22-46 years. Serum cortisol varied in a typical way preceding inverse changes in serum osteocalcin by about 4 h (r=0.78, p<0.0001). Changes in serum osteocalcin following the early morning increase in serum cortisol were statistically indistinguishable from the changes seen after oral administration of 2.5 or 10 mg of prednisone. Serum PTH (1-84) showed a diurnal rhythm (p<0.01) with peak values (4.06±0.42 pmol/l) at 20.30 h and nadir (2.81±0.10 pmol/l) around 10.30 h, preceding changes in serum osteocalcin in the same direction by 5 h (r=0.55, p<0.02). Prednisone at a dose of 10 mg did not change the time course significantly. Serum Ca2+ varied in an almost bi-phasic pattern (p<0.01) with maximal mean levels around 16.30 and 09.30 h and minimal levels around 05.30 and 14.30 h. Serum Ca2+ correlated inversely with PTH (1-84) (r=0.53, p<0.01), and serum osteocalcin was inversely related to Ca2+ at concurrent time points (r=0.59, p<0.005). Prednisone caused a 2-3 h lasting increase in serum Ca2+ 3-5 h after ingestion (p<0.001). In conclusion, our results suggest that cortisol is strongly associated to the diurnal rhythm in serum osteocalcin. The biological relevance of the reported relation between serum osteocalcin and PTH (1-84) and serum Ca2+ is uncertain.

scholarly journals MINERAL'NAYa PLOTNOST' KOSTII POKAZATELI KOSTNOGO METABOLIZMAU PATsIENTOV S IDIOPATIChESKIM VARIANTOM TsENTRAL'NOGO NESAKhARNOGO DIABETA (TsND)

2008 ◽  
Vol 11 (2) ◽  
pp. 6-9
Author(s):  
E A PIGAROVA ◽  
L Ya ROZhINSKAYa ◽  
N I SAZONOVA ◽  
G S KOLESNIKOVA
Keyword(s):  
Bone Metabolism ◽  
Type I Collagen ◽  
Mesangial Cells ◽  
Urine Osmolality ◽  
Study Groups ◽  
Ionized Calcium ◽  
Type I ◽  
Serum Osteocalcin ◽  
Mineral Density ◽  
Pituitary Dysfunction

Central diabetes insipidus is a rare pituitary disease due to impairment of synthesis or/and secretion of vasopressin (AVP), characterized by polyuria, polydipsia, low urine osmolality and hyperosmolality of plasma. Main therapy for CDI is substitutive therapy with desmopressin. Lately, it has been shown that AVP stimulates bone formation through the induction of PG synthesis in mesangial cells, contributing to prevent osteoporosis. Pivonello et al. (1998) found that patients with CDI even on nasal desmopessin therapy had a significant impairment in BMD and serum osteocalcin. The aim of this study was to assess the biochemical parameters of bone metabolism and the bone mineral density (BMD) in patients with idiopathic variant of CDI, treated with oral desmopressin. In 24 patients with idiopathic CDI, treated with oral desmopressin and 24 healthy controls we evaluated BMD (analyzer Prodigy, Lunar, DXA), serum osteocalcin (OK) and C-terminal telopeptide of type I collagen (CTx), (ECLIA, Roche Elecsys 1010/2010) as well as calcium total, ionized calcium and alkaline phosphatase (analyzer Hitachi 912, commercial kits Roche). Anterior pituitary dysfunction and concomitant conditions associated with osteoporosis were eliminated on clinical and laboratory basis. The results showed no significant differences between study groups with the exception for ionized calcium which was higher in the group of CDI (p=0,02). We were not able to confirm detrimental effects of idiopathic CDI on BMD and biochemical markers of bone metabolism.

Aging alters calcium regulation of serum concentration of parathyroid hormone in healthy men

1997 ◽  
Vol 272 (1) ◽  
pp. E139-E146 ◽  
Author(s):  
A. A. Portale ◽  
E. T. Lonergan ◽  
D. M. Tanney ◽  
B. P. Halloran
Keyword(s):  
Parathyroid Hormone ◽  
Young Men ◽  
The Elderly ◽  
Ionized Calcium ◽  
Elderly Men ◽  
Elderly Age ◽  
Healthy Men ◽  
Age Related ◽  
Serum Pth ◽  
The Relationship

We examined the effect of aging on the relationship between the concentrations of blood ionized calcium and of serum parathyroid hormone (PTH) in 22 healthy men [9 elderly (age 74 +/- 2 yr) and 13 young (age 39 +/- 1 yr)] in whom the glomerular filtration rate was > 70 ml/min. Throughout a 24-h period, serum concentrations of PTH in the elderly men were twice those in the young men, whereas blood ionized calcium did not differ between the two groups. With intravenous infusion of calcium gluconate, the minimum PTH concentration was two- to threefold higher in the elderly men. With infusion of NaEDTA. the maximum PTH concentration was 20% higher in the elderly men. The calcium set point for PTH release was higher in the elderly than in the young men (4.71 +/- 0.04 vs. 4.54 +/- 0.03 mg/dl, respectively, P < 0.005). In these healthy men, the age-related increase in serum PTH could not be attributed to a sustained decrease in concentration of either blood ionized calcium or 1,25-hydroxyvitamin D. These findings suggest that, with aging, the relationship between calcium and PTH is altered such that at any given level of calcium, the concentration of PTH is higher.

scholarly journals Сalcium-phosphorus balance and bone metabolism markers estimation in the combination therapy of patients with chronic generalized severe periodontitis

2016 ◽  
Vol 12 (2) ◽  
pp. 25-29
Author(s):  
А. Казакова ◽  
A. Kazakova ◽  
М. Гуртовая ◽  
M. Gurtovaya
Keyword(s):  
Combination Therapy ◽  
Bone Metabolism ◽  
Periodontal Diseases ◽  
Ionized Calcium ◽  
Balance Study ◽  
Bone Metabolism Markers ◽  
Phosphorus Balance ◽  
Low Level ◽  
Periodontal Tissues ◽  
Severe Periodontitis

<p class="p1"><span class="s1">The serum calcium-phosphorus balance and bone metabolism markers estimation in 72 patients with severe chronic generalized periodontitis and 20 patients of control healthy group at the age of 25 to 55 was performed. A comprehensive laboratory mineral balance study plays an important role in modern diagnostics of periodontal diseases and allows not only to determine the process of bone destruction activity, but also to control the periodontal treatment ef ciency. The rst examination revealed that 19,4% patients with severe periodontitis had low level of serum ionized calcium, its level being 1,05 mmol/l and less. The Drug-induced management of such patients included prescribing osteogenon in their preoperative period which resulted in 12,61% calcium levels increase within 2 months of osteogenon taking. Thus, adding osteogenon to severe periodontitis combination therapy leads to ionized calcium low level recovery in patients’ serum, bene ts bone regeneration and clinical stabilization of periodontal tissues process due to this medicine active components: hydroxyl apatite and ossein, represented by different growth factors, having a direct impact on bone tissue. </span></p>

scholarly journals Serum Sclerostin Levels Vary With Season

2014 ◽  
Vol 99 (1) ◽  
pp. E149-E152 ◽  
Author(s):  
Bess Dawson-Hughes ◽  
Susan S. Harris ◽  
Lisa Ceglia ◽  
Nancy J. Palermo
Keyword(s):  
Physical Activity ◽  
Seasonal Variation ◽  
Clinical Utility ◽  
Older Men ◽  
Serum Osteocalcin ◽  
Biological Variability ◽  
Men And Women ◽  
Potential Clinical Utility ◽  
Serum Pth ◽  
Older Men And Women

Context: To establish the clinical utility of serum sclerostin levels, it is important to know whether there is seasonal variation in the measurements. Objective: This study was done to determine whether serum sclerostin levels vary by season in healthy older men and women. Methods: Serum sclerostin levels were measured in archived serum of 314 healthy men and women aged 65 years and older and examined for seasonal variation. Several factors known to vary by season and previously reported to be associated with serum sclerostin levels, including serum osteocalcin, physical activity, and serum PTH levels, were also measured in these subjects. Sex did not modify the association of season with sclerostin, so the men and women were analyzed together. Results: Serum sclerostin levels varied significantly by season (P &lt; .001, after adjustment for sex). Sclerostin levels in the wintertime were 20% higher than the all-year mean, the levels gradually declined through the spring and summer, and by the fall, they were 20% below the all-year mean. Adjustment for serum osteocalcin, physical activity, and serum PTH did not alter the seasonal means. Seasonal differences in serum osteocalcin, physical activity, and serum PTH were not statistically significant. Conclusions: This study documents marked seasonal variation in serum sclerostin levels. It is important to recognize this source of biological variability when considering the potential clinical utility of sclerostin measurements.

Comparison of the Effects of Tai Chi and Resistance Training on Bone Metabolism in the Elderly: A Feasibility Study

2007 ◽  
Vol 35 (03) ◽  
pp. 369-381 ◽  
Author(s):  
Chwan-Li Shen ◽  
James S. Williams ◽  
Ming-Chien Chyu ◽  
Robert L. Paige ◽  
Allen L. Stephens ◽  
...  
Keyword(s):  
Resistance Training ◽  
Bone Metabolism ◽  
Feasibility Study ◽  
Tai Chi ◽  
Compliance Rate ◽  
The Elderly ◽  
Urinary Calcium ◽  
Bone Specific Alkaline Phosphatase ◽  
Serum Pth ◽  
Elder Adults

This feasibility study compared the effects of Tai Chi (TC) and resistance training (RT) on bone metabolism in the elderly. Twenty eight sedentary, elder adults, were randomized into either TC ( n = 14, 78.8 +/-1.3 years) or RT ( n = 14, 79.4 +/-2.2 years) to participate in 40 min of exercise per session, 3 sessions/week for 24 weeks. The outcome measures assessed were the concentrations of serum bone-specific alkaline phosphatase (BAP), pyridinoline (PYD), parathyroid hormone (PTH) and calcium, and urinary calcium. The TC group had a higher compliance rate than the RT group. After 6 weeks, (i) both TC and RT resulted in higher level of serum BAP relative to the baseline and the TC group exhibited a greater increase in serum BAP than the RT group; (ii) there was an increase of serum PYD in the RT group only, not in the TC group; and (iii) the BAP/PYD ratio was higher than baseline only in the TC group, and the increase of the ratio in the TC group was greater than that in the RT group. After 12 weeks, the increase in serum PTH in the TC group was higher than the RT group. After 24 weeks, there was a reduction of the urinary calcium level in the TC group relative to the baseline. In conclusion, these findings support that TC is beneficial for increasing bone formation in elderly, and long-term application is needed to substantiate the effect of TC as an alternative exercise in promotion of bone health.

Secretion of Parathyroid Hormone Oscillates Depending on the Change in Serum Ionized Calcium during Hemodialysis and May Affect Bone Metabolism

2005 ◽  
Vol 101 (1) ◽  
pp. c9-c17 ◽  
Author(s):  
Tokuyuki Kitahara ◽  
Kazue Ueki ◽  
Takashi Kuroiwa ◽  
Yoriaki Kaneko ◽  
Keiju Hiromura ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Bone Metabolism ◽  
Ionized Calcium ◽  
Serum Ionized Calcium ◽  
Affect Bone Metabolism

scholarly journals Control of hyperparathyroidism with the intravenous calcimimetic etelcalcetide in dialysis patients adherent and non-adherent to oral calcimimetics

2020 ◽  
Author(s):  
Maria Dolores Arenas ◽  
Cristian Rodelo-Haad ◽  
M Victoria Pendón-Ruiz de Mier ◽  
Mariano Rodriguez
Keyword(s):  
Parathyroid Hormone ◽  
Standard Deviation ◽  
Secondary Hyperparathyroidism ◽  
Serum Phosphate ◽  
Dialysis Patients ◽  
Serum Parathyroid Hormone ◽  
Apparent Lack ◽  
Serum Pth ◽  
And Control ◽  
Possible Cause

Abstract Background In dialysis patients, non-adherence to oral cinacalcet adds complexity to the control of secondary hyperparathyroidism. The present study aims to evaluate the use of intravenous calcimimetic, etelcalcetide, in the control of secondary hyperparathyroidism in patients adherent and non-adherent to oral calcimimetics. Method The Simplified Medication Adherence Questionnaire was used to identify non-adherence. Almost half of the patients were non-adherent to the treatment with cinacalcet. Twenty-five patients (15 non-adherent) were switched from cinacalcet to etelcalcetide and were followed-up monthly for 8 months. Results Cinacalcet was discontinued for 1 week before the initiation of etelcalcetide. After this period, the serum PTH levels increased by2-fold in adherent patients, whereas it did not change in non-adherent patients suggesting that they were not taking the medication. Etelcalcetide progressively reduced serum parathyroid hormone (PTH) (mean ± standard deviation) from 818 ± 395 to 367 ± 289 pg/mL (P &lt; 0.001) in non-adherents, and from 496 ± 172 to 228 ± 111 pg/mL (P &lt; 0.01) in adherent patients with a mean dose of 7.0 ± 2.3 and 5.1 ± 1.2 mg in non-adherent and in adherent patients, respectively. Etelcalcetide increased the percentage of patients with PTH on target from 28% to 58%. Patients with serum calcium &lt;8.4 mg/dL increased from 8% to 40%, although they remained asymptomatic. The percent of patients with serum phosphate on target increased from 40% to 65%. Conclusion The lack of adherence to cinacalcet is a possible cause of the apparent lack of response to oral calcimimetic. The use of etelcalcetide ensures compliance and control of secondary hyperparathyroidism in both non-adherent and adherent patients.

scholarly journals Role of FGF23 in Pediatric Hypercalciuria

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Maria Goretti Moreira Guimarães Penido ◽  
Marcelo de Sousa Tavares ◽  
Uri Saggie Alon
Keyword(s):  
Urinary Calcium ◽  
Serum Phosphate ◽  
Calcium Excretion ◽  
Urine Calcium ◽  
Lower Serum ◽  
Median Plasma ◽  
Registration Number ◽  
Serum Pth ◽  
Lower Urinary

Background. This study explored the possible role of FGF23 in pediatric hypercalciuria. Methods. Plasma FGF23 was measured in 29 controls and 58 children and adolescents with hypercalciuria: 24 before treatment (Pre-Treated) and 34 after 6 months of treatment (Treated). Hypercalciuric patients also measured serum PTH hormone, 25(OH)vitD, phosphate, calcium, creatinine, and 24 h urine calcium, phosphate, and creatinine. Results. There were no differences in age, gender, ethnicity, or body mass index either between controls and patients, or between Pre-Treated and Treated patients. Median plasma FGF23 in controls was 72 compared with all patients, 58 RU/mL (p=0.0019). However, whereas FGF23 in Pre-Treated patients, 73 RU/mL, was not different from controls, in Treated patients it was 50 RU/mL, significantly lower than in both controls (p<0.0001) and Pre-Treated patients (p=0.02). In all patients, there was a correlation between FGF23 and urinary calcium (r=0.325; p=0.0014). Treated patients had significantly lower urinary calcium (p<0.0001), higher TP/GFR (p<0.001), and higher serum phosphate (p=0.007) versus Pre-Treated patients. Conclusions. Pharmacological treatment of hypercalciuric patients resulted in significantly lower urinary calcium excretion, lower serum FGF23, and elevated TP/GFR and serum phosphate concentration, without significant changes in PTH. Further studies are indicated. This trial is registered with Clinical Registration Number RBR 8W27X5.

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