scholarly journals Disease Burden of Patients Living With Hypoparathyroidism: Results From the Voices of Hypopara Survey

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A260-A261
Author(s):  
Deborah Murphy ◽  
Bob Sanders ◽  
Loretta Gulley ◽  
Ami Knoefler ◽  
Alden Smith ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Disease Burden ◽  
Vitamin D Supplementation ◽  
Urgent Care ◽  
Monitoring Device ◽  
Active Vitamin ◽  
The Past ◽  
Active Vitamin D ◽  
At Home

Abstract Background: Hypoparathyroidism (HP) is a rare disease that is characterized by insufficient levels of parathyroid hormone, resulting in hypocalcemia, hyperphosphatemia and hypercalciuria. Standard of care (SoC) consists of calcium and active vitamin D supplementation. Some patients may suffer from “calcium crashes”, sudden hypocalcemia symptoms that can be severe enough to require a visit to the emergency room (ER) or urgent care. Conversely, chronic use of SoC supplements can also increase risk of hypercalciuria and renal failure. The HypoPARAthyroidism Association (HPA), a nonprofit organization dedicated to improving the lives of hypoparathyroid patients, developed the “Voices of Hypopara” survey to capture the journey of patients with HP in the US. Methods: The online survey was distributed to all HPA members (approximately 1,000) in May 2020. Questions focused on evaluating patients’ experiences including diagnosis, treatment, quality of care, and impact on daily living. Results: The survey was completed by 146 HPA members (89% female; mean age 51). Most participants reported they are currently taking SoC (calcium 91%; active vitamin D 77%). However, over half felt that this did not optimally address their disease and 29% were extremely concerned about hypocalcemia despite supplementation. Many (69%) felt that taking SoC was moderately to extremely burdensome. More than two-thirds (69%) of respondents reported a “calcium crash” in the past year; of these, 43% reported calcium crashes monthly or weekly. Almost half (42%) of all participants required a visit to an ER/urgent care in the last year as a result of HP symptoms; of these, 56% believed that the staff was inexperienced with management of a calcium crash. More than 60% of participants checked serum calcium levels at least every couple of months at a physician’s office or lab in the past year, with 36% checking monthly or more frequently; the majority of respondents (70%) said the reason was due to symptoms of hypocalcemia. Participants viewed an at-home device for measuring serum calcium, phosphate, and magnesium levels as one key approach to manage their HP symptoms (47% ranked as “most preferred”), followed by more effective medications as the second most preferred option (23%). Almost all (99%) responded that they would use an at-home monitoring device and would test frequently. Conclusions: Results from this survey underscore the high disease burden of patients with HP, highlighting sudden hypocalcemic episodes as a key morbidity despite treatment with calcium and active vitamin D supplementation, and sub-optimal management by clinicians as an impediment to optimal treatment. These findings reinforce the need for more frequent, easily accessible, and real-time serum calcium level monitoring device, more efficacious therapies, and greater disease understanding among health care workers to best manage patients with HP.

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

scholarly journals Leukaemic Secretion of Calcitriol: A Novel Mechanism of Hypercalcaemia in AML

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5098-5098
Author(s):  
Joshua Misha Lewis Casan ◽  
Sarah Ghotb ◽  
Sue Morgan ◽  
Stephen B Ting
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Rare Complication ◽  
Kidney Injury ◽  
Active Vitamin ◽  
Normal Range ◽  
Lymphoid Malignancies ◽  
Active Vitamin D ◽  
Upper Limit

Abstract Introduction: Whilst relatively common in lymphoid malignancies, hypercalcaemia is an extremely rare complication of acute myeloid leukaemia (AML). Previous case reports have described ectopic parathyroid hormone secretion, leukaemic bony invasion and the release of boneresorptivemediators as causes of hypercalcaemia in AML (GewirtzAM et al. Br JHaematology1983;31(12):1590,ZidarBL, et al.NEJM.1976;295:692). We describe a case of severe hypercalcaemia with acute kidney injury (AKI) accompanying a new diagnosis of AML, subsequently demonstrated to be secondary to leukaemic blast production of active vitamin D (calcitriol) with gross over-expression of vitamin D related genes. This represents a novel pathogenic mechanism causing hypercalcaemia in a myeloid malignancy. Case Report: AA, a 68 year old male presenting with fatigue and found to have circulating blasts was subsequently diagnosed with acutemyelomonocyticleukaemia(78% blasts on bone marrow biopsy). Additionally, he had marked hypercalcaemia (calcium 3.3mmol/L, normal range 2.1-2.6mmol/L) and AKI (creatinine 263umol/L, normal range 60-110umol/L). Given the rarity of AML-associated hypercalcaemia, extensive investigations were undertaken to elucidate the cause. In search of a second concurrent malignancy, AA underwent computed tomography and positron emission tomography scanning, with subsequent biopsy of FDG avid vocal cord nodules; but only benign pathology could be demonstrated. Parathyroid hormone (PTH) levels were appropriately suppressed (0.9pmol/L, normal range 1.6-6.9pmol/L) and levels of PTH-related peptide and serum ACE were normal (<2pmol/L, and 37units/L, normal range 20-70units/L, respectively). Inactive vitamin D, (calcidiol or 25(OH)D3) levels were also normal (88nmol/L, normal range 50-250nmol/L). However, the active vitamin D (calcitriol or 1,25(OH)2D3) level was grossly elevated beyond the upper limit of assay (>500pmol/L, upper limit of normal: 190pmol/L). Both the hypercalcaemia and kidney injury proved refractory to multiple therapeutic strategies including aggressive hydration with an average of over 2.5L of crystalloid per day, as well as intravenouspamidronate. However, as depicted in Figure 1, there was a precipitous response following the initiation of chemotherapy (idarubicinandcytarabine, 7+3 regimen). Within several days, AA's serum calcium levels returned to normal levels, and his kidney function followed a similar pattern of improvement shortly thereafter. The rapid resolution of serum calcium levels also mirrored peripheral blast clearance, and repeat testing of calcitriol levels showed progressive improvement towards a normal concentration. AA achieved complete remission following induction chemotherapy and remains leukaemia free after consolidation chemotherapy and current maintenanceazacitidine. His hypercalcaemia has not recurred and his renal function remains normal. Having excluded other causes of hypercalcaemia and given the dramatic response to chemotherapy, we hypothesised that AA's AML blasts were secreting calcitriol. Accordingly, quantitative PCR was performed on AA's stored leukaemic cells for genes essential to vitamin D metabolism: the vitamin-D receptor (VDR), CYP24A1, and CYP27B1 (1-α-hydroxylase). RNA was extracted from AML cells using the QIAGEN RNeasykit. cDNAwas synthesised from 400ng of RNA using the Roche First Strand cDNASynthesis Kit. Gene expression was assessed by quantitative real-time PCR, relative to the housekeeping gene GAPDH. AA's leukaemia cells demonstrated markedly elevated expression of these vitamin-D related genes compared to healthy control CD34+ cells and four other independent primary AML cells (Figure 2, labelled AML 1-4), which were selected for absence of patient hypercalcaemia from our institution's tissue bank (Figure 2). Conclusion: Hypercalcaemia secondary to secretion of calcitriol can be a manifestation of lymphoid malignancies, however our case is the first documented occurrence of this phenomenon in a myeloid cancer. The PCR studies demonstrated striking overexpression of vitamin D related genes in leukaemia cells, resulting in the patient's hypercalcaemia and AKI. This finding represents a novel mechanism for a rare complication in AML. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Standards of care for hypoparathyroidism in adults: a Canadian and International Consensus

2019 ◽  
Vol 180 (3) ◽  
pp. P1-P22 ◽  
Author(s):  
Aliya A Khan ◽  
Christian A Koch ◽  
Stan Van Uum ◽  
Jean Patrice Baillargeon ◽  
Jens Bollerslev ◽  
...  
Keyword(s):  
Vitamin D ◽  
Patient Education ◽  
Serum Calcium ◽  
Standards Of Care ◽  
Close Monitoring ◽  
Active Vitamin ◽  
Vitamin D Analogs ◽  
Diagnosis And Management ◽  
Active Vitamin D

Purpose: To provide practice recommendations for the diagnosis and management of hypoparathyroidism in adults. Methods: Key questions pertaining to the diagnosis and management of hypoparathyroidism were addressed following a literature review. We searched PubMed, MEDLINE, EMBASE and Cochrane databases from January 2000 to March 2018 using keywords ‘hypoparathyroidism, diagnosis, treatment, calcium, PTH, calcidiol, calcitriol, hydrochlorothiazide and pregnancy’. Only English language papers involving humans were included. We excluded letters, reviews and editorials. The quality of evidence was evaluated based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. These standards of care for hypoparathyroidism have been endorsed by the Canadian Society of Endocrinology and Metabolism. Results: Hypoparathyroidism is a rare disease characterized by hypocalcemia, hyperphosphatemia and a low or inappropriately normal serum parathyroid hormone level (PTH). The majority of cases are post-surgical (75%) with nonsurgical causes accounting for the remaining 25% of cases. A careful review is required to determine the etiology of the hypoparathyroidism in individuals with nonsurgical disease. Hypoparathyroidism is associated with significant morbidity and poor quality of life. Treatment requires close monitoring as well as patient education. Conventional therapy with calcium supplements and active vitamin D analogs is effective in improving serum calcium as well as in controlling the symptoms of hypocalcemia. PTH replacement is of value in lowering the doses of calcium and active vitamin D analogs required and may be of value in lowering long-term complications of hypoparathyroidism. This manuscript addresses acute and chronic management of hypoparathyroidism in adults. Main conclusions: Hypoparathyroidism requires careful evaluation and pharmacologic intervention in order to improve serum calcium and control the symptoms of hypocalcemia. Frequent laboratory monitoring of the biochemical profile and patient education is essential to achieving optimal control of serum calcium.

MO579POST-TRANSPLANT HYPERCALCEMIA AND VITAMIN D SUPPLEMENTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Andrey Vatazin ◽  
Ekaterina Parshina ◽  
Rusudana Kantaria ◽  
Vadim Stepanov ◽  
Aleksei Zulkarnaev
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Vitamin D Supplementation ◽  
Target Range ◽  
First Year ◽  
Concomitant Therapy ◽  
Active Vitamin ◽  
Active Vitamin D

Abstract Background and Aims Post-transplant hypercalcemia is common after successful kidney transplantation in patients with chronic kidney disease (CKD) and can be partially explained by the side effects of concomitant therapy. We aimed to evaluate the prevalence of hypercalcemia among recipients of kidney transplant and its relationship with vitamin D supplementation. Method We performed a cross-sectional study of 236 patients underwent successful kidney transplantation in our clinic. Median age was 49 [Q1-Q3: 39; 58] years, mean estimated glomerular filtration rate (eGFR) was 51,1±21,8 ml/min/1,73 m2. Most of the patients received hemo- or peritoneal dialysis treatment, pre-emptive transplantation was performed in 6% cases. For those previously received dialysis, median duration of any type of dialysis was 21 [Q1-Q3: 11; 36] months. Median time after transplantation reached 42 [Q1-Q3: 19; 75] months. Target range for total serum Ca was defined according to National guidelines on CKD-MBD as 2,1 - 2,5 mmol/l. Results In our cohort median serum total Ca level was 2,41 [Q1-Q3: 2,36; 2,56] mmol/l. Hypercalcemia was encountered in 21% (7 of 33) cases during the first year after transplantation and in 30% (61 of 203) – after first year. Serum total Ca weakly correlated with iPTH (ρ= 0,282 [95%CI: 0,15; 0,4], р&lt;0,0001), alkaline phosphatase (ρ=0,181 [95%CI: 0,05; 0,31], р=0,006) and total duration of renal replacement therapy (dialysis + transplantation) - ρ=0,2 [95%CI: 0,07; 0,32], р=0,002. We did not observe statistically significant correlations between serum total Ca and eGFR (p=0,132), total Ca level and time after transplantation (p=0,06). Total Ca levels did not differ in groups with different eGFR (p=0,04 in Kruskall-Wallis test, but no statistically significant differences after correction for multiply comparisons). Data on concomitant therapy were available for 230 patients. 173 of 230 recipients received any therapy of CKD-MBD. Of them, 123 patients took only active vitamin D (alfacalcidol), 33 patients received monotherapy with inactive vitamin D (cholecalciferol). 57 patients not taking any medications were the control group. Serum total Ca level varied significantly between groups (p=0,0006, Kruskall-Wallis test), being higher in patients supplemented with cholecalciferol - fig.1. Meanwhile, iPHT (p=0,171), serum phosphorus (p=0,563) and alkaline phosphatase levels did not differ in these three groups. Fraction of patients with normocalcemia was the lowest in cholecalciferol group (χ2, р=0,0018) - fig. 2. Conclusion We observed a high prevalence of hypercalcemia in kidney transplant patients, that was not associated with transplant function or time after transplantation. Our data suggest usage of active vitamin D to be safer than cholecalciferol to prevent hypercalcemia development in renal allograft recipients.

scholarly journals Parathyroid hormone replacement versus oral calcium and active vitamin D supplementation in hypoparathyroidism: A meta-analysis

2020 ◽  
Vol 24 (2) ◽  
pp. 206
Author(s):  
Jayaprakash Sahoo ◽  
Rajan Palui ◽  
RashmiRanjan Das ◽  
Ayan Roy ◽  
Sadishkumar Kamalanathan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Meta Analysis ◽  
Hormone Replacement ◽  
Vitamin D Supplementation ◽  
Active Vitamin ◽  
Oral Calcium ◽  
Active Vitamin D

scholarly journals Effects of active vitamin D on insulin resistance and islet β-cell function in non-diabetic chronic kidney disease patients: a randomized controlled study

2021 ◽  
Author(s):  
Yongxin Lu ◽  
Yi’an Wang ◽  
Yang Sun ◽  
Yongyan Li ◽  
Jingrui Wang ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Vitamin D ◽  
Cell Function ◽  
Vitamin D Supplementation ◽  
Controlled Study ◽  
Control Group ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Β Cell Function ◽  
Experimental Group

Abstract Purpose The purpose of the study is to observe the effects of active vitamin D supplementation on insulin resistance and islet β-cell function (HOMA-β) in patients with non-diabetic chronic kidney disease (NDCKD). Methods A total of 134 patients with NDCKD who met the inclusion criteria were enrolled in the prospective controlled study and categorized as such: 60 patients in the non-dialysis (ND) group; 36, hemodialysis (HD) group; and 38, peritoneal dialysis (PD) group. Each group was divided into two equal-numbered subgroups for vitamin D supplementation. Those in the experimental subgroups received calcitriol 0.5 ug/day orally, and were followed-up for 6 months. A total of 117 patients were followed-up, including 57 patients in the ND group; 29, HD group; and 31, PD group. Changes in the insulin resistance index (HOMA-IR) and HOMA-β index were calculated and compared at the time of enrollment and after 1, 3, and 6 months of intervention. Results (1) Mean HOMA-IR value: In the ND group, mean HOMA-IR value of the experimental group significantly decreased compared with that of the control group after 3 months of intervention (P = 0.02). In the HD and PD groups, there was no statistical difference between the experimental and control groups (P > 0.05). (2) Mean HOMA-β index: In the ND group, mean HOMA-β index of the experimental group was higher than that of the control group after 1 month of active vitamin D treatment (P = 0.03), and, with an extended intervention time, the index gradually increased (P < 0.001). In the HD group, mean HOMA-β index of the experimental group was higher than that of the control group after 3 months of active vitamin D treatment (P = 0.01). Among PD patients, mean HOMA-β index of the patients in the experimental group was higher than that of the control group after 6 months of active vitamin D treatment (P = 0.02). Conclusions Active vitamin D supplementation improved insulin resistance and HOMA-β after 6 months in ND patients, but only improved HOMA-β in the dialysis patients, with no significant effect on insulin resistance.

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