Serum Phosphate Level among Chronic Kidney Disease Patients on Chronic Dialysis

Introduction: The prevalence of bone mineral disorder is best known in end-stage renal disease (ESRD) patients, but less data is available for the earlier stages. Objectives: We aimed to compare the prevalence of bone metabolic disorder at all stages of chronic kidney disease (CKD) and assess its contribution to CKD progression and patients’ outcome. Patients and Methods: In a retrospective cohort study, CKD patients who were under treatment for three years were selected from a nephrology clinic in Tehran, Iran. Patients’ demographic and laboratory data, as well as the outcome of their treatment were gathered and analyzed. Results: In 473 patients with an average age of 61.5, 60.1% were at stage III, 35.8% were at stage IV, and 4.1% were at stage V of CKD. There was a significant relationship between CKD stage and serum phosphate, calcium-phosphate product, and systolic blood pressure (SBP). Furthermore, the patients’ outcome was significantly related to advanced stages of CKD, higher first phosphate level, diabetes mellitus in medical history, and higher stages of SBP. By multiple Cox regression analysis, after adjustment for glomerular filtration rate (GFR), the first serum phosphate level, and the calcium-phosphate product did not contribute to the undesirable outcome. Conclusion: Although bone metabolic disorder is more frequently seen in advanced stages of chronic kidney disease, these changes can be seen even in earlier stages of the disease. The influence of phosphate abnormality in the patients’ outcome should be studied more in earlier stages for better control.

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Prevalence, progression and implications of breast artery calcification in patients with chronic kidney disease

Clinical Kidney Journal ◽

10.1093/ckj/sfab178 ◽

2021 ◽

Author(s):

Brecht Van Berkel ◽

Chantal Van Ongeval ◽

Amaryllis H Van Craenenbroeck ◽

Hans Pottel ◽

Katrien De Vusser ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Vitamin K ◽

Vitamin K Antagonist ◽

Serum Phosphate ◽

Specific Marker ◽

Progression Rate ◽

Serum Phosphate Level ◽

Adverse Cardiovascular Event

Abstract Breast artery calcification (BAC) is increasingly recognized as a specific marker of medial calcification. The present retrospective observational cohort study aimed to define the prevalence, progression rate, risk factors and clinical implications of BAC in chronic kidney disease (CKD) patients across stages of disease. Presence and extent of BAC were determined on mammograms in 310 females (58.7 ± 10.8 yrs, Caucasian) with CKD across stages of disease (CKDG2-5D n = 132; transplant recipients [Tx]: n = 178). In a subset of 88 patients, a repeat mammography was performed, allowing to calculate the annualized BAC rate. Overall, BAC was observed in 34.7% of the patients. BAC prevalence (P = 0.02) and BAC score (P = 0.05) increased along the progression of CKD. In the overall cohort, patients with BAC were characterized by older age, more cardiovascular disease, more inflammation, higher pulse pressure, and borderline higher prevalence of diabetes, and were more often treated with a vitamin K antagonist. BAC progression rate was significantly lower in Tx as compared to CKD G5D. Progressors were characterized by more inflammation, worse kidney function, higher BAC score, higher serum phosphate level (Tx only) at baseline and were more often treated with a vitamin K antagonist. Major adverse cardiovascular event free survival was significantly worse in Tx with BAC. In conclusion, BAC is common among CKD patients, progresses at a slower pace in Tx as compared to CKD5D, and associates with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and vitamin K antagonist usage seem to be important determinants of progression.

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Características Clínicas, epidemiológicas y evolución de Pacientes con Enfermedad Renal Crónica estadío 5, del año 2005 al 2015 en el Hospital de Especialidades Pediátricas Omar Torrijos H. Panamá.

Revista Médica de Panamá - ISSN 2412-642X ◽

10.37980/im.journal.rmdp.2018492 ◽

2018 ◽

Vol 1 (38) ◽

Author(s):

Ariana Guerra ◽

Basilio Dobras

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Situation ◽

Chronic Dialysis ◽

Dialysis Treatment ◽

Evolution Characteristics ◽

Specialty Hospital ◽

Common Etiology ◽

Male Sex ◽

Epidemiologic Characteristics

[Clinical and epidemiologic characteristics and evolution of patients with stage 5 Renal cronic disease, from year 2005 to 2015 at the Omar Torrijos H. Pediatric Hospital, Panama]Resumen Introducción: La incidencia y prevalencia de ERC-5 en niños ha ido en aumento. Es poco lo que se conoce respecto a la epidemiología de la ERC en niños y su manejo constituye un reto importante para los sistemas de salud. En Panamá no contamos con estudios que analicen la situación epidemiológica y clínica de niños con ERC. El objetivo del presente estudio es describir las características clínicas, epidemiológicas y evolución de pacientes pediátricos con enfermedad renal crónica estadio 5 atendidos en el servicio de Nefrología del hospital de Especialidades Pediátricas. Metodología: Se realizó un estudio observacional, descriptivo, retrospectivo, de los pacientes con enfermedad renal crónica estadio 5 atendidos en el Servicio de Nefrología del Hospital de Especialidades Pediátricas desde enero de 2005 a diciembre de 2015. Resultados: El promedio de edad al momento de la detección de la ERC-5 fue de 8.4 años. El sexo masculino predominó con una relación 1.4: 1. Predominó el grupo etario escolar de 6 a 10 años, y los adolescentes entre 11 a 15 años, con 14 casos cada uno. La incidencia anual fue de 3.0 casos, o 3.4 por millón de la población relacionada con la edad. La etiología más común fue la glomerulopatía 15 (44.1 %) Todos los pacientes tenían anemia y todos recibieron tratamiento dialítico crónico luego del establecimiento del diagnóstico mayormente diálisis peritoneal. Conclusión: Para Panamá, el promedio de edad al momento de la detección de la ERC-5 fue de 8.4 años, predominando el sexo masculino. La causa etiológica más común fue la glomerulopatía. Todos presentaban anemia al momento del diagnóstico y todos recibieron tratamiento dialítico crónico luego del establecimiento del diagnóstico, mayormente peritoneal. Abstract Introduction: The incidence and prevalence of CKD-5 in children has been increasing. Little is known about the epidemiology of CKD in children and its management constitutes a major challenge for health systems. In Panama, we do not have studies that analyze the epidemiological and clinical situation of children with CKD. The aim of the present study is to describe the clinical, epidemiological and evolution characteristics of pediatric patients with stage 5 chronic kidney disease treated in the Nephrology service of the Pediatric Specialty Hospital. Methodology: An observational, descriptive, retrospective study of patients with stage 5 chronic kidney disease treated at the Nephrology Service of the Pediatric Specialty Hospital from January 2005 to December 2015 was performed. Results: The average age at the time of The detection of CKD-5 was 8.4 years. The male sex predominated with a 1.4: 1 ratio. The school age group was predominantly between 6 and 10 years old, and adolescents between 11 and 15 years old, with 14 cases each. The annual incidence was 3.0 cases, or 3.4 per million of the population related to age. The most common etiology was glomerulopathy 15 (44.1%). All the patients had anemia and all received chronic dialysis treatment after the establishment of the diagnosis, mainly peritoneal dialysis. Conclusion: For Panama, the average age at the time of detection of CKD-5 was 8.4 years, predominantly male. The most common etiologic cause was glomerulopathy. All had anemia at the time of diagnosis and all received chronic dialysis treatment after the establishment of the diagnosis, mostly peritoneal.

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Solubleα-Klotho Serum Levels in Chronic Kidney Disease

International Journal of Endocrinology ◽

10.1155/2015/872193 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 39

Author(s):

Silverio Rotondi ◽

Marzia Pasquali ◽

Lida Tartaglione ◽

Maria Luisa Muci ◽

Giusy Mandanici ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Clinical Significance ◽

Serum Levels ◽

Serum Phosphate ◽

Renal Tubules ◽

Ckd Stage ◽

Tubular Transport ◽

Negative Effect

Transmembraneα-Klotho (TM-Klotho), expressed in renal tubules, is a cofactor for FGF23-receptor. Circulating soluble-α-Klotho (s-Klotho) results from TM-Klotho shedding and acts on Phosphate (P) and Calcium (Ca) tubular transport. Decreased TM-Klotho, described in experimental chronic kidney disease (CKD), prevents actions of FGF23 and lessens circulating s-Klotho. Thus, levels of s-Klotho could represent a marker of CKD-MBD. To evaluate the clinical significance of s-Klotho in CKD we assayed serum s-Klotho and serum FGF23 in 68 patients (age58±15; eGFR45±21 mL/min). s-Klotho was lower than normal (519±183versus845±330 pg/mL,P<.0001) in renal patients and its reduction was detectable since CKD stage 2 (P<.01). s-Klotho correlated positively with eGFR and serum calcium (Cas) and negatively with serum phosphate (Ps), PTH and FGF23. FGF23 was higher than normal (73±51versus36±11,P<.0002) with significantly increased levels since CKD stage 2 (P<.001). Our data indicate a negative effect of renal disease on circulating s-Klotho starting very early in CKD. Assuming that s-Klotho mirrors TM-Klotho synthesis, low circulating s-Klotho seems to reflect the ensuing of tubular resistance to FGF23, which, accordingly, is increased. We endorse s-Klotho as an early marker of CKD-MBD.

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Is serum phosphate a useful target in patients with chronic kidney disease and what is the role for dietary phosphate restriction?

Nephrology ◽

10.1111/nep.13025 ◽

2017 ◽

Vol 22 ◽

pp. 36-41 ◽

Cited By ~ 3

Author(s):

Nigel D Toussaint ◽

Stephen G Holt

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Phosphate ◽

Dietary Phosphate

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Systematic Review and Meta-analyses of Effects of Phosphate-lowering Agents in Non-dialysis Chronic Kidney Disease

Journal of the American Society of Nephrology ◽

10.1681/asn.2021040554 ◽

2021 ◽

pp. ASN.2021040554

Author(s):

Nicole Lioufas ◽

Elaine Pascoe ◽

Carmel Hawley ◽

Grahame Elder ◽

Sunil Badve ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Outcomes ◽

Serum Phosphate ◽

Risk Of Bias ◽

Lowering Therapy ◽

Mean Differences ◽

Meta Analyses

Background: Benefits of phosphate-lowering interventions on clinical outcomes in patients with chronic kidney disease (CKD) are unclear; systematic reviews have predominantly involved dialysis patients. This study aimed to summarize evidence from randomized controlled trials (RCTs) concerning benefits and risks of non-calcium-based phosphate-lowering treatment in non-dialysis CKD. Methods: We conducted a systematic review and meta-analyses of RCTs involving noncalcium-based phosphate-lowering therapy compared to placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant. RCTs had ≥3 months follow up and outcomes included biomarkers of mineral metabolism, cardiovascular parameters, and adverse events. Outcomes were meta-analyzed using the Sidik-Jonkman method for random effects. Unstandardized mean differences were used as effect sizes for continuous outcomes, with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. Odds ratios were used for binary outcomes. Cochrane risk of bias and GRADE assessment determined the certainty of evidence. Results: Twenty trials involving 2,498 participants (median sample size 120, median follow up 9 months) were eligible for inclusion. Overall, risk of bias was low. Compared with placebo, non calcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37, 95% CI -0.58,-0.15 mg/dL, low certainty evidence) and urinary phosphate excretion (8 trials, SMD -0.61, 95% CI -0.90,-0.31, low certainty evidence), but resulted in increased constipation (9 trials, log odds ratio [OR] 0.93, 95% CI 0.02, 1.83, low certainty evidence) and greater vascular calcification score (3 trials, SMD 0.47, 95% CI 0.17, 0.77, very low certainty evidence). Data for effects of phosphate-lowering therapy on cardiovascular events (log OR 0.51 [95% CI -0.51, 1.17]) and death were scant. Conclusions: Non-calcium-based phosphate-lowering therapy reduced serum phosphate and urinary phosphate excretion, but there was an unclear effect on clinical outcomes and intermediate cardiovascular end-points. Adequately powered RCTs are required to evaluate benefits and risks of phosphate-lowering therapy on patient-centered outcomes.

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Can we IMPROVE cardiovascular outcomes through phosphate lowering in CKD? Rationale and protocol for the IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease (IMPROVE-CKD) study

BMJ Open ◽

10.1136/bmjopen-2018-024382 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024382 ◽

Cited By ~ 8

Author(s):

Nicole Lioufas ◽

Nigel D Toussaint ◽

Eugenia Pedagogos ◽

Grahame Elder ◽

Sunil V Badve ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Compliance ◽

Left Ventricular ◽

Serum Phosphate ◽

Lanthanum Carbonate ◽

Cardiovascular Morbidity And Mortality ◽

Fgf 23 ◽

The Impact

IntroductionPatients with chronic kidney disease (CKD) are at heightened cardiovascular risk, which has been associated with abnormalities of bone and mineral metabolism. A deeper understanding of these abnormalities should facilitate improved treatment strategies and patient-level outcomes, but at present there are few large, randomised controlled clinical trials to guide management. Positive associations between serum phosphate and fibroblast growth factor 23 (FGF-23) and cardiovascular morbidity and mortality in both the general and CKD populations have resulted in clinical guidelines suggesting that serum phosphate be targeted towards the normal range, although few randomised and placebo-controlled studies have addressed clinical outcomes using interventions to improve phosphate control. Early preventive measures to reduce the development and progression of vascular calcification, left ventricular hypertrophy and arterial stiffness are crucial in patients with CKD.Methods and analysisWe outline the rationale and protocol for an international, multicentre, randomised parallel-group trial assessing the impact of the non-calcium-based phosphate binder, lanthanum carbonate, compared with placebo on surrogate markers of cardiovascular disease in a predialysis CKD population—the IMpact of Phosphate Reduction On Vascular End-points (IMPROVE)-CKD study. The primary objective of the IMPROVE-CKD study is to determine if the use of lanthanum carbonate reduces the burden of cardiovascular disease in patients with CKD stages 3b and 4 when compared with placebo. The primary end-point of the study is change in arterial compliance measured by pulse wave velocity over a 96-week period. Secondary outcomes include change in aortic calcification and biochemical parameters of serum phosphate, parathyroid hormone and FGF-23 levels.Ethics and disseminationEthical approval for the IMPROVE-CKD trial was obtained by each local Institutional Ethics Committee for all 17 participating sites in Australia, New Zealand and Malaysia prior to study commencement. Results of this clinical trial will be published in peer-reviewed journals and presented at conferences.Trial registration numberACTRN12610000650099.

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