scholarly journals MEDICAL METHODS OF CORRECTION OF RENAL OSTEODYSTROPHY

2014 ◽  
Vol 17 (2) ◽  
pp. 29-35
Author(s):  
L V Egshatyan ◽  
L Ya Rozhinskaya
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Drug Therapy ◽  
Pilot Study ◽  
Kidney Disease ◽  
Literature Review ◽  
Bone Metabolism ◽  
Renal Osteodystrophy ◽  
Phosphate Binders

The article presents a literature review summarizing the contemporary data on the effects of drug therapy on various parameters of renal osteodystrophy: phosphate binders, vitamin D preparations, bisphosphonates, denosumab, and calcimimetics. We discuss the results of pilot study of the efficacy of teriparatide and denosumab on parameters of bone metabolism in patients with chronic kidney disease.

Renal Osteodystrophy in Peritoneal Dialysis: Special Considerations

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 11-19 ◽  
Author(s):  
Ronen Levy ◽  
Anca Gal-Moscovici
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Lesion ◽  
Phosphate Binders ◽  
Vitamin D Metabolites ◽  
Bone Disorder

Bone disease is one of the most challenging complications in patients with chronic kidney disease. Today, it is considered to be part of a complex systemic disorder manifested by disturbances of mineral metabolism and vascular calcifications called chronic kidney disease – mineral bone disorder (CKD-MBD). The term renal osteodystrophy is reserved to define the specific bone lesion in CKD-MBD, whose spectrum ranges from high turnover to low turnover disease. Phosphate retention, decreased serum calcium, and 1,25-dihydroxy vitamin D synthesis are involved in the pathogenesis of high bone turnover. However, the various therapeutic approaches (calcium supplements, phosphate binders, and vitamin D metabolites, among others), the renal replacement modality (hemodialysis or continuous ambulatory peritoneal dialysis), and the types of patients to whom dialysis is offered (more patients who are diabetic or older, or both) may influence the evolution of the bone disorder. As a result, recent studies have reported a greater prevalence of adynamic forms of renal osteodystrophy, especially in diabetic and peritoneal dialysis patients. The present article reviews, for patients treated with peritoneal dialysis, the pathophysiologic mechanisms involved in the evolution and perpetuation of this bone disease and the therapeutic modalities for treating and preventing adynamic bone.

P0889TO WHAT EXTENT CAN WE ACHIEVE MINERAL BONE METABOLISM TREATMENT TARGETS AS SUGGESTED BY UPDATED 2017 KDIGO GUIDELINES IN PATIENTS WITH PREDIALYSIS CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mevlut Tamer Dincer ◽  
Şeyda Gül Özcan ◽  
Selma Alagoz ◽  
Cebrail Karaca ◽  
Sibel Gulcicek ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Phosphate Binders ◽  
Time Points ◽  
Therapeutic Inertia ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Kdigo Guidelines ◽  
Data Point

Abstract Background and Aims The mineral bone disorder is an essential problem in chronic kidney disease (CKD). It is an independent modifiable risk factor for renal damage progression and CKD related mortality. Therefore, it is important to treat chronic kidney disease mineral bone disorder (CKD-MBD) according to international guidelines. Data on the management of mineral bone disorders in predialysis patients is scarce. We aimed to investigate the proportion of CKD-MBD patients reaching targets suggested by the updated 2017 KDIGO guidelines. Method We performed a multicenter cross-sectional study. We recruited consecutive adult (>18 years of age) CKD 3-5 patients who were on regular nephrology outpatient clinic follow up. Patients who have GFR loss over 30% in the last six months, patients with malignancy, and decreased life expectancy due to severe comorbid disease and patients on renal replacement therapy were excluded. Data were collected in two-time points: one during the recruitment (second data point) and one, three to six months prior to the current visit (first data point). Persistent laboratory abnormalities were defined by out of normal range values in both time points. Therapeutic inertia was calculated for hyperphosphatemia. It was defined as a lack of using phosphate binders despite hyperphosphatemia. Results We examined a total of 213 patients for 3 different nephrology outpatient clinics. Of these patients, 49.5 % were male, with a mean age of 64,9 ± 12,0 years. 51.7 % of the patients were diabetic, 78 % were hypertensive, and 20.1 % had a history of coronary artery disease. Laboratory values related to MBD are shown in Table 1. KDIGO guideline targets were not reached in 14.8%, 18.4%, 59.0%, 71.0% patients regarding Ca, P, PTH, and vitamin D in the first visit. The targets were not reached in 15.0%, 19,2%, 61,2%, 81% patients regarding Ca, P, PTH, and vitamin D in the second visit. Persistence of out of target values were observed in 5.8%, 9.9%, 49.2% and 65.4% of the patients for Ca,P, PTH and Vitamin D respectively. The prevalence of therapeutic inertia for hyperphosphatemia was 34,4 % in the second visit Conclusion Regarding KDIGO guidelines, MBD is not optimally managed in predialysis CKD patients. Clinicians should have an active attitude regarding the correction of MBD even at the earlier stages of CKD.

scholarly journals Prescribing quality in secondary care patients with different stages of chronic kidney disease: a retrospective study in the Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025784 ◽  
Author(s):  
Kirsten PJ Smits ◽  
Grigory Sidorenkov ◽  
Frans J van Ittersum ◽  
Femke Waanders ◽  
Henk JG Bilo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Secondary Care ◽  
Phosphate Binders ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Prescribing Quality ◽  
Raas Inhibitors ◽  
To Receive

ObjectivesInsight in the prescribing quality for patients with chronic kidney disease (CKD) in secondary care is limited. The aim of this study is to assess the prescribing quality in secondary care patients with CKD stages 3–5 and possible differences in quality between CKD stages.DesignThis was a retrospective cohort study.SettingData were collected at two university (n=569 and n=845) and one non-university nephrology outpatient clinic (n=1718) in the Netherlands.ParticipantsBetween March 2015 and August 2016, data were collected from patients with stages 3a–5 CKD seen at the clinics. Blood pressure measurements, laboratory measurements and prescription data were extracted from medical records. For each prescribing quality indicator, patients with incomplete data required for calculation were excluded.Outcome measuresPotentially appropriate prescribing of antihypertensives, renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, phosphate binders and potentially inappropriate prescribing according to prevailing guidelines was assessed using prescribing quality indicators. Χ2or Fisher’s exact tests were used to test for differences in prescribing quality.ResultsRAAS inhibitors alone or in combination with diuretics (57% or 52%, respectively) and statins (42%) were prescribed less often than phosphate binders (72%) or antihypertensives (94%) when indicated. Active vitamin D was relatively often prescribed when potentially not indicated (19%). Patients with high CKD stages were less likely to receive RAAS inhibitors but more likely to receive statins when indicated than stage 3 CKD patients. They also received more active vitamin D and erythropoietin-stimulating agents when potentially not indicated.ConclusionsPriority areas for improvement of prescribing in CKD outpatients include potential underprescribing of RAAS inhibitors and statins, and potential overprescribing of active vitamin D. CKD stage should be taken into account when assessing prescribing quality.

Effect of topical vitamin D on chronic kidney disease-associated pruritus: An open-label pilot study

2015 ◽  
Vol 42 (8) ◽  
pp. 800-803 ◽  
Author(s):  
Kyung Eun Jung ◽  
Yu Ri Woo ◽  
Joong Sun Lee ◽  
Jong Ho Shin ◽  
Jin Uk Jeong ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Pilot Study ◽  
Kidney Disease ◽  
Open Label

scholarly journals Calcium, Phosphorus and PTH in Patients with End Stage of Chronic Kidney Disease, Undergoing Hemodialysis

2020 ◽  
Vol 3 (2) ◽  
pp. 21
Author(s):  
Serfa Faja ◽  
Amir Shoshi
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Treatment Options ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Phosphate Binders ◽  
Calcium Phosphorus ◽  
End Stage

Renal hyperparathyroidism (rHPT) is a common complication of chronic kidney disease characterized by elevated parathyroid hormone levels secondary to derangements in the homeostasis of calcium, phosphate, and vitamin D. Patients with rHPT experience increased rates of cardiovascular problems and bone disease. The Kidney Disease: Improving Global Outcomes guidelines recommend that screening and management of rHPT be initiated for all patients with chronic kidney disease stage 3 (estimated glomerular filtration rate, - 60 mL/min/1.73 m2). Since the 1990s, improving medical management with vitamin D analogs, phosphate binders, and calcimimetic drugs has expanded the treatment options for patients with rHPT, but some patients still require a parathyroidectomy to mitigate the sequelae of this challenging disease.

scholarly journals Paricalcitol in management of chronic kidney disease–mineral and bone disorder

2021 ◽  
pp. 190-198
Author(s):  
A. K. Eremkina ◽  
M. G. Mokrysheva
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Bone Metabolism ◽  
Randomized Clinical Trials ◽  
High Morbidity ◽  
Bone Disorders ◽  
Positive Effects ◽  
Organ Systems

Mineral and bone disorders in chronic kidney disease (CKD) is a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism  (secondary hyperparathyroidism); abnormalities in  bone turnover, mineralization, volume, linear growth, or strength; or vascular or other soft tissue calcification. Decreasing 1,25(OH)2D (calcitriol) and rising parathyroid hormone (PTH) levels occur on early stages of CKD. Secondary hyperparathyroidism contributes to the high morbidity and mortality noted in this population. Long-term decompensation of  secondary hyperparathyroidism in  patients with impaired renal function leads to irreversible changes in multiple organ systems, resistance to conservative treatment and the requirement for surgical intervention. Suppress of renal CYP27B1 and the calcitriol deficiency play a major role in the development of mineral and bone disorders in CKD, thus VDR activators are widely used for management of secondary hyperparathyroidism. These medications are effective in suppression of PTH and demonstrate the positive effects on bone metabolism. There is evidence of pleiotropic effects of VDR activators that are crucial for the prevention of renal fibrosis and extraskeletal calcification. This review focuses on the involvement of vitamin D in the pathogenesis of mineral and bone disorders and the role of paricalcitol in their correction. The efficacy of paricalcitol in patients with various stages of CKD has been evaluated in a large number of observational and randomized clinical trials, the comparative effectiveness of paricalcitol therapy has been summarized in several metanalyses.

scholarly journals Management of Disturbances of Calcium & Phosphate Metabolism in Patients with Chronic Kidney Disease

2012 ◽  
Vol 2 (2) ◽  
pp. 37-40
Author(s):  
Md Masum Kamal Khan ◽  
Saquiba Yesmine ◽  
MA Rashid ◽  
Rehnuma Tasmin Chowdhury ◽  
Iqbal Hasan Mahmood ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Calcium Phosphate ◽  
Kidney Disease ◽  
Phosphate Binders ◽  
Vitamin D Metabolism ◽  
Single Measure ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Calcium Phosphate Metabolism

Management of chronic kidney disease-mineral bone disorder (CKD-MBD) can be difficult in patients with chronic kidney disease (CKD). This review aims to explain why the control of disturbed calcium, phosphate, parathyroid hormone and vitamin D metabolism is important in CKD patients. The available means to control these parameters include diet, phosphate binders, native Vitamin D, active Vitamin D derivatives and calcimimetics. However, no single measure is not enough and concerted efforts give the best result. Ibrahim Cardiac Med J 2012; 2(2): 37-40

scholarly journals Pharmacotherapy in chronic kidney disease hyperphosphatemia – effects on vascular calcification and bone health

2017 ◽  
Vol 63 (01) ◽  
pp. 3-24
Author(s):  
Dimce Dzingarski ◽  
Kristina Mladenovska
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Bone Health ◽  
Mineral Metabolism ◽  
Phosphate Binders ◽  
Active Vitamin ◽  
Bone Disorders ◽  
Active Vitamin D ◽  
Active Vitamin D Sterols

Hyperphosphatemia (HP) in patients with chronic kidney disease (CKD) leads to complications such as renal osteodistrophy, cardiovascular calcification and hemodynamic abnormalities, all of them having a serious impact on the survival rate and quality of life. Also, HP is a key pathogenic factor in the development of secondary hyperparathyroidism (SHPT) in CKD. Having in regard the significance of controlling serum phosphorus levels (Pi), in this paper, the needs and obstacles to successful pharmacological management of HP in CKD are presented, with an overview of major classes of phosphate binders (PBs) and other drugs affecting Pi level, such as active vitamin D sterols and calcimimetics (CMs). In addition, their effects on progression of cardiovascular calcification and bone health are elaborated. In this regard, a PubMed search was carried out to capture all abstracts and articles relevant to the topic of CKD, HP and mineral metabolism, bone disorders and vascular/valvular calcification (VC), published from January 2007 to August 2017. The search was limited to English language, with the search terms including drug name AND hyperphosphatemia or cardiovascular calcification or bone disorder. Comparative studies, clinical studies/trials and meta-analyses related to different classes/representatives of PBs, vitamin D analogues and CMs were reviewed and research data related to their efficacy and safety compared. Keywords: chronic kidney disease, hyperphosphatemia, phosphate binders, active vitamin D sterols, calcimimetics, bone disorders, cardiovascular calcification

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