Predictors of Secondary Hyperparathyroidism in Chronic Kidney Disease Stage 3 and 4

2017 ◽  
Vol 06 (04) ◽  
Author(s):  
Abbas Ali Mansourand Hassan Abdulrazzaq Swaid
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage

scholarly journals Experience with Cinacalcet for Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease Stage III and IV

2009 ◽  
Vol 1 ◽  
pp. CMT.S2983 ◽  
Author(s):  
Terje Forslund ◽  
Arvo Koistinen ◽  
Marja Miettinen
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Chronic Kidney Disease Stage ◽  
Stage Iii ◽  
Disease Stage ◽  
Phosphate Binders ◽  
Increased Risk ◽  
Ckd Stage ◽  
Patient Reported

Dysequilibrium in calcium and phosphate metabolism with development of secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD) stage III and IV. Dietary phosphate restrictions and calcium based oral phosphate binders have not been effective in all subjects with SHPT, and soft tissue and vascular calcifications with an increased risk of cardiovascular death related are known consequences. Treatment with the calcimimetic Cinacalcet (Cc) has contributed to a better calcium and phosphate control in patients given hemodialysis treatment. In this retrospective study we present our experience with Cc given to ten (one year) or five (two years) patients with CKD stage III and IV and SHPT not suitable for surgery. With conventional therapy target levels of intact parathyroid hormon (iPTH) are seldomly reached the reason why an iPTH value < 300 ng/l was considered acceptable. Levels of iPTH decreased significantly after 3 months of Cc treatment and remained at the lower level. Plasma ionized-Ca (Ca) concentrations decreased initially but remained above 1.00 mmol/l in all but one patient. Phophate (P) levels increased to 1.41 ± 0.09 mmol/l (mean ± SE) leaving the Ca × P product unchanged. While patients with high iPTH needed high Cc doses up to 90 mg/day, some of the patients required very low doses 4.5-20 mg/day in order to achieve a decrease in iPTH levels. Only one patient reported gastric pain needing dose reduction and other adverse effects were not found. No changes in QT-time were observed. We experienced that Cc treatment was promising to control SHPT and stabilized the Ca-P balance in patients with CKD stage III and IV. Dosing may be challenging and laboratory values should be controlled often (monthly) as these patients may have variable response to Cc treatment. Due to the minimal knowledge about its effect on morbidity and mortality in the predialytic population further controlled studies are needed to confirm its efficacy and safety.

scholarly journals Efficacy and Safety of Cinacalcet in Chronic Kidney Disease Stage III and IV

2009 ◽  
Vol 1 ◽  
pp. CMT.S3189
Author(s):  
Aiji Yajima ◽  
Andreas Pasch ◽  
Kosaku Nitta
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Chronic Kidney Disease Stage ◽  
Stage Iii ◽  
Disease Stage ◽  
Control Serum ◽  
Ckd Stage ◽  
Cinacalcet Hydrochloride

Treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) stage III and IV with vitamin D sterols is useful to maintain optimal parathyroid hormone (PTH) levels and thereby, reduces the severity of bone abnormalities caused by high PTH levels. However, it should be borne in mind that serum calcium (Ca) levels may easily increase as bone turnover is easily suppressed due to diffuse or early nodular parathyroid tissue in these patients. Furthermore, an elevated risk of cardiovascular disease due to advanced atherosclerosis associated with both secondary hyperparathyroidism and the administration of vitamin D sterols has been reported in patients with moderate to severe CKD, resulting in a high mortality in these patients. In order to control serum Ca levels, therefore, additional use of cinacalcet hydrochloride may be useful. However, acute reduction of serum Ca levels and chronic hyperphosphatemia should be avoided; therefore, the doses of phosphorus (P) binders should be increased or the initiation of low doses of vitamin D sterols may be favorable in patients with stage III and IV CKD receiving cinacalcet hydrochloride. The phosphaturic effect of FGF-23 after treatment with cinacalcet is estimated to be small as compared with that of vitamin D in moderate to severe CKD patients, therefore, evaluation of osteocytes should be performed in patients with secondary hyperparathyroidism treated with cinacalcet hydrochloride.

Phosphate binders in patients with chronic kidney disease: Between the new and the old.

2019 ◽  
pp. 2-3
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Phosphate Binders ◽  
Advanced Chronic Kidney Disease ◽  
Phosphate Retention ◽  
Stage 4 ◽  
Dietary Phosphate

Impaired phosphate excretion by the kidney leads to Hyperphosphatemia. It is an independent predictor of cardiovascular disease and mortality in patients with advanced chronic kidney disease (stage 4 and 5) particularly in case of dialysis. Phosphate retention develops early in chronic kidney disease (CKD) due to the reduction in the filtered phosphate load. Overt hyperphosphatemia develops when the estimated glomerular filtration rate (eGFR) falls below 25 to 40 mL/min/1.73 m2. Hyperphosphatemia is typically managed with oral phosphate binders in conjunction with dietary phosphate restriction. These drugs aim to decrease serum phosphate by binding ingested phosphorus in the gastrointestinal tract and its transformation to non-absorbable complexes [1].

1049-P: Preexisting Chronic Kidney Disease Stage 3 Does Not Reduce Glycemic Efficacy of Metformin in U.S. Veterans with Type 2 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1049-P
Author(s):  
ELVIRA GOSMANOVA ◽  
DARREN E. GEMOETS ◽  
LAURENCE S. KAMINSKY ◽  
CSABA P. KOVESDY ◽  
AIDAR R. GOSMANOV
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage

Sarcopenia is an actual problem in chronic kidney disease of the 5d stage

2020 ◽  
Vol 24 (1) ◽  
pp. 60-66
Author(s):  
I. V. Lavrishcheva ◽  
A. Sh. Rumyantsev ◽  
M. V. Zakharov ◽  
N. N. Kulaeva ◽  
V. M. Somova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Chronic Kidney Disease Stage ◽  
Age Groups ◽  
Disease Stage ◽  
Actual Problem ◽  
European Working ◽  
Low Performance ◽  
6 Minute Walk Test

BACKGROUND. The lack of data on the epidemiology of presarcopenia/sarcopenia leads to an underestimation of the role of this condition in the structure of morbidity and mortality of haemodialysis patients in theRussian Federation. THE AIM: to study the epidemiological aspects of presarcopenia /sarcopenia in patients with chronic kidney disease stage 5d. PATIENTS AND METHODS. This study comprised 317 patients receiving programmed bicarbonate haemodialysis for 8.2 ± 5.1 years, among them 171 women and 146 men, the average age was 57.1 ± 11.3 years. The assessment of the presence of sarcopenia was performed using the method recommended by the European Working Group on Sarcopenia in Older People. RESULTS. The prevalence of presarcopenia was 0.7 % and sarcopenia 29.6 %. The incidence of skeletal muscle mass deficiency according to muscle mass index (IMM) was 30.3 %, 48.7 % showed a decrease in muscle strength according to dynamometry, and low performance of skeletal muscles according to 6 minute walk test was determined in 42.8 %. Sarcopenia patients were significantly characterized by lower body mass index, as well as higher body fat mass values. The duration of haemodialysis (χ2 = 22.376, p = 0.0001) and the patient's age (χ2 = 10.545 p = 0.014) were an independent risk factors for the development of sarcopenia. CONCLUSION. Sarcopenia is recorded more frequently in hemodialysis patients than presarcopenia. Its prevalence increases among patients of older age groups and with a hemodialysis duration of more than 5 years. The age and experience of dialysis make their independent contribution to the development of this syndrome.

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