scholarly journals Effects of the Use of Non-Calcium Phosphate Binders in the Control and Outcome of Vascular Calcifications: A Review of Clinical Trials on CKD Patients

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Piergiorgio Bolasco
Keyword(s):  
Calcium Phosphate ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Phosphate Binders ◽  
Vascular Calcifications ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Advanced Stages ◽  
The Impact ◽  
Specific Contribution

Vascular calcifications produce a high impact on morbidity and mortality rates in patients affected by chronic kidney disease and mineral bone disorder (CKD-MBD). Effects are manifested from the more advanced stages of CKD (stages 3-4), particularly in patients undergoing dialysis (CKD5D). In recent years, a large number of therapeutic options have been successfully used in the treatment of secondary hyperparathyroidism (SHPT), despite eliciting less marked effects on nonbone calcifications associated with CKD-MBD. In addition to the use of Vitamin D and analogues, more recently treatment with calcimimetic drugs has also been undertaken. The present paper aims to analyze comparative and efficacy studies undertaken to assess particularly the impact on morbidity and mortality rates of non-calcium phosphate binders. Moreover, the mechanism of action underlying the depositing of calcium and phosphate along blood vessel walls, irrespective of the specific contribution provided in reducing the typical phosphate levels observed in CKD largely at more advanced stages of the disease, will be investigated. The aim of this paper therefore is to evaluate which phosphate binders are characterised by the above action and the mechanisms through which these are manifested.

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

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.

Spectrum of mineral bone disorder in patients with CKD stage 3-5 from eastern India

JMS SKIMS ◽  
2019 ◽  
Vol 22 (3) ◽  
Author(s):  
Rayees Yousuf Sheikh ◽  
Nucksheeba Aziz Bhat ◽  
Arunansu Bandyopadhay ◽  
Arpita Roy Chowdhury
Keyword(s):  
Serum Calcium ◽  
Surrogate Marker ◽  
Phosphate Binders ◽  
Eastern India ◽  
Cross Sectional ◽  
Female Ratio ◽  
Mineral Bone Disorder ◽  
Ckd Stage ◽  
Significant Difference ◽  
Bone Disorder

Introduction: Chronic kidney disease mineral bone disorder (CKD-MBD) is a major determinant of CKD associated morbidity and morbidity. We sought to find the spectrum of CKD-MBD in Eastern India. Methodology: This cross-sectional study was conducted at the Department of Nephrology Institute of Postgraduate Medical Sciences and Research Seth Sukhlal Karnani Memorial hospital Kolkata India from June 2013 and July 2014. The patients with newly diagnosed stage 3-5 CKD were evaluated for bone mineral abnormalities. Patients already on some form of phosphate binders or vitamin D analogs were excluded. Results: Total of 242 patients was included. Male to female ratio was 2.1:1. 52.1% had Diabetic nephropathy. Mean eGFR was 26.51±12.33 ml/min/1.73m2. 36.8% had CKD stage 3, 46.7% CKD stage 4 and 16.5 % had CKD stage 5. 56% had hyperphosphatemia (Phosphate>4.0mg/dl). 30% had hypocalcaemia (corrected calcium <8.5mg/dl). 53.4% had Vit D deficiency (25-OH Vit D < 20ng/ml) and 64.9% had hyperparathyroidism (iPTH>65pg/ml). There was a significant negative correlation of eGFR with Phosphate, iPTH and ALP. The distribution of phosphate, ALP and iPTH across CKD stage 3-5 was significantly different; p-<0.001. 21.3% of patients with iPTH more than twice the upper limit of normal had normal ALP. There was no significant difference in serum calcium and 25-OH Vit D levels across CKD stage 3-5. Conclusions: CKD-MBD has a high prevalence. Secondary hyperparathyroidism is the most common type of CKD-MBD. 25-OH Vit D and serum calcium are determined predominantly by diet and exposure to sunlight. ALP can’t serve as a surrogate marker for iPTH.

The pathophysiology of early-stage chronic kidney disease-mineral bone disorder (CKD-MBD) and response to phosphate binders in the rat

2011 ◽  
Vol 26 (11) ◽  
pp. 2672-2681 ◽  
Author(s):  
Sharon M Moe ◽  
J Scott Radcliffe ◽  
Kenneth E White ◽  
Vincent H Gattone ◽  
Mark F Seifert ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Early Stage ◽  
Phosphate Binders ◽  
Mineral Bone Disorder ◽  
Bone Disorder

scholarly journals Diagnostic utility of FGF-23 in mineral bone disorder during chronic kidney disease

2022 ◽  
Vol 11 ◽  
pp. 1-4
Author(s):  
Luisa Albanese ◽  
Gemma Caliendo ◽  
Giovanna D'Elia ◽  
Luana Passariello ◽  
Anna Maria Molinari ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Added Value ◽  
Automated Method ◽  
Mineral Bone Disorder ◽  
Bone Disorder ◽  
Advanced Stages ◽  
25 Oh Vitamin D ◽  
Fgf 23

Our data confirm that intact fibroblast growth factor 23 (iFGF-23) concentration is increased in patients with chronic kidney disease (CKD) and that it increases with disease progression (stages I-V). Therefore, iFGF-23 could be considered an early biomarker in the course of chronic kidney disease-mineral bone disorder (CKD-MBD), which has several aspects that make it potentially useful in clinical practice. The availability of an automated method for iFGF-23 assay may represent an added value in the management of the patient with CKD-MBD already from the early stages of the disease, before the increase of the routinely used laboratory parameters, 1-84 parathyroid hormone (PTH) and 25-OH-vitamin D (25-OH-vitD), which occur in more advanced stages of the disease.

scholarly journals Effect of CKD-MBD therapies on the gastrointestinal expression of phosphate transporters

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Olivia Carlton ◽  
Neal Chen ◽  
Sharon Moe ◽  
Annabel Biruete
Keyword(s):  
Plasma Concentrations ◽  
Phosphate Binders ◽  
Male Rat ◽  
Vascular Calcifications ◽  
Mineral And Bone Disorder ◽  
Phosphate Transporters ◽  
Limited Effectiveness ◽  
The Impact ◽  
Plasma Phosphorus ◽  
Biochemical Abnormalities

Background: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is prevalent and encompasses biochemical abnormalities, bone alterations, and vascular calcifications. CKD-MBD treatments include phosphate binders and calcimimetics that effectively lower phosphorus and PTH, respectively, but the impact of these treatments on phosphate transporters in the gastrointestinal tract is still unknown. NaPi2B is considered the primary intestinal phosphate transporter. However, NaPi2B inhibition shows limited effectiveness, thus the importance of PIT1 and PIT2 requires further investigation. Methods: We tested the effects phosphate binders (ferric citrate (FC) and calcium gluconate (Ca)) and the calcimimetic KP2326 (KP) in (Cy/+ male rat; CKD) and untreated normal littermates (NL). Treatments lasted 10 weeks until euthanasia at 28 weeks (moderate-to-advanced CKD), where we collected mucosa samples from duodenum, jejunum, and ileum. Blood was collected for biochemistry measurements. Total RNA was isolated, and qPCR performed to assess phosphate transporters expression (NaPi2B, PIT1, PIT2) normalized to b-actin. Results were analyzed via 2-way ANOVA. Results: As expected, CKD had abnormal plasma concentrations of phosphorus, PTH, and FGF23. FC and KP effectively lowered phosphorus. KP and Ca lowered PTH, but Ca increased FGF23. NaPi2B was expressed in the duodenum and jejunum but not in the ileum, and its expression was upregulated with FC compared to NL. PIT1 was expressed in all segments, but the expression was the highest in the ileum, while PIT2 was constitutively expressed in all segments. Ca led to higher PIT1 and PIT2 expression in the duodenum and jejunum compared to NL, CKD, or KP. KP led to higher expression of PIT1 in the ileum compared to CKD, FC, and Ca. Conclusions: CKD-MBD therapies differentially impacted biochemistries and phosphate transporters expression. The effect of Ca on gastrointestinal expression of PIT1 and PIT2 may explain the higher plasma phosphorus and should be further explored.    

MO797JUXTAPOSING THE EFFICACIES BETWEEN IRON-BASED AND NON-CALCIUM PHOSPHATE BINDERS FOR IMPROVING MINERAL AND BONE DISORDER PARAMETERS IN DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Chronic Kidney Disease ◽  
Calcium Phosphate ◽  
Kidney Disease ◽  
Serum Phosphate ◽  
Ferric Citrate ◽  
Phosphate Binders ◽  
Mineral And Bone Disorder ◽  
Randomized Controlled ◽  
Bone Disorder ◽  
Iron Based

Abstract Background and Aims Hyperphosphatemia is a serious complication in chronic kidney disease (CKD) patients that serves as the main risk factor of CKD–mineral and bone disorder (CKD-MBD) progression. Previous studies suggested that iron-based phosphate binder showed better improvement in CKD-MBD parameters although the results were still inconclusive. This study aims to juxtapose the efficacies between iron-based and non-calcium phosphate binders for improving CKD-MBD parameters in dialysis-dependent (DD)-CKD patients. Method We did comprehensive searching to screen all relevant literature until November 2020 in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library. We included all randomized controlled trials (RCTs) accessing the efficacies of iron-based phosphate binders (sucroferric oxyhydroxide, ferric citrate) in improving CKD-MBD parameters compared with non-calcium phosphate binders (sevelamer) in DD-CKD patients. The parameters compared in this study are changes in serum phosphate (P), serum calcium ions (Ca), fibroblast growth factors-23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (calcidiol), and 1,25-dihydroxyvitamin D (calcitriol). Bias risk was accessed by using the revised Cochrane Risk-of-bias (RoB-2) tool. Analysis was performed to provide standard mean difference (SMD) with 95% confidence interval (CI) using random-effect heterogeneity test. Results Ten RCTs with total of 1,139 participants were included in this analysis. The sucroferric oxyhydroxide decreases FGF23 although not statistically significant (SMD = 0.22. 95% CI = -0.49 to 0.05, p = 0.11, I2 = 52%), but ferric citrate (SMD = -0.92. 95%CI = -1.56 to -0.29, p = 0.004, I2 = 69%) and the overall estimate (SMD = -0.45. 95% CI = -0.82 to -0.09, p = 0.02, I2 = 79%) showed significant FGF23 decline compared with sevelamer. The sucroferric oxyhydroxide showed no significant improvement of calcidiol (SMD = 0.08. 95%CI = -0.02 to 0.17, p = 0.13, I2 = 0%) and calcitriol (SMD = 0.02. 95% CI = -0.08 to 0.12, p = 0.74, I2 = 0%) compared with selevamer. There is also no significant improvement of iPTH in sucroferric oxyhydroxide subgroup (SMD = -0.14. 95%CI = -0.43 to 0.14, p = 0.32, I2 = 85%), ferric citrate subgroup (SMD = -0.02. 95%CI = -0.16 to 0.12, p = 0.80, I2 = 0%), and pooled group analysis (SMD = -0.10. 95%CI = -0.27 to 0.07, p = 0.27, I2 = 75%). Besides, this study also suggests no significant improvement comparison of serum P (SMD = -0.09. 95%CI = -0.19 to 0.02, p = 0.12, I2 = 38%) and Ca (SMD = 0.04. 95%CI = -0.12 to 0.20, p = 0.61, I2 = 57%). Conclusion There is no significant efficacies differences between iron-based and non-calcium phosphate binders for improving serum phosphate, serum calcium ions, iPTH, calcidiol, and calcitriol in dialysis-dependent chronic kidney disease patients, except for the FGF-23 parameter. However, further trials are needed to establish the juxtaposition.

One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Potential effect of pharmaceutical care to improve outcomes in patients with chronic kidney disease-mineral bone disorder in Sulaimani dialysis centers

2020 ◽  
pp. 82-94
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pharmaceutical Care ◽  
Biochemical Parameters ◽  
Positive Impact ◽  
Potential Effect ◽  
Care Group ◽  
Mineral Bone Disorder ◽  
Bone Disorder

Objective: the present study was aimed to evaluate the role of pharmaceutical services in improving the outcome of mineral bone disorder in patients with advanced chronic kidney disease. Methodology: One hundred and twenty patients with chronic kidney disease-mineral bone disorder (CKD-MBD) screened for eligibility, seventy-six patients enrolled in the study and randomly allocated into two groups: pharmaceutical care and usual care, both groups interviewed by the pharmacist using specific questionnaire for assessing the quality of life (QoL). All the drug related problems (DRPs) including drug-drug interactions (DDIs) were recorded by the pharmacist. Blood samples were collected and utilized for analyzing the levels of vitamin D, phosphorous, calcium, albumin and parathyroid hormone at baseline and three months after. The pharmaceutical care group received all the educations about their medications and how to minimize DRPs; improve the QoL. Additionally, the pharmaceutical intervention included correcting the biochemical parameters. Results: Pharmaceutical care significantly improved patients QoL and minimized DRPs and DDIs. It was also effective in improving the biochemical parameters. Conclusion: Pharmaceutical care has a positive impact on improving the outcome of patients with CKD-MBD through attenuating DRPs, improving the biochemical parameters and the QoL.

Sign in / Sign up

Export Citation Format

Share Document