Bone disesase in end-stage kidney disease – renal and non-renal components
Authors:
Sylvie Dusilová Sulková 1; Anita Pokorná 1; Roman Šafránek 1; Ladislava Pavlíková 2; Vladimír Palička 2
Authors‘ workplace:
Hemodialyzační středisko FN Hradec Králové a katedra interních oborů, Lékařská fakulta UK v Hradci Králové
1; Ústav klinické biochemie a diagnostiky, FN Hradec Králové
2
Published in:
Vnitř Lék 2021; 67(5): 258-263
Category:
Main Topic
Overview
Metabolic bone disease in chronic kidney disease and end-stage renal failure represents one of the most severe clinical complication in kidney patients, namely those on maintenance dialysis. Traditionally, bone changes are induced by secondary hyperparathyroidism. The CKD-MBD concept reflects the link between bone and cardiovascular disease in these patients. Studies documented also other bone pathological pathways in renal patients, such as osteoporosis, as in kidney and dialysis patients its risk factors are present as well as in general population. Resulting bone disease in renal disease and failure is far more complex than previously seen. However, the secondary hyperparathyroidism still represents the main pathological pathway.
Keywords:
Parathyroid hormone – dialysis – secondary hyperparathyroidism – chronic kidney disease – FGF-23 – hyperphosphatemia – renal bone disease – osteoporosis in kidney disease
Sources
1. Moe S, Drüeke T, Cunningham J et al. Kidney Disease: Improving Global Outcomes (KDIGO). Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69(11): 1945–1953.
2. Ketteler M, Block GA, Evenepoel P et al. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med. 2018; 168(6): 422–430.
3. Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 2011; 6: 913–921.
4. Cannata-Andía JB, Martín-Carro B, Martín-Vírgala J et al. Chronic Kidney Disease-Mineral and Bone Disorders: Pathogenesis and Management. Calcif Tissue Int 2021; 108: 410–422.
5. Jørgensen HS, David K, Salam S. et al. European Renal Osteodystrophy (EUROD) workgroup, an initiative of the CKD-MBD working group of the ERA-EDTA. Traditional and Non-traditional Risk Factors for Osteoporosis in CKD. Calcif Tissue Int. 2021; 108: 496–511.
6. Evenepoel P, Cunningham J, Ferrari S et al. European Renal Osteodystrophy (EUROD) workgroup, an initiative of the CKD-MBD working group of the ERA-EDTA, and the committee of Scientific Advisors and National Societies of the IOF. European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4-G5D. Nephrol Dial Transplant. 2021; 36: 42–59.
7. Vilaca T, Salam S, Schini M et al. Risks of Hip and Nonvertebral Fractures in Patients with CKD G3a-G5D: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2020; 76: 521–532.
8. Hampson G, Elder GJ, Cohen-Solal M et al. Abrahamsen B. A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease. Endocrine. 2021 May 11. doi: 10.1007/s12020-021-02735-9.
9. Brunerova L, Palicka V, Dusilova Sulkova S. Commentary on Management of Osteoporosis in Advanced CKD: Common View of a Nephrologist and a Bone Specialist. Endocrine Practice 2019; 25: 193–196.
10. Blaine J, Chonchol M, Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol 2015; 10: 1257–1272.
11. Tatsumi S, Miyagawa A, Kaneko I et al. Regulation of renal phosphate handling: inter- -organ communication in health and disease. J Bone Miner Metab. 2016; 34: 1–10.
12. Ureña-Torres PA, Vervloet M, Mazzaferro S et al. ERA-EDTA CKD-MBD Working Group. Novel insights into parathyroid hormone: report of The Parathyroid Day in Chronic Kidney Disease. Clin Kidney J 2018; 12: 269–280.
13. Bover J, Arana C, Ureña P et al. Hyporesponsiveness or resistance to the action of parathyroid hormone in chronic kidney disease. Nefrologia (Engl Ed). 2021; doi: 10.1016/j.nefro.2020.12.019.
14. Goto S, Fuji H, Hamada Y et al. Association between indoxyl sulphate and skeletal resistance in hemodialysis patients. Ther Apher Dial. 2010; 14: 417–423.
15. Watanabe K, Tominari T, Hirata M et al. Indoxyl sulphate, a uremic toxin in chronic kidney disease, suppresses both bone formation and bone resorption. FEBS Open Bio. 2017; 20(7): 1178–1185.
16. Yamamoto S, Fukagawa M. Uremic Toxicity and Bone in CKD. J Nephrol. 2017; 30: 623–627.
17. Hu MC, Shi M, Zhang J et al. Klotho deficiency causes vascular calcification in chronic kidney disease. J Am Soc Nephrol 2011; 22: 124–136.
18. Graciolli FG, Neves KR, dos Reis LM et al. Phosphorus overload and PTH induce aortic expression of Runx2 in experimental uraemia. Nephrol Dial Transplant. 2009; 24: 1416–1421.
19. Schlieper G, Schurgers L, Brandenburg V et al. Vascular calcification in chronic kidney disease: an update. Nephrol Dial Transplant 2015.
20. Graciolli FG, Neves KR, dos Reis LM et al. Phosphorus overload and PTH induce aortic expression of Runx2 in experimental uraemia. Nephrol Dial Transplant. 2009; 24: 1416–1421.
21. Carrilo-Lopez N, Panizo S, Alonso-Montes C et al. High serum phosphate and parathyroid hormone distinctly regulate bone loss and vascular calcifications in experimental chronic kidney disease. Nephrol Dial Transplant 2018; 34: 934–941.
22. Razzaque MS. The dualistic role of vitamin D in vascular calcifications Kidney Int. 2011; 79: 708–714.
23. Dusilová Sulková S, Horáček J, Vykoukalová E et al. Parathyroidectomy in Hyperparathyroidism- Associated Calciphylaxis in End-Stage Renal Disease Should be Prompt and Radical – a Case Report with Two Original Therapeutic Modifications and Successful Outcome. Acta Medica (Hradec Kralove). 2017; 60: 85–88.
24. Duque EJ, Elias RM, Moysés RMA. Parathyroid Hormone: A Uremic Toxin. Toxins (Basel). 2020; 12:189. doi: 10.3390/toxins12030189.
25. Silver J, Naveh-Many T. FGF-23 and secondary hyperparathyroidism in chronic kidney disease. Nat Rev Nephrol 2013; 9: 641–649.
26. Ketteler M, Ambühl P. Where are we now? Emerging opportunities and challenges in the management of secondary hyperparathyroidism in patients with non-dialysis chronic kidney disease. J Nephrol. 2021; doi: 10.1007/s40620-021-01082-2.
27. Komaba H, Ketteler M, Cunningham J et al. Old and New Drugs for the Management of Bone Disorders in CKD. Calcif Tissue Int. 2021; 108: 486–495.
28. Shutto Y, Shimada M, Kitajima M et al. Lack of awareness among future medical professionals about the risk of consuming hidden phosphate- containing processed food and drinks. PLoS One. 2011; 6: e29105.
29. D’Alessandro C, Piccoli GB, Cupisti A. The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients. BMC Nephrol. 2015; 16: 9.
30. Christodoulou M, Aspray TJ, Schoenmakers I. Vitamin D Supplementation for Patients with Chronic Kidney Disease: A Systematic Review and Meta-analyses of Trials Investigating the Response to Supplementation and an Overview of Guidelines. Calcif Tissue Int. 2021 Apr 25. doi: 10.1007/s00223-021-00844-1.
31. Sista SK, Arum SM. Management of adynamic bone disease in chronic kidney disease: A brief review. J Clin Transl Endocrinol 2016; 5: 32–35.
32. Dusilová-Sulková S, Šafránek R, Vávrová J et al. Low-dose cholecalciferol supplementation and dual vitamin D therapy in haemodialysis patients. Int Urol Nephrol 2015; 47: 169–176.
33. Hu MC, Kuro-o M, Moe OW. The emerging role of Klotho in clinical nephrology. Nephrol Dial Transplant 2012; 27(7): 2650–2657.
34. Drueke TB, Massy ZA. Changing bone patterns with progression of chronic kidney disease. Kidney Int 2016; 89(2): 289–302.
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Internal Medicine
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