Vnitr Lek 2012, 58(7-8):12-18

Changes to calcium-phosphate metabolism associated with chronic nephropathies

J. Blahoš1,*, I. Sotorník1,2
1 Oddělení klinické endokrinologie a osteocentrum Ústřední vojenské nemocnice Praha, vedoucí prof. MUDr. Jaroslav Blahoš, DrSc.
2 Osteologická ambulance Synlab Czech, Praha, vedoucí lékařka MUDr. Kateřina Kotrčová, Ph.D.

The paper discusses bone mineral and bone disorders associated with chronic nephropathies that are a logical consequence of reduced renal function. These are principally driven by changes in parathormone production and vitamin D synthesis. Bones are usually affected by renal osteopathy - osteodystrophy with abnormities of bone turnover, mineralization and volume, and with growth retardation in children. Extra-skeletal calcifications may occur, of which vascular wall localization is the most serious. A collection of pathologies develops, now termed chronic kidney disease - mineral and bone disorder (CKD-MBD).

Keywords: bone minerals; chronic nephropathy; parathormone; vitamin D; skeletal changes; calcification

Received: May 15, 2012; Published: July 1, 2012  Show citation

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Blahoš J, Sotorník I. Changes to calcium-phosphate metabolism associated with chronic nephropathies. Vnitr Lek. 2012;58(7-8):12-18.
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    References

    1. Kidney Disease: KDIGO clinical practice guidelines for the diagnosis, evaluation, presentation and treatment of chronic kidney disease - mineral bone disorder (CKD-MBD). Kidney Int 2009; 76: 1-130. Go to original source...
    2. Levey AS, Atkins R, Coresh J et al. Chronic kidney disease as a global public health problem: approaches and initiations - a position statement from Kidney Disease: Improving Global Outcomes. Kidney Int 2007; 72: 247-259. Go to original source... Go to PubMed...
    3. Moorthi R, Moe SM. CKD - Mineral and bone disorder: Core curriculum 2011. Am J Kidney Dis 2011; 58: 1022-1036. Go to original source... Go to PubMed...
    4. Liu SH, Gupta A, Quarles LD. Emerging role of fibroblast growth factor 23 in bone-kidney axis regulating systemic phosphate homeostasis and extracellular matrix mineralization. Cur Opin Nephrol Hypertens 2007; 16: 329-335. Go to original source... Go to PubMed...
    5. John GB, Cheng CY, Kuro-o M. Role of klotho in aging, phosphate metabolism, and CKD. Am J Kidney Dis 2011; 58: 127-134. Go to original source... Go to PubMed...
    6. Kobama H, Fukagawa M. FGF-23-parathyroid interaction: implications in chronic kidney disease. Kidney Int 2010; 77: 292-298. Go to original source... Go to PubMed...
    7. Prié D, Beck L, Ureña P et al. Recent findings in phosphate homeostasis. Curr Opin Nephrol Hypertens 2005; 13: 675-681. Go to original source... Go to PubMed...
    8. Nakanishi S, Kazama JJ, Nii-Kono T et al. Serum fibroblast growth factor 23 levels predict the future refractory hyperparathyroidism in dialysis patients. Kidney Int 2005; 67: 1171-1178. Go to original source... Go to PubMed...
    9. Galitzer H, Ben-Dov IZ, Silver J et al. Parathyroid cell resistance to fibroblast growth factor 23 in secondary hyperparathyroidism of chronic kidney disease. Kidney Int 2010; 77: 200-218. Go to original source... Go to PubMed...
    10. Gutiérrez OM, Mannstadt M, Isakova T et al. Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 2008; 359: 584-592. Go to original source... Go to PubMed...
    11. Gutiérrez OM, Januzzi JL, Isakova T et al. Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease. Circulation 2009; 119: 546-551. Go to original source... Go to PubMed...
    12. Yilmaz MI, Sinmez A, Saglan M et al. FGF-23 and vascular dysfunction in patients with stage 3 and 4 of chronic kidney disease. Kidney Int 2010; 78: 679-685. Go to original source... Go to PubMed...
    13. Sato T, Tominaga Y, Ueki T et al. Total parathyroidectomy reduces elevated circulating fibroblast growth factor 23 in advanced secondary hyperparathyroidism. Am J Kidney Dis 2004; 44: 481-487. Go to original source... Go to PubMed...
    14. Evenepoel P, Naesens M, Claes K et al. Tertiary hyperphosphatonism accentuates hypophosphatemia and suppreses calcitriol levels in renal transplant recipients. Am J Transplant 2007; 7: 1193-1200. Go to original source... Go to PubMed...
    15. Kuro-o M, Matsumara Y, Aizawa H et al. Mutation of the mouse klotho gene leads to a syndrome resembling ageing. Nature 1997; 390: 49-51. Go to original source... Go to PubMed...
    16. Chang Q, Hoeps S, van der Kemp AW et al. The β-glucuronidase hydroxylyzes and activates the TRPV5 channel. Science 2005; 310: 490-493. Go to original source... Go to PubMed...
    17. Kurosu M, Yamamoto M, Clark JD et al. Suppression of aging in mice by the hormone klotho. Science 2005; 309: 1829-1833. Go to original source... Go to PubMed...
    18. Blahoš J. Stárnutí kosti a význam osteocytů. Osteol Bull 2011; 16: 1-3.
    19. Haruna Y, Kashihara N, Satoh M et al. Amelioration of progressive renal injury by genetic manipulation of klotho gene. Proc Natl Acad Sci USA 2007; 104: 2331-2336. Go to original source... Go to PubMed...
    20. Hu MC, Shi M, Zhang J et al. Klotho deficiency causes vascular calcification in chronic kidney disease. J Am Soc Nephrol 2011; 22: 124-126. Go to original source... Go to PubMed...
    21. Krishnan V, Bryant HU, Macdougald OA. Regulation of bone mass by Wnt signaling. J Clin Invest 2006; 116: 1202-1208. Go to original source... Go to PubMed...
    22. Keller H, Kneissel M. SOST is a target gene for PTH in bone. Bone 2005; 37: 148-158. Go to original source... Go to PubMed...
    23. van Bezooijen RL, Svensson JP, Eefting D et al. Wnt but not BMP signaling is involved in the inhibitory action of sclerostin on BMP-stimulated bone formation. J Bone Miner Res 2007; 22: 19-28. Go to original source... Go to PubMed...
    24. Sotorník R. Mechanismy vlivu glukokortikoidů na skelet. In: Sotorník I, Kutílek Š (eds). Kostní minerály a skelet při chronickém onemocnění ledvin. Praha: Galén 2011: 230-281.
    25. Bellido T, Ali AA, Gubrij I et al. Chronic elevation of parathyroid hormone in mice reduces expression of sclerostin by osteocytes: a novel mechanism for hormonal control of osteoclastogenesis. Endocrinology 2005; 146: 4577-4583. Go to original source... Go to PubMed...
    26. Cejka D, Herberth J, Branscum AJ et al. Sclerostin and Dickkopf-1 in renal osteodystrophy. Clin J Am Soc Nephrol 2011; 6: 877-882. Go to original source... Go to PubMed...
    27. Gaudio A, Pennisi P, Bratengeier C et al. Increased sclerostin serum levels associated with bone formation and resorption markers in patients with immobilization - induced bone loss. J Clin Endocrinol Metab 2010; 95: 2248-2253. Go to original source... Go to PubMed...
    28. Cirmanová V, Stárka L. Sklerostin - nový regulační marker kostního obratu a klíčový cíl v terapii osteoporózy. Osteol Bull 2011; 16: 16-19.
    29. Mirza FS, Padhi ID, Raisz LG et al. Serum sclerostin levels negatively corelate with parathyroid hormone levels and free estrogen index in postmenopausla women. J Clin Endocrinol Metab 2010; 95: 1991-1997. Go to original source... Go to PubMed...
    30. Cejka D, Jäger-Lansky A, Kieweg H et al. Sclerostin serum levels correlate positively with bone mineral density and microarchitecture in haemodialysis patients. Nephrol Dial Transplant 2012; 27: 226-230. Go to original source... Go to PubMed...
    31. Dusilová Sulková S. Sklerostin a jeho význam v kontextu renální osteopatie. Postgradualní nefrol 2011; IX: 79-80.
    32. Gooi JH, Pompolo S, Karsdal MA et al. Calcitonin impairs the anabolic effect of PTH in young rats and stimulates expression of sclerostin by osteocytes. Bone 2010; 46: 1486-1497. Go to original source... Go to PubMed...
    33. Zikán V. Význam parathormonu, kalcitoninu a sklerostinu v regulaci kostní remodelace. Osteol Bull 2010; 15: 48-50. Go to original source...
    34. Chan A, van Bezooijen RL, Löwik CW. A new paradigm in the treatment of osteoporosis: Wnt pathway proteins and their antagonists. Curr Opin Invest Drugs 2007; 8: 293-298. Go to PubMed...
    35. Sotorník I, Karasová L, Kautznerová D et al. Vyšetřovací postupy. In: Sotorník I, Kutílek Š et al (eds). Kostní minerály a skelet při chronickém onemocnění ledvin. Praha: Galén 2011: 107-155.
    36. Chowdhury UK, Airan B, Mishra TK et al. Histopathology and morphometry of radial artery conduits: basic study and clinical application. Ann Thorac Surg 2004; 78: 1614-1621. Go to original source... Go to PubMed...
    37. Raggi P, Boulay A, Chasa-Taber S et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 2002; 39: 695-701. Go to original source... Go to PubMed...
    38. Amann K. Medial calcification and intima calcification are distinct entities in chronic kidney disease. J Am Soc Nephrol 2008; 3: 1599-1605. Go to original source... Go to PubMed...
    39. Nolan CR, Qunibi WY. Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. Curr Opin Nephrol Hypertens 2003; 12: 373-379. Go to original source... Go to PubMed...
    40. Giachelli CM. Vascular calcification mechanism. J Am Soc Nephrol 2004; 15: 2959-2964. Go to original source... Go to PubMed...
    41. Lomashvili KA, Garg P, O'Neill WC. Chemical and hormonal determinants of vascular calcification in vitro. Kidney Int 2006; 69: 1464-1470. Go to original source... Go to PubMed...
    42. Block GA, Raggi P, Bellaso A et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007; 71: 438-441. Go to original source... Go to PubMed...
    43. O'Neill WC, Wang X, Faugere MS et al. Effect of calcitriol on vascular calcification and uremic osteodystrophy. J Am Soc Nephrol 2009; 20: 37A.
    44. Wolf M, Shah A, Gutiérrez O et al. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 2007; 72: 1004-1013. Go to original source... Go to PubMed...
    45. O'Neill WC, Lomashvili KA. Recent progress in the treatment of vascular calcification. Kidney Int 2010; 78: 1232-1239. Go to original source... Go to PubMed...
    46. London GM, Guerin AP, Marchais SJ et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18: 1731-1740. Go to original source... Go to PubMed...
    47. Block GA, Klassen PS, Lazarus JM et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15: 2208-2218. Go to original source... Go to PubMed...
    48. Moorthi RN, Moe SM. CKD - Mineral and Bone Disorder: Core curriculum 2011. Am J Kidney Dis 2011; 58: 1022-1036. Go to original source... Go to PubMed...
    49. Bolland MV, Avenell A, Baron JA et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. Brit Med J 2010; 341: c3691. Go to original source... Go to PubMed...
    50. Reid IR, Bolland MJ, Avenell A et al. Cardiovascular effects of calcium supplementation. Osteoporosis Int 2011; 22: 1649-1658. Go to original source... Go to PubMed...
    51. Elder GJ. Calcium supplementation: lessons from the general population for chronic kidney disease and back. Curr Opin Nephrol Hypertens 2011; 20: 369-375. Go to original source... Go to PubMed...
    52. Salusky IB. A new era in phosphate binder therapy: What are the options? Kidney Int 2006; 70: 10-15. Go to original source... Go to PubMed...
    53. Navaneethan SD, Palmer SC, Craig JC et al. Benefits and harms of phosphate binders in CKD: A systematic review of randomized controlled trials. Am J Kidney Dis 2009; 54: 619-637. Go to original source... Go to PubMed...
    54. Block GA, Spiegel DM, Ehrich J et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to dialysis. Kidney Int 2005; 68: 1815-1824. Go to original source... Go to PubMed...
    55. Braulin W, Zhorov E, Guo A et al. Bile acid binding to sevelamer HCl. Kidney Int 2002; 62: 611-619. Go to original source... Go to PubMed...
    56. Garg JP, Chasan-Taber S, Blair A et al. Effect of sevelamer and calcium-based phosphate binders on uric acid concentration in patients undergoing hemodialysis: a randomized clinical trial. Arthritis Rheum 2005; 52: 290-295. Go to original source... Go to PubMed...
    57. Neri L, Rocca Rey LA, Lentine KL et al. Joint association of hyperuricemia and reduced GFR on cardiovascular morbidity: A historical cohort study based on laboratory and claims data from a National Insurance Provider. Am J Kidney Dis 2011; 58: 398-408. Go to original source... Go to PubMed...
    58. Suki WA, Zabaneh R, Cangiano JL et al. Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Kidney Int 2007; 72: 1130-1137. Go to original source... Go to PubMed...
    59. Goto S, Fujii H, Kim JI et al. Homocysteine and folic acid levels in hemodialysis patients treatment with sevelamer hydrochloride. Clin Nephrol 2010; 73: 420-425. Go to original source... Go to PubMed...
    60. DeBroe ME, D'Haase PC. Improving outcomes in hyperphosphatemia. Nephrol Dial Transplant 2004; 19 (Suppl 1): 14-18. Go to original source... Go to PubMed...
    61. Spiegel DM, Farmer B, Smits G et al. Magnesium carbonate is an effective phosphate binder for chronic hemodialysis patients: a pilot study. J Renal Nutrition 2007; 17: 416-422. Go to original source... Go to PubMed...
    62. Geisser P, Philipp E. PA21: a novel phosphate binder for the treatment of hyperphosphatemia in chronic kidney disease. Clin Nephrol 2010; 74: 4-11. Go to original source... Go to PubMed...
    63. Maccubin D, Tipping D, Kuznetsova O et al. Hypophosphatemic effect of niacin in patients without renal failure: a randomized trial. Clin J Am Soc Nephrol 2010; 5: 528-529. Go to original source... Go to PubMed...
    64. Holick MF. Vitamin D deficiency. N Engl Med J 2007; 357: 266-281. Go to original source... Go to PubMed...
    65. Kennel KA, Drake MT, Horley DL. Vitamin D deficiency in adults: When to test and how to treat. Mayo Clin Proc 2010; 85: 752-758. Go to original source... Go to PubMed...
    66. Gal-Moscovici A, Sprague SM. Use of vitamin D in chronic kidney disease patients. Kidney Int 2010; 78: 146-151. Go to original source... Go to PubMed...
    67. Pilz S, Iodice S, Zittermann A et al. Vitamin D status and mortality risk in CKD: A meta analysis of prospective studies. Am J Kidney Dis 2011; 58: 374-382. Go to original source... Go to PubMed...
    68. Navaneethan SD, Schold JD, Arrigain S et al. Low 25-hydroxyvitamin D levels and mortality in non-dialysis-dependent CKD. Am J Kidney Dis 2011; 58: 536-543. Go to original source... Go to PubMed...
    69. Matias PJ, Jorge C, Ferreira C et al. Cholecalciferol supplementation in hemodialysis patients: Effects on mineral metabolism, inflammation, and cardiac dimension parameters. Clin J Am Soc Nephrol 2010; 5: 905-911. Go to original source... Go to PubMed...
    70. Kovesdy CP, Lu JL, Malkauskas SM et al. Paricalcitol versus ergocalciferol for secondary hyperparathyroidism in CKD stages 3 and 4: A randomized controlled trial. Am J Kidney Dis 2012; 59: 58-66. Go to original source... Go to PubMed...
    71. Li YC, Kong J, Wei M et al. 1,25-dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002; 110: 229-238. Go to original source...
    72. Sun J, Kong J, Duan Y et al. Increased NF-(kappa)B activity in fibroblasts lacking the vitamin D receptor. Am J Physiol Endocrinol Metab 2006; 291: E315-E322. Go to original source... Go to PubMed...
    73. Li YC. Renoprotective effects of vitamin D analogs. Kidney Int 2010; 78: 134-139. Go to original source... Go to PubMed...
    74. Kuhlmann A, Haas CS, Gross ML et al. 1,25-dihydroxyvitamin D3 decreases podocyte loss and podocyte hypertrophy in the subtotally nephrectomied rat. Am J Physiol Renal Physiol 2004; 286: F526-F533. Go to original source... Go to PubMed...
    75. Tan X, Li Y, Liu Y. Paricalcitol alternates renal interstitial fibrosis in obstructive nephropathy. J Am Soc Nephrol 2006; 17: 3382-3393. Go to original source... Go to PubMed...
    76. Agarwal R, Acharya M, Tian J et al. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int 2005; 68: 2823-2828. Go to original source... Go to PubMed...
    77. Teng M, Wolf M, Ofsthun MN et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol 2005; 16: 1115-1125. Go to original source... Go to PubMed...
    78. Zhang Z, Zhang Y, Ming G et al. Combination therapy with AT1 blocker and vitamin D analog markedly ameliorates diabetic nephropathy: blockade of compensatory renin increase. Proc Natl Acad Soc USA 2008; 105: 15896-15901. Go to original source... Go to PubMed...
    79. Fishbane S, Chittineni H, Packman M et al. Oral paricalcitol in the treatment of patients with CKD and proteinuria: a randomized trial. Am J Kidney Dis 2009; 54: 647-652. Go to original source... Go to PubMed...
    80. Lambers Meerspink HJ, Agarwal R, Cuyne DW et al. The selective vitamin D receptor activator for albuminuria lowering (VITAL) study: design an baseline characteristics. Am J Nephrol 2009; 30: 280-286. Go to original source... Go to PubMed...
    81. de Zeeuw D, Agarwal R, Amdahl M et al. Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomized controlled trial. Lancet 2010; 376: 1543-1551. Go to original source... Go to PubMed...
    82. Sotorník I. Terapie renální osteopatie. In: Sotorník I, Kutílek Š (eds). Kostní minerály a skelet při chronickém onemocnění ledvin. Praha: Galén 2011: 173-223.
    83. Frazāo JM, Messa P, Mellotte GJ et al. Cinacalcet reduces plasma intact parathyroid hormone, serum phosphate and calcium levels in patients with secondary hyperparathyroidism irrespective of its severity. Clin Nephrol 2011; 76: 233-243. Go to original source... Go to PubMed...
    84. Toussaint ND. Extracellular matrix calcification in chronic kidney disease. Curr Opin Nephrol Hypertens 2011; 20: 360-368. Go to original source... Go to PubMed...
    85. Toussaint ND, Elder GJ, Kerr PG. Bisphosphonates in chronic kidney disease; balancing potential benefits and adverse effects on bone and soft tissue. Clin J Am Soc Nephrol 2009; 4: 221-233. Go to original source... Go to PubMed...
    86. Pasch A, Schaffner T, Huynh-Do U et al. Sodium thiosulphate prevents vascular calcification in uremic rats. Kidney Int 2008; 74: 1444-1453. Go to original source... Go to PubMed...
    87. Yatzidis H, Agroyanis B. Sodium thiosulphate treatment of soft tissue calcifications in patients with end-stage renal disease. Perit Dial Bull 1987; 7: 250-252. Go to original source...
    88. Mendoza FJ, Lopez I, Montes de Oga A et al. Metabolic acidosis inhibits soft tisssue calcification in uremic rats. Kidney Int 2008; 73: 407-414. Go to original source... Go to PubMed...
    89. Cai Y, Xu MJ, Teng X et al. Intermedin inhibits vascular calcification by increasing the level of matrix gama-carboxy-glutamic acid proteins. Cardiovasc Res 2010; 85: 864-873. Go to original source... Go to PubMed...

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