Comparative Effects of Etelcalcetide and Maxacalcitol on Serum Calcification Propensity in Secondary Hyperparathyroidism: A Randomized Clinical Trial.

Background And Objectives: Vitamin D receptor activators and calcimimetics (calcium-sensing receptor agonists) are two major options for medical treatment of secondary hyperparathyroidism. A higher serum calcification propensity (a shorter T value) is a novel surrogate marker of calcification stress and mortality in patients with CKD. We tested a hypothesis that a calcimimetic agent etelcalcetide is more effective in increasing T value than a vitamin D receptor activator maxacalcitol.

Higher serum bone alkaline phosphatase as a predictor of mortality in male hemodialysis patients.

Aims: Higher serum alkaline phosphatase predicts lower mortality in chronic kidney disease and hemodialysis patients without liver dysfunction because it reflects high bone turnover. The purpose of our study was to compare the significance of serum bone alkaline phosphatase (BAP) with that of other bone markers in prediction of all-cause mortality(ACM) in male hemodialysis patients.

Main Methods: The study was performed for 5 years.

Cerebral microbleeds in predialysis patients with chronic kidney disease.

Background: Gradient-echo T2*-weighted magnetic resonance imaging (T2*-weighted MRI) is highly sensitive for detecting cerebral microbleeds (CMBs). CMBs have been reported to be a risk factor for future cerebrovascular events and a marker of cerebral small vessel disease in the general population. Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease.

Renal biopsy in a patient with haemophilia A and cryoglobulinaemic membranoproliferative glomerulonephritis associated with hepatitis C virus infection.

A renal biopsy was performed in a 47-year-old man with haemophilia A. Thirty minutes after administration of an intravenous bolus of 4000 units of recombinant factor VIII, which increased the activity to 74-91%, a needle renal biopsy was successfully performed, followed by administration of 3000 units of factor VIII in the evening, and then the subsequent morning and evening. The patient was diagnosed with hepatitis C virus-associated membranoproliferative glomerulonephritis.

[Bone metabolic marker for osteoporosis].

The purposes hypothesized for the determination of bone metabolic markers, among which we can measure serum BAP, NTX, TRAP-5b or urinary NTX, DPD, CTX in routine clinical practice, are to predict the rate of bone loss and the resultant fracture risk, and to estimate bone quality. The higher value of bone markers, which might reflect high turnover bone disease, allows us to discriminate those who require early introduction of drug therapy such as bisphosphonate, and raloxifene. Furthermore, early reduction of bone resorption markers, but not bone formation markers, possibly 3-6 month after initiation of bone anti-resorptive drugs, enables us to predict bone gain thereafter.

Association of glycated albumin, but not glycated hemoglobin, with peripheral vascular calcification in hemodialysis patients with type 2 diabetes.

Aims: Elevated HbA(1C) is a predictor of mortality as well as peripheral vascular calcification in hemodialysis (HD) patients with diabetes. However, improved glycemic control as reflected by reduction in HbA(1C) may dismiss the relationship between HbA(1C) and mortality in those patients, due possibly to the underestimation of HbA(1C) by erythropoietin use. This study was to establish the significance of glycated albumin (GA) as a useful marker of peripheral vascular calcification in diabetic HD patients, in comparison with HbA(1C).

Serum levels of TRAP5b, a new bone resorption marker unaffected by renal dysfunction, as a useful marker of cortical bone loss in hemodialysis patients.

Tartrate-resistant acid phosphatase (TRAP) 5b is a new marker of bone resorption that is unaffected by renal dysfunction. The significance of TRAP5b was assessed in hemodialysis (HD) patients. Serum concentrations of TRAP5b and cross-linked N-telopeptide of type I collagen (NTX) were determined as bone resorption markers, and those of bone alkaline phosphatase (BAP) and intact osteocalcin (OC) were measured as bone formation markers in 58 HD patients.

Utility of serum tartrate-resistant acid phosphatase (TRACP5b) as a bone resorption marker in patients with chronic kidney disease: independence from renal dysfunction.

Background: Serum tartrate-resistant acid phosphatase (TRACP) 5b levels were assessed in predialysis patients with chronic kidney disease (CKD). The aim of the study was to establish the usefulness of a new assay for TRACP5b in assessing bone turnover in these patients.

Methods: Serum concentrations of two bone resorption markers, TRACP5b and N-terminal cross-linking telopeptide of type I collagen (NTX); two bone formation markers, bone specific alkaline phosphatase (bone ALP) and intact osteocalcin (OC[1-49]); and PTH were measured in 98 predialysis CKD patients.

Influence of nutritional status on serum large N-truncated PTH, but not PTH(1-84) in hemodialysis patients.

Background: Serum level of parathyroid hormone (PTH), measured by second-generation intact PTH (I-PTH), is known to be associated with nutritional status in hemodialysis (HD) patients. We investigated whether PTH(7-84) and larger N-truncated PTH or PTH(1-84) might be affected by nutritional status in HD patients.

Methods: Serum PTH was determined in 170 male HD patients by either a Bio-intact PTH (Bio-PTH) or I-PTH assay.

[Significance of serum PTH (7-84) as a reliable nutritional marker in hemodialysis patients].

To evaluate the significance of serum PTH (7-84) in hemodialysis patients, correlation of the serum PTH (7-84) level with various nutritional markers was investigated in HD patients. Serum PTH was determined in 170 male HD patients by either a Bio intact PTH assay or a second-generation intact PTH assay. The level of bone formation markers and bone resorption markers were also measured.