Background: Institutionalized older people have a high risk of bone fractures due to osteoporosis. In addition, chronic kidney disease (CKD) is highly prevalent in older people living in residential homes. Secondary hyperparathyroidism, poor calcium intake and deficiency of 1,25-dihydroxyvitamin D may lead to decreased bone mass in people with CKD. The present cross-sectional study assessed the relationship between markers of bone mineral metabolism and kidney function in a residential care home population.
Methods: Older subjects were recruited from residential care homes and kidney function stratified by the estimated glomerular filtration rate (GFR). Parathyroid hormone (PTH), 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured in 188 residents not receiving vitamin D/calcium treatment [mean age 85 (range 68- 100) years, 75% female] and in 52 residents receiving vitamin D/calcium supplementation.
Results: Amongst those not receiving vitamin D/calcium, median PTH increased with declining GFR (P < 0.0001), particularly as GFR (mL/min/1.73 m(2)) fell below 45. PTH concentration was suppressed by increasing 25-hydroxyvitamin D (P < 0.0001), but not 1,25-dihydroxyvitamin D (P > 0.05) concentration. Nearly all residents (92%) had 25-hydroxyvitamin D deficiency or insufficiency and this was uninfluenced by kidney function (P > 0.05). Concentration of 1,25-dihydroxyvitamin D declined with worsening renal function (P < 0.0004) but 1,25-dihydroxyvitamin D deficiency was prevalent at all stages of kidney disease, including amongst residents receiving vitamin D/calcium supplementation.
Conclusion: Vitamin D deficiency and secondary hyperparathyroidism are common in this population irrespective of renal function. However, as GFR falls below 45, the prevalence of secondary hyperparathyroidism and 1,25-dihydroxyvitamin D deficiency increases. Unidentified CKD appears to exacerbate secondary hyperparathyroidism in this at risk population.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1093/ndt/gfn302 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Surgical outcomes of parathyroidectomy for pre-kidney transplantation versus post-kidney transplantation patients.
World J Surg
January 2025
Collaborative Outcomes Research in Endocrine Surgery (CORES) Lab, Division of Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Background: Hyperparathyroidism (HPT) is common in end-stage kidney disease and resolves in less than half of kidney transplant (KT) recipients. The ideal timing of parathyroidectomy (PTX), before or after KT, remains unclear. We sought to understand differences in morbidity and mortality after PTX pre-KT and post-KT.
View Article and Find Full Text PDFCase report: Prolonged and severe hungry bone syndrome after parathyroidectomy in X-linked hypophosphatemia.
Front Endocrinol (Lausanne)
January 2025
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Tertiary hyperparathyroidism is characterized by hypercalcemia resulting from autonomous parathyroid hormone production and usually occurs after a prolonged period of secondary hyperparathyroidism. This condition can be a complication of X-linked hypophosphatemia (XLH), a rare genetic disease characterized by renal phosphate loss and consequent hypophosphatemia. Parathyroidectomy is considered the first-line therapy but surgical intervention can be complicated by hungry bone syndrome.
View Article and Find Full Text PDFSodium Thiosulfate Treatment for Calciphylaxis: Is There an Optimal Duration of Therapy?
Hemodial Int
January 2025
Nephrology Division, Medical School, Universidade de São Paulo, São Paulo, Brazil.
Calciphylaxis is a rare and serious disorder characterized by vascular calcification and occlusion of the microvessels in the dermis, subcutaneous adipose tissue, visceral organs, and musculature. Studies have suggested that the major risk factors for developing calciphylaxis are chronic kidney disease and secondary hyperparathyroidism. Its diagnosis is clinical, and the treatment includes a multidisciplinary approach, although there are no clinical protocols based on randomized clinical trials.
View Article and Find Full Text PDFChronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) in Pediatric Kidney Transplant Recipients.
Pediatr Transplant
February 2025
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Kidney transplantation remains the gold standard treatment for end-stage kidney disease (ESKD), effectively alleviating numerous comorbidities and offering a substantial survival advantage over long-term dialysis. Despite advancements in immunosuppressive regimens and improvements in graft and patient survival rates, extended patient longevity brings an accumulating burden and complexity of bone disease in this population, which often goes underrecognized. The present study reviews the pathophysiology of CKD-MBD in pediatric KTR, focusing on the progression of bone disease before and after transplantation.
View Article and Find Full Text PDFFahr's syndrome (FS) is a rare disorder characterized by intracerebral calcification, presenting with various neuropsychiatric symptoms. This case highlights a rare presentation of FS with secondary hyperparathyroidism. It underscores the importance of comprehensive evaluation of early symptoms, effective use of diagnostic procedures, and proper management of symptoms.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!