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Erschienen in: Current Osteoporosis Reports 6/2018

05.10.2018 | Kidney and Bone (I Salusky and T Nickolas, Section Editors)

CKD-MBD: from the Pathogenesis to the Identification and Development of Potential Novel Therapeutic Targets

verfasst von: Rosilene Motta Elias, Maria Aparecida Dalboni, Ana Carolina E. Coelho, Rosa M. A. Moysés

Erschienen in: Current Osteoporosis Reports | Ausgabe 6/2018

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Abstract

Purpose of Review

Although we have seen tremendous advances in the comprehension of CKD-MBD pathophysiology during the last few years, this was not accompanied by a significant change in mortality rate and quality of life. This review will address the traditional and updated pathophysiology of CKD-MBD along with the therapeutic limitations that affect CKD-MBD and proposed alternative treatment targets.

Recent Findings

An innovative concept brings the osteocyte to the center of CKD-MBD pathophysiology, in contrast to the traditional view of the skeleton as a target organ for disturbances in calcium, phosphate, parathyroid hormone, and vitamin D. Osteocytes, through the synthesis of FGF-23, sclerostin, among others, are able to interact with other organs, making bone an endocrine organ. Thus, osteocyte dysregulation might be an early event during the course of CKD.

Summary

This review will revisit general concepts on the pathophysiology of CKD-MBD and discuss new perspectives for its treatment.
Literatur
1.
Zurück zum Zitat Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.PubMedPubMedCentral Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765.PubMedPubMedCentral
2.
Zurück zum Zitat McQueen RB, Farahbakhshian S, Bell KF, Nair KV, Saseen JJ. Economic burden of comorbid chronic kidney disease and diabetes. J Med Econ. 2017;20(6):585–91.PubMed McQueen RB, Farahbakhshian S, Bell KF, Nair KV, Saseen JJ. Economic burden of comorbid chronic kidney disease and diabetes. J Med Econ. 2017;20(6):585–91.PubMed
3.
Zurück zum Zitat Wang V, Vilme H, Maciejewski ML, Boulware LE. The economic burden of chronic kidney disease and end-stage renal disease. Semin Nephrol. 2016;36(4):319–30.PubMed Wang V, Vilme H, Maciejewski ML, Boulware LE. The economic burden of chronic kidney disease and end-stage renal disease. Semin Nephrol. 2016;36(4):319–30.PubMed
4.
Zurück zum Zitat Penno G, Solini A, Bonora E, Orsi E, Fondelli C, Zerbini G, et al. Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol. 2018;55(6):603–12.PubMed Penno G, Solini A, Bonora E, Orsi E, Fondelli C, Zerbini G, et al. Defining the contribution of chronic kidney disease to all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study. Acta Diabetol. 2018;55(6):603–12.PubMed
5.
Zurück zum Zitat Herzog CA, Asinger RW, Berger AK, Charytan DM, Diez J, Hart RG, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011;80(6):572–86.PubMed Herzog CA, Asinger RW, Berger AK, Charytan DM, Diez J, Hart RG, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011;80(6):572–86.PubMed
6.
Zurück zum Zitat Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006;69(11):1945–53.PubMed Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006;69(11):1945–53.PubMed
7.
Zurück zum Zitat Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607–17.PubMed Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31(4):607–17.PubMed
8.
Zurück zum Zitat Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18.PubMed Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18.PubMed
9.
Zurück zum Zitat Albright F, Bauer W, Cockrill JR, Ellsworth R. Studies on the physiology of the Parathyroid glands: II. The relation of the serum calcium to the serum phosphorus at different levels of parathyroid activity. J Clin Invest. 1931;9(4):659–77.PubMedPubMedCentral Albright F, Bauer W, Cockrill JR, Ellsworth R. Studies on the physiology of the Parathyroid glands: II. The relation of the serum calcium to the serum phosphorus at different levels of parathyroid activity. J Clin Invest. 1931;9(4):659–77.PubMedPubMedCentral
10.
Zurück zum Zitat Liu SH, Chu HI. Treatment of renal osteodystrophy with dihydrotachysterol (A.T.10) and iron. Science. 1942;95(2467):388–9.PubMed Liu SH, Chu HI. Treatment of renal osteodystrophy with dihydrotachysterol (A.T.10) and iron. Science. 1942;95(2467):388–9.PubMed
11.
Zurück zum Zitat Slatopolsky E. The intact nephron hypothesis: the concept and its implications for phosphate management in CKD-related mineral and bone disorder. Kidney Int. 2011;79121:S3–8.PubMed Slatopolsky E. The intact nephron hypothesis: the concept and its implications for phosphate management in CKD-related mineral and bone disorder. Kidney Int. 2011;79121:S3–8.PubMed
12.
Zurück zum Zitat Kuro OM. A phosphate-centric paradigm for pathophysiology and therapy of chronic kidney disease. Kidney Int Suppl. 2013;3(5):420–6. Kuro OM. A phosphate-centric paradigm for pathophysiology and therapy of chronic kidney disease. Kidney Int Suppl. 2013;3(5):420–6.
13.
Zurück zum Zitat • Tong A, Manns B, Hemmelgarn B, Wheeler DC, Evangelidis N, Tugwell P, et al. Establishing core outcome domains in hemodialysis: report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop. Am J Kidney Dis. 2017;69(1):97–107 This study shows a new approach driving clinical trials focusing in quality of life and survival, giving less importance to surrogate markers.PubMed • Tong A, Manns B, Hemmelgarn B, Wheeler DC, Evangelidis N, Tugwell P, et al. Establishing core outcome domains in hemodialysis: report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop. Am J Kidney Dis. 2017;69(1):97–107 This study shows a new approach driving clinical trials focusing in quality of life and survival, giving less importance to surrogate markers.PubMed
14.
Zurück zum Zitat Bonewald LF. The amazing osteocyte. J Bone Miner Res. 2011;26(2):229–38.PubMed Bonewald LF. The amazing osteocyte. J Bone Miner Res. 2011;26(2):229–38.PubMed
15.
Zurück zum Zitat Ferrari GO, Ferreira JC, Cavallari RT, Neves KR, dos Reis LM, Dominguez WV, et al. Mineral bone disorder in chronic kidney disease: head-to-head comparison of the 5/6 nephrectomy and adenine models. BMC Nephrol. 2014;15:69.PubMedPubMedCentral Ferrari GO, Ferreira JC, Cavallari RT, Neves KR, dos Reis LM, Dominguez WV, et al. Mineral bone disorder in chronic kidney disease: head-to-head comparison of the 5/6 nephrectomy and adenine models. BMC Nephrol. 2014;15:69.PubMedPubMedCentral
16.
Zurück zum Zitat • Graciolli FG, Neves KR, Barreto F, Barreto DV, Dos Reis LM, Canziani ME, et al. The complexity of chronic kidney disease-mineral and bone disorder across stages of chronic kidney disease. Kidney Int. 2017;91(6):1436–46 This study reported the natural history of CKD-MBD as the renal function deteriorates. Authors showed the behavior of biochemical markers, as well as of osteocyte-related proteins.PubMed • Graciolli FG, Neves KR, Barreto F, Barreto DV, Dos Reis LM, Canziani ME, et al. The complexity of chronic kidney disease-mineral and bone disorder across stages of chronic kidney disease. Kidney Int. 2017;91(6):1436–46 This study reported the natural history of CKD-MBD as the renal function deteriorates. Authors showed the behavior of biochemical markers, as well as of osteocyte-related proteins.PubMed
17.
Zurück zum Zitat Oliveira RB, Cancela AL, Graciolli FG, Dos Reis LM, Draibe SA, Cuppari L, et al. Early control of PTH and FGF23 in normophosphatemic CKD patients: a new target in CKD-MBD therapy? Clin J Am Soc Nephrol. 2010;5(2):286–91.PubMedPubMedCentral Oliveira RB, Cancela AL, Graciolli FG, Dos Reis LM, Draibe SA, Cuppari L, et al. Early control of PTH and FGF23 in normophosphatemic CKD patients: a new target in CKD-MBD therapy? Clin J Am Soc Nephrol. 2010;5(2):286–91.PubMedPubMedCentral
18.
Zurück zum Zitat Cancela AL, Oliveira RB, Graciolli FG, dos Reis LM, Barreto F, Barreto DV, et al. Fibroblast growth factor 23 in hemodialysis patients: effects of phosphate binder, calcitriol and calcium concentration in the dialysate. Nephron Clin Pract. 2011;117(1):c74–82.PubMed Cancela AL, Oliveira RB, Graciolli FG, dos Reis LM, Barreto F, Barreto DV, et al. Fibroblast growth factor 23 in hemodialysis patients: effects of phosphate binder, calcitriol and calcium concentration in the dialysate. Nephron Clin Pract. 2011;117(1):c74–82.PubMed
19.
Zurück zum Zitat Sabbagh Y, Graciolli FG, O'Brien S, Tang W, dos Reis LM, Ryan S, et al. Repression of osteocyte Wnt/beta-catenin signaling is an early event in the progression of renal osteodystrophy. J Bone Miner Res. 2012;27(8):1757–72.PubMed Sabbagh Y, Graciolli FG, O'Brien S, Tang W, dos Reis LM, Ryan S, et al. Repression of osteocyte Wnt/beta-catenin signaling is an early event in the progression of renal osteodystrophy. J Bone Miner Res. 2012;27(8):1757–72.PubMed
20.
Zurück zum Zitat Pereira RC, Juppner H, Azucena-Serrano CE, Yadin O, Salusky IB, Wesseling-Perry K. Patterns of FGF-23, DMP1, and MEPE expression in patients with chronic kidney disease. Bone. 2009;45(6):1161–8.PubMedPubMedCentral Pereira RC, Juppner H, Azucena-Serrano CE, Yadin O, Salusky IB, Wesseling-Perry K. Patterns of FGF-23, DMP1, and MEPE expression in patients with chronic kidney disease. Bone. 2009;45(6):1161–8.PubMedPubMedCentral
21.
Zurück zum Zitat • Murali SK, Andrukhova O, Clinkenbeard EL, White KE, Erben RG. Excessive osteocytic Fgf23 secretion contributes to pyrophosphate accumulation and mineralization defect in hyp mice. PLoS Biol. 2016;14(4):e1002427 In this experimental research, it was demonstrated that FGF-23 inhibits bone mineralization through the inhibition of bone alkaline phosphatase.PubMedPubMedCentral • Murali SK, Andrukhova O, Clinkenbeard EL, White KE, Erben RG. Excessive osteocytic Fgf23 secretion contributes to pyrophosphate accumulation and mineralization defect in hyp mice. PLoS Biol. 2016;14(4):e1002427 In this experimental research, it was demonstrated that FGF-23 inhibits bone mineralization through the inhibition of bone alkaline phosphatase.PubMedPubMedCentral
22.
Zurück zum Zitat Rhee Y, Bivi N, Farrow E, Lezcano V, Plotkin LI, White KE, et al. Parathyroid hormone receptor signaling in osteocytes increases the expression of fibroblast growth factor-23 in vitro and in vivo. Bone. 2011;49(4):636–43.PubMedPubMedCentral Rhee Y, Bivi N, Farrow E, Lezcano V, Plotkin LI, White KE, et al. Parathyroid hormone receptor signaling in osteocytes increases the expression of fibroblast growth factor-23 in vitro and in vivo. Bone. 2011;49(4):636–43.PubMedPubMedCentral
23.
Zurück zum Zitat • Komaba H, Kaludjerovic J, Hu DZ, Nagano K, Amano K, Ide N, et al. Klotho expression in osteocytes regulates bone metabolism and controls bone formation. Kidney Int. 2017;92(3):599–611 Osteocyte-specific Klotho deletion leads to a unexpected improvement of bone formation. This effect is abrogated in CKD and hyperparathyroidism.PubMed • Komaba H, Kaludjerovic J, Hu DZ, Nagano K, Amano K, Ide N, et al. Klotho expression in osteocytes regulates bone metabolism and controls bone formation. Kidney Int. 2017;92(3):599–611 Osteocyte-specific Klotho deletion leads to a unexpected improvement of bone formation. This effect is abrogated in CKD and hyperparathyroidism.PubMed
24.
Zurück zum Zitat • Carrillo-Lopez N, Panizo S, Alonso-Montes C, Roman-Garcia P, Rodriguez I, Martinez-Salgado C, et al. Direct inhibition of osteoblastic Wnt pathway by fibroblast growth factor 23 contributes to bone loss in chronic kidney disease. Kidney Int. 2016;90(1):77–89 Experimental study showing the local inhibitory effects of FGF-23 and Klotho on bone formation mediated by the increase of DKK1.PubMed • Carrillo-Lopez N, Panizo S, Alonso-Montes C, Roman-Garcia P, Rodriguez I, Martinez-Salgado C, et al. Direct inhibition of osteoblastic Wnt pathway by fibroblast growth factor 23 contributes to bone loss in chronic kidney disease. Kidney Int. 2016;90(1):77–89 Experimental study showing the local inhibitory effects of FGF-23 and Klotho on bone formation mediated by the increase of DKK1.PubMed
25.
Zurück zum Zitat Pereira RC, Juppner H, Gales B, Salusky IB, Wesseling-Perry K. Osteocytic protein expression response to doxercalciferol therapy in pediatric dialysis patients. PLoS One. 2015;10(3):e0120856.PubMedPubMedCentral Pereira RC, Juppner H, Gales B, Salusky IB, Wesseling-Perry K. Osteocytic protein expression response to doxercalciferol therapy in pediatric dialysis patients. PLoS One. 2015;10(3):e0120856.PubMedPubMedCentral
26.
Zurück zum Zitat Wesseling-Perry K. Osteocyte dysfunction and renal osteodystrophy: not just calcium and phosphorus anymore. Kidney Int. 2017;91(6):1276–8.PubMed Wesseling-Perry K. Osteocyte dysfunction and renal osteodystrophy: not just calcium and phosphorus anymore. Kidney Int. 2017;91(6):1276–8.PubMed
27.
Zurück zum Zitat • de Oliveira RA, Barreto FC, Mendes M, dos Reis LM, Castro JH, Britto ZM, et al. Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease. Kidney Int. 2015;87(5):1039–45 First study to show the role of sclerotin causing adynamic bone disease in patients on peritoneal dialysis.PubMed • de Oliveira RA, Barreto FC, Mendes M, dos Reis LM, Castro JH, Britto ZM, et al. Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease. Kidney Int. 2015;87(5):1039–45 First study to show the role of sclerotin causing adynamic bone disease in patients on peritoneal dialysis.PubMed
28.
Zurück zum Zitat Santos MFP, Hernandez MJ, de Oliveira IB, Siqueira FR, Dominguez WV, Dos Reis LM, et al. Comparison of clinical, biochemical and histomorphometric analysis of bone biopsies in dialysis patients with and without fractures. J Bone Miner Metab. 2018. Santos MFP, Hernandez MJ, de Oliveira IB, Siqueira FR, Dominguez WV, Dos Reis LM, et al. Comparison of clinical, biochemical and histomorphometric analysis of bone biopsies in dialysis patients with and without fractures. J Bone Miner Metab. 2018.
29.
Zurück zum Zitat Kanbay M, Solak Y, Siriopol D, Aslan G, Afsar B, Yazici D, et al. Sclerostin, cardiovascular disease and mortality: a systematic review and meta-analysis. Int Urol Nephrol. 2016;48(12):2029–42.PubMed Kanbay M, Solak Y, Siriopol D, Aslan G, Afsar B, Yazici D, et al. Sclerostin, cardiovascular disease and mortality: a systematic review and meta-analysis. Int Urol Nephrol. 2016;48(12):2029–42.PubMed
30.
Zurück zum Zitat Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377(15):1417–27.PubMed Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377(15):1417–27.PubMed
31.
Zurück zum Zitat Martola L, Barany P, Stenvinkel P. Why do dialysis patients develop a heart of stone and bone of China? Blood Purif. 2005;23(3):203–10.PubMed Martola L, Barany P, Stenvinkel P. Why do dialysis patients develop a heart of stone and bone of China? Blood Purif. 2005;23(3):203–10.PubMed
32.
Zurück zum Zitat David V, Martin A, Isakova T, Spaulding C, Qi L, Ramirez V, et al. Inflammation and functional iron deficiency regulate fibroblast growth factor 23 production. Kidney Int. 2016;89(1):135–46.PubMedPubMedCentral David V, Martin A, Isakova T, Spaulding C, Qi L, Ramirez V, et al. Inflammation and functional iron deficiency regulate fibroblast growth factor 23 production. Kidney Int. 2016;89(1):135–46.PubMedPubMedCentral
33.
Zurück zum Zitat • Singh S, Grabner A, Yanucil C, Schramm K, Czaya B, Krick S, et al. Fibroblast growth factor 23 directly targets hepatocytes to promote inflammation in chronic kidney disease. Kidney Int. 2016;90(5):985–96 This study shows that FGF-23 synthesis not only is stimulated by inflammation, but can itself increase the synthesis of inflammatory cytokines by the hepatocytes.PubMedPubMedCentral • Singh S, Grabner A, Yanucil C, Schramm K, Czaya B, Krick S, et al. Fibroblast growth factor 23 directly targets hepatocytes to promote inflammation in chronic kidney disease. Kidney Int. 2016;90(5):985–96 This study shows that FGF-23 synthesis not only is stimulated by inflammation, but can itself increase the synthesis of inflammatory cytokines by the hepatocytes.PubMedPubMedCentral
34.
Zurück zum Zitat Viaene L, Behets GJ, Heye S, Claes K, Monbaliu D, Pirenne J, et al. Inflammation and the bone-vascular axis in end-stage renal disease. Osteoporos Int. 2016;27(2):489–97.PubMed Viaene L, Behets GJ, Heye S, Claes K, Monbaliu D, Pirenne J, et al. Inflammation and the bone-vascular axis in end-stage renal disease. Osteoporos Int. 2016;27(2):489–97.PubMed
35.
Zurück zum Zitat Christensen MH, Fenne IS, Nordbo Y, Varhaug JE, Nygard KO, Lien EA, et al. Novel inflammatory biomarkers in primary hyperparathyroidism. Eur J Endocrinol. 2015;173(1):9–17.PubMed Christensen MH, Fenne IS, Nordbo Y, Varhaug JE, Nygard KO, Lien EA, et al. Novel inflammatory biomarkers in primary hyperparathyroidism. Eur J Endocrinol. 2015;173(1):9–17.PubMed
36.
Zurück zum Zitat Ben-awadh AN, Delgado-Calle J, Tu X, Kuhlenschmidt K, Allen MR, Plotkin LI, et al. Parathyroid hormone receptor signaling induces bone resorption in the adult skeleton by directly regulating the RANKL gene in osteocytes. Endocrinology. 2014;155(8):2797–809.PubMedPubMedCentral Ben-awadh AN, Delgado-Calle J, Tu X, Kuhlenschmidt K, Allen MR, Plotkin LI, et al. Parathyroid hormone receptor signaling induces bone resorption in the adult skeleton by directly regulating the RANKL gene in osteocytes. Endocrinology. 2014;155(8):2797–809.PubMedPubMedCentral
37.
Zurück zum Zitat Young N, Mikhalkevich N, Yan Y, Chen D, Zheng WP. Differential regulation of osteoblast activity by Th cell subsets mediated by parathyroid hormone and IFN-gamma. J Immunol. 2005;175(12):8287–95.PubMedPubMedCentral Young N, Mikhalkevich N, Yan Y, Chen D, Zheng WP. Differential regulation of osteoblast activity by Th cell subsets mediated by parathyroid hormone and IFN-gamma. J Immunol. 2005;175(12):8287–95.PubMedPubMedCentral
38.
Zurück zum Zitat •• Neale Weitzmann M, Pacifici R. Parathyroid diseases and T cells. Curr Osteoporos Rep. 2017;15(3):135–41 This review highlights the actions of T-cell on PTH-induced bone resorption, reinforcing the link between hyperparathyroidism, inflammation and bone loss.PubMedPubMedCentral •• Neale Weitzmann M, Pacifici R. Parathyroid diseases and T cells. Curr Osteoporos Rep. 2017;15(3):135–41 This review highlights the actions of T-cell on PTH-induced bone resorption, reinforcing the link between hyperparathyroidism, inflammation and bone loss.PubMedPubMedCentral
39.
Zurück zum Zitat Tawfeek H, Bedi B, Li JY, Adams J, Kobayashi T, Weitzmann MN, et al. Disruption of PTH receptor 1 in T cells protects against PTH-induced bone loss. PloS One. 2010;5(8):e12290.PubMedPubMedCentral Tawfeek H, Bedi B, Li JY, Adams J, Kobayashi T, Weitzmann MN, et al. Disruption of PTH receptor 1 in T cells protects against PTH-induced bone loss. PloS One. 2010;5(8):e12290.PubMedPubMedCentral
40.
Zurück zum Zitat Maung SC, El Sara A, Chapman C, Cohen D, Cukor D. Sleep disorders and chronic kidney disease. World J Nephrol. 2016;5(3):224–32.PubMedPubMedCentral Maung SC, El Sara A, Chapman C, Cohen D, Cukor D. Sleep disorders and chronic kidney disease. World J Nephrol. 2016;5(3):224–32.PubMedPubMedCentral
41.
Zurück zum Zitat Elias RM, Chan CT, Bradley TD. Altered sleep structure in patients with end-stage renal disease. Sleep Med. 2016;20:67–71.PubMed Elias RM, Chan CT, Bradley TD. Altered sleep structure in patients with end-stage renal disease. Sleep Med. 2016;20:67–71.PubMed
42.
Zurück zum Zitat Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484–92.PubMed Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484–92.PubMed
43.
Zurück zum Zitat Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.PubMedPubMedCentral Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.PubMedPubMedCentral
44.
Zurück zum Zitat Huang HC, Walters G, Talaulikar G, Figurski D, Carroll A, Hurwitz M, et al. Sleep apnea prevalence in chronic kidney disease - association with total body water and symptoms. BMC Nephrol. 2017;18(1):125.PubMedPubMedCentral Huang HC, Walters G, Talaulikar G, Figurski D, Carroll A, Hurwitz M, et al. Sleep apnea prevalence in chronic kidney disease - association with total body water and symptoms. BMC Nephrol. 2017;18(1):125.PubMedPubMedCentral
45.
Zurück zum Zitat Adams RJ, Appleton SL, Vakulin A, Hanly PJ, McDonald SP, Martin SA, et al. Chronic kidney disease and sleep apnea association of kidney disease with obstructive sleep apnea in a population study of men. Sleep. 2017;40(1). Adams RJ, Appleton SL, Vakulin A, Hanly PJ, McDonald SP, Martin SA, et al. Chronic kidney disease and sleep apnea association of kidney disease with obstructive sleep apnea in a population study of men. Sleep. 2017;40(1).
46.
Zurück zum Zitat Drager LF, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: an emerging risk factor for atherosclerosis. Chest. 2011;140(2):534–42.PubMedPubMedCentral Drager LF, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: an emerging risk factor for atherosclerosis. Chest. 2011;140(2):534–42.PubMedPubMedCentral
47.
Zurück zum Zitat Jenner R, Lorenzi-Filho G, Drager LF. Cardiovascular impact of obstructive sleep apnea: does gender matter? Expert Rev Cardiovasc Ther. 2014;12(3):281–3.PubMed Jenner R, Lorenzi-Filho G, Drager LF. Cardiovascular impact of obstructive sleep apnea: does gender matter? Expert Rev Cardiovasc Ther. 2014;12(3):281–3.PubMed
48.
Zurück zum Zitat Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–7.PubMed Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811–7.PubMed
49.
Zurück zum Zitat Elias RM, Bradley TD, Kasai T, Motwani SS, Chan CT. Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea. Nephrol Dial Transplant. 2012;27(4):1569–73.PubMed Elias RM, Bradley TD, Kasai T, Motwani SS, Chan CT. Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea. Nephrol Dial Transplant. 2012;27(4):1569–73.PubMed
50.
Zurück zum Zitat • Stockings vs. continuous positive airway pressure on overnight fluid shift and obstructive sleep apnea among patients on hemodialysis. Frontiers in medicine. 2017;4:57. Authors show an improvement of sleep apnea by appliyng compression stockings in patients on hemodialysis. • Stockings vs. continuous positive airway pressure on overnight fluid shift and obstructive sleep apnea among patients on hemodialysis. Frontiers in medicine. 2017;4:57. Authors show an improvement of sleep apnea by appliyng compression stockings in patients on hemodialysis.
51.
Zurück zum Zitat Hirai T, Tanaka K, Togari A. Beta-adrenergic receptor signaling regulates Ptgs2 by driving circadian gene expression in osteoblasts. J Cell Sci. 2014;127(Pt 17):3711–9.PubMed Hirai T, Tanaka K, Togari A. Beta-adrenergic receptor signaling regulates Ptgs2 by driving circadian gene expression in osteoblasts. J Cell Sci. 2014;127(Pt 17):3711–9.PubMed
52.
Zurück zum Zitat Fujihara Y, Kondo H, Noguchi T, Togari A. Glucocorticoids mediate circadian timing in peripheral osteoclasts resulting in the circadian expression rhythm of osteoclast-related genes. Bone. 2014;61:1–9.PubMed Fujihara Y, Kondo H, Noguchi T, Togari A. Glucocorticoids mediate circadian timing in peripheral osteoclasts resulting in the circadian expression rhythm of osteoclast-related genes. Bone. 2014;61:1–9.PubMed
53.
Zurück zum Zitat Guner I, Uzun DD, Yaman MO, Genc H, Gelisgen R, Korkmaz GG, et al. The effect of chronic long-term intermittent hypobaric hypoxia on bone mineral density in rats: role of nitric oxide. Biol Trace Elem Res. 2013;154(2):262–7.PubMed Guner I, Uzun DD, Yaman MO, Genc H, Gelisgen R, Korkmaz GG, et al. The effect of chronic long-term intermittent hypobaric hypoxia on bone mineral density in rats: role of nitric oxide. Biol Trace Elem Res. 2013;154(2):262–7.PubMed
54.
Zurück zum Zitat Chen G, Chen L, Wen J, Yao J, Li L, Lin L, et al. Associations between sleep duration, daytime nap duration, and osteoporosis vary by sex, menopause, and sleep quality. J Clin Endocrinol Metab. 2014;99(8):2869–77.PubMed Chen G, Chen L, Wen J, Yao J, Li L, Lin L, et al. Associations between sleep duration, daytime nap duration, and osteoporosis vary by sex, menopause, and sleep quality. J Clin Endocrinol Metab. 2014;99(8):2869–77.PubMed
55.
Zurück zum Zitat Kobayashi D, Takahashi O, Deshpande GA, Shimbo T, Fukui T. Association between osteoporosis and sleep duration in healthy middle-aged and elderly adults: a large-scale, cross-sectional study in Japan. Sleep Breathing. 2012;16(2):579–83.PubMed Kobayashi D, Takahashi O, Deshpande GA, Shimbo T, Fukui T. Association between osteoporosis and sleep duration in healthy middle-aged and elderly adults: a large-scale, cross-sectional study in Japan. Sleep Breathing. 2012;16(2):579–83.PubMed
56.
Zurück zum Zitat Fu X, Zhao X, Lu H, Jiang F, Ma X, Zhu S. Association between sleep duration and bone mineral density in Chinese women. Bone. 2011;49(5):1062–6.PubMed Fu X, Zhao X, Lu H, Jiang F, Ma X, Zhu S. Association between sleep duration and bone mineral density in Chinese women. Bone. 2011;49(5):1062–6.PubMed
57.
Zurück zum Zitat Everson CA, Folley AE, Toth JM. Chronically inadequate sleep results in abnormal bone formation and abnormal bone marrow in rats. Exp Biol Med. 2012;237(9):1101–9. Everson CA, Folley AE, Toth JM. Chronically inadequate sleep results in abnormal bone formation and abnormal bone marrow in rats. Exp Biol Med. 2012;237(9):1101–9.
58.
Zurück zum Zitat Casazza K, Hanks LJ, Fernandez JR. Shorter sleep may be a risk factor for impaired bone mass accrual in childhood. J Clin Densitom. 2011;14(4):453–7.PubMedPubMedCentral Casazza K, Hanks LJ, Fernandez JR. Shorter sleep may be a risk factor for impaired bone mass accrual in childhood. J Clin Densitom. 2011;14(4):453–7.PubMedPubMedCentral
59.
Zurück zum Zitat Sforza E, Thomas T, Barthelemy JC, Collet P, Roche F. Obstructive sleep apnea is associated with preserved bone mineral density in healthy elderly subjects. Sleep. 2013;36(10):1509–15.PubMedPubMedCentral Sforza E, Thomas T, Barthelemy JC, Collet P, Roche F. Obstructive sleep apnea is associated with preserved bone mineral density in healthy elderly subjects. Sleep. 2013;36(10):1509–15.PubMedPubMedCentral
60.
Zurück zum Zitat Torres M, Montserrat JM, Pavia J, Dalmases M, Ros D, Fernandez Y, et al. Chronic intermittent hypoxia preserves bone density in a mouse model of sleep apnea. Respir Physiol Neurobiol. 2013;189(3):646–8.PubMed Torres M, Montserrat JM, Pavia J, Dalmases M, Ros D, Fernandez Y, et al. Chronic intermittent hypoxia preserves bone density in a mouse model of sleep apnea. Respir Physiol Neurobiol. 2013;189(3):646–8.PubMed
61.
Zurück zum Zitat Mariani S, Fiore D, Varone L, Basciani S, Persichetti A, Watanabe M, et al. Obstructive sleep apnea and bone mineral density in obese patients. Diabetes Metab Syndr Obes. 2012;5:395–401.PubMedPubMedCentral Mariani S, Fiore D, Varone L, Basciani S, Persichetti A, Watanabe M, et al. Obstructive sleep apnea and bone mineral density in obese patients. Diabetes Metab Syndr Obes. 2012;5:395–401.PubMedPubMedCentral
62.
Zurück zum Zitat Uzkeser H, Yildirim K, Aktan B, Karatay S, Kaynar H, Araz O, et al. Bone mineral density in patients with obstructive sleep apnea syndrome. Sleep Breath. 2013;17(1):339–42.PubMed Uzkeser H, Yildirim K, Aktan B, Karatay S, Kaynar H, Araz O, et al. Bone mineral density in patients with obstructive sleep apnea syndrome. Sleep Breath. 2013;17(1):339–42.PubMed
63.
Zurück zum Zitat Takaki J, Nishi T, Nangaku M, Shimoyama H, Inada T, Matsuyama N, et al. Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney dis. 2003;41(4):833–9.PubMed Takaki J, Nishi T, Nangaku M, Shimoyama H, Inada T, Matsuyama N, et al. Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney dis. 2003;41(4):833–9.PubMed
64.
Zurück zum Zitat Wali S, Shukr A, Boudal A, Alsaiari A, Krayem A. The effect of vitamin D supplements on the severity of restless legs syndrome. Sleep Breath. 2015;19(2):579–83.PubMed Wali S, Shukr A, Boudal A, Alsaiari A, Krayem A. The effect of vitamin D supplements on the severity of restless legs syndrome. Sleep Breath. 2015;19(2):579–83.PubMed
65.
Zurück zum Zitat Neves PD, Graciolli FG, Oliveira IB, Bridi RA, Moyses RM, Elias RM. Effect of mineral and bone metabolism on restless legs syndrome in hemodialysis patients. J Clin Sleep Med. 2017;13(1):89–94.PubMedPubMedCentral Neves PD, Graciolli FG, Oliveira IB, Bridi RA, Moyses RM, Elias RM. Effect of mineral and bone metabolism on restless legs syndrome in hemodialysis patients. J Clin Sleep Med. 2017;13(1):89–94.PubMedPubMedCentral
66.
Zurück zum Zitat Hruska KA, Sugatani T, Agapova O, Fang Y. The chronic kidney disease - mineral bone disorder (CKD-MBD): advances in pathophysiology. Bone. 2017;100:80–6.PubMedPubMedCentral Hruska KA, Sugatani T, Agapova O, Fang Y. The chronic kidney disease - mineral bone disorder (CKD-MBD): advances in pathophysiology. Bone. 2017;100:80–6.PubMedPubMedCentral
67.
Zurück zum Zitat Metzinger-Le Meuth V, Burtey S, Maitrias P, Massy ZA, Metzinger L. microRNAs in the pathophysiology of CKD-MBD: biomarkers and innovative drugs. Biochim Biophys Acta. 2017;1863(1):337–45. Metzinger-Le Meuth V, Burtey S, Maitrias P, Massy ZA, Metzinger L. microRNAs in the pathophysiology of CKD-MBD: biomarkers and innovative drugs. Biochim Biophys Acta. 2017;1863(1):337–45.
68.
Zurück zum Zitat Sprague SM, Wetmore JB, Gurevich K, Da Roza G, Buerkert J, Reiner M, et al. Effect of cinacalcet and vitamin D analogs on fibroblast growth factor-23 during the treatment of secondary hyperparathyroidism. Clin J Am Soc. 2015;10(6):1021–30. Sprague SM, Wetmore JB, Gurevich K, Da Roza G, Buerkert J, Reiner M, et al. Effect of cinacalcet and vitamin D analogs on fibroblast growth factor-23 during the treatment of secondary hyperparathyroidism. Clin J Am Soc. 2015;10(6):1021–30.
69.
Zurück zum Zitat Goldenstein PT, Elias RM, Pires de Freitas do Carmo L, Coelho FO, Magalhaes LP, Antunes GL, et al. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PloS One. 2013;8(8):e68870.PubMedPubMedCentral Goldenstein PT, Elias RM, Pires de Freitas do Carmo L, Coelho FO, Magalhaes LP, Antunes GL, et al. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PloS One. 2013;8(8):e68870.PubMedPubMedCentral
70.
Zurück zum Zitat Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13(6):952–61.PubMed Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2018;13(6):952–61.PubMed
71.
Zurück zum Zitat Karakose M, Caliskan M, Arslan MS, Demirci T, Karakose S, Cakal E. The impact of parathyroidectomy on serum ADAMTS1, ADAMTS4 levels, insulin resistance, and subclinical cardiovascular disease in primary hyperparathyroidism. Endocrine. 2017;55(1):283–8.PubMed Karakose M, Caliskan M, Arslan MS, Demirci T, Karakose S, Cakal E. The impact of parathyroidectomy on serum ADAMTS1, ADAMTS4 levels, insulin resistance, and subclinical cardiovascular disease in primary hyperparathyroidism. Endocrine. 2017;55(1):283–8.PubMed
72.
Zurück zum Zitat Santos RS, Coelho FM, Silva BC, Graciolli FG, Dominguez WV, Menezes Montenegro FL, et al. Parathyroidectomy improves restless leg syndrome in patients on hemodialysis. PLoS One. 2016;11(5):e0155835.PubMedPubMedCentral Santos RS, Coelho FM, Silva BC, Graciolli FG, Dominguez WV, Menezes Montenegro FL, et al. Parathyroidectomy improves restless leg syndrome in patients on hemodialysis. PLoS One. 2016;11(5):e0155835.PubMedPubMedCentral
73.
Zurück zum Zitat Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, et al. Executive summary of the 2017 KDIGO chronic kidney disease-mineral and bone disorder (CKD-MBD) guideline update: what’s changed and why it matters. Kidney Int. 2017;92(1):26–36.PubMed Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, et al. Executive summary of the 2017 KDIGO chronic kidney disease-mineral and bone disorder (CKD-MBD) guideline update: what’s changed and why it matters. Kidney Int. 2017;92(1):26–36.PubMed
74.
Zurück zum Zitat Steller Wagner Martins C, Jorgetti V, Moyses RMA. Time to rethink the use of bone biopsy to prevent fractures in patients with chronic kidney disease. Curr Opin Nephrol Hypertens. 2018;27(4):243–50.PubMed Steller Wagner Martins C, Jorgetti V, Moyses RMA. Time to rethink the use of bone biopsy to prevent fractures in patients with chronic kidney disease. Curr Opin Nephrol Hypertens. 2018;27(4):243–50.PubMed
75.
Zurück zum Zitat Isakova T, Anderson CA, Leonard MB, Xie D, Gutierrez OM, Rosen LK, et al. Diuretics, calciuria and secondary hyperparathyroidism in the chronic renal insufficiency cohort. Nephrol Dial Transplant. 2011;26(4):1258–65.PubMedPubMedCentral Isakova T, Anderson CA, Leonard MB, Xie D, Gutierrez OM, Rosen LK, et al. Diuretics, calciuria and secondary hyperparathyroidism in the chronic renal insufficiency cohort. Nephrol Dial Transplant. 2011;26(4):1258–65.PubMedPubMedCentral
76.
Zurück zum Zitat • Vasco RF, Moyses RM, Zatz R, Elias RM. Furosemide increases the risk of hyperparathyroidism in chronic kidney disease. Am J Nephrol. 2016;43(6):421–30 The role of diuretic in CKD-MBD was the main focus in this study showing and increased risk of hyperparathyroidism with furosemide. PubMed • Vasco RF, Moyses RM, Zatz R, Elias RM. Furosemide increases the risk of hyperparathyroidism in chronic kidney disease. Am J Nephrol. 2016;43(6):421–30 The role of diuretic in CKD-MBD was the main focus in this study showing and increased risk of hyperparathyroidism with furosemide. PubMed
77.
Zurück zum Zitat Elias RM, Moyses RMA. Elderly patients with chronic kidney disease have higher risk of hyperparathyroidism. Int Urol Nephrol. 2017;49(10):1815–21.PubMed Elias RM, Moyses RMA. Elderly patients with chronic kidney disease have higher risk of hyperparathyroidism. Int Urol Nephrol. 2017;49(10):1815–21.PubMed
78.
Zurück zum Zitat Vasco RFV, Reis ET, Moyses RMA, Elias RM. Thiazide increases serum calcium in anuric patients: the role of parathyroid hormone. Arch Osteoporos. 2017;12(1):31.PubMed Vasco RFV, Reis ET, Moyses RMA, Elias RM. Thiazide increases serum calcium in anuric patients: the role of parathyroid hormone. Arch Osteoporos. 2017;12(1):31.PubMed
79.
Zurück zum Zitat Koppel MH, Massry SG, Shinaberger JH, Hartenbower DL, Coburn JW. Thiazide-induced rise in serum calcium and magnesium in patients on maintenance hemodialysis. Ann Intern Med. 1970;72(6):895–901.PubMed Koppel MH, Massry SG, Shinaberger JH, Hartenbower DL, Coburn JW. Thiazide-induced rise in serum calcium and magnesium in patients on maintenance hemodialysis. Ann Intern Med. 1970;72(6):895–901.PubMed
80.
Zurück zum Zitat Dvorak MM, De Joussineau C, Carter DH, Pisitkun T, Knepper MA, Gamba G, et al. Thiazide diuretics directly induce osteoblast differentiation and mineralized nodule formation by interacting with a sodium chloride co-transporter in bone. J Am Soc Nephrol. 2007;18(9):2509–16.PubMedPubMedCentral Dvorak MM, De Joussineau C, Carter DH, Pisitkun T, Knepper MA, Gamba G, et al. Thiazide diuretics directly induce osteoblast differentiation and mineralized nodule formation by interacting with a sodium chloride co-transporter in bone. J Am Soc Nephrol. 2007;18(9):2509–16.PubMedPubMedCentral
81.
Zurück zum Zitat Brauer M, Frei E, Claes L, Grissmer S, Jager H. Influence of K-Cl cotransporter activity on activation of volume-sensitive Cl- channels in human osteoblasts. Am J Physiol Cell Physiol. 2003;285(1):C22–30.PubMed Brauer M, Frei E, Claes L, Grissmer S, Jager H. Influence of K-Cl cotransporter activity on activation of volume-sensitive Cl- channels in human osteoblasts. Am J Physiol Cell Physiol. 2003;285(1):C22–30.PubMed
82.
Zurück zum Zitat Kim CH, Kim SW, Kim GS. Effects of hydrochlorothiazide and furosemide diuretics on human bone marrow stromal osteoprogenitor cells. Metab Clin Exp. 2000;49(1):17–21.PubMed Kim CH, Kim SW, Kim GS. Effects of hydrochlorothiazide and furosemide diuretics on human bone marrow stromal osteoprogenitor cells. Metab Clin Exp. 2000;49(1):17–21.PubMed
83.
Zurück zum Zitat Berry SD, Zhu Y, Choi H, Kiel DP, Zhang Y. Diuretic initiation and the acute risk of hip fracture. Osteoporos Int. 2013;24(2):689–95.PubMed Berry SD, Zhu Y, Choi H, Kiel DP, Zhang Y. Diuretic initiation and the acute risk of hip fracture. Osteoporos Int. 2013;24(2):689–95.PubMed
84.
Zurück zum Zitat Muller ME, Forni Ogna V, Maillard M, Stoudmann C, Zweiacker C, Anex C, et al. Furosemide stimulation of parathormone in humans: role of the calcium-sensing receptor and the renin-angiotensin system. Pflugers Arch – Eur J Physiol. 2015;467(12):2413–21. Muller ME, Forni Ogna V, Maillard M, Stoudmann C, Zweiacker C, Anex C, et al. Furosemide stimulation of parathormone in humans: role of the calcium-sensing receptor and the renin-angiotensin system. Pflugers Arch – Eur J Physiol. 2015;467(12):2413–21.
85.
Zurück zum Zitat Zhou X, Chen K, Lei H, Sun Z. Klotho gene deficiency causes salt-sensitive hypertension via monocyte chemotactic protein-1/CC chemokine receptor 2-mediated inflammation. J Am Soc Nephrol. 2015;26(1):121–32.PubMed Zhou X, Chen K, Lei H, Sun Z. Klotho gene deficiency causes salt-sensitive hypertension via monocyte chemotactic protein-1/CC chemokine receptor 2-mediated inflammation. J Am Soc Nephrol. 2015;26(1):121–32.PubMed
Metadaten
Titel
CKD-MBD: from the Pathogenesis to the Identification and Development of Potential Novel Therapeutic Targets
verfasst von
Rosilene Motta Elias
Maria Aparecida Dalboni
Ana Carolina E. Coelho
Rosa M. A. Moysés
Publikationsdatum
05.10.2018
Verlag
Springer US
Erschienen in
Current Osteoporosis Reports / Ausgabe 6/2018
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-018-0486-0

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