Effectiveness of fibroblast growth factor 23 lowering modalities in chronic kidney disease: a systematic review and meta-analysis

ConclusionsThe present meta-analysis demonstrated that non-calcium-based phosphate binders including sevelamer, lanthanum, and iron-based phosphate binders, iron supplements, calcimimetics, hemoperfusion, and preservation of RRF could effectively reduce FGF23 in CKD patients.
Source: International Urology and Nephrology - Category: Urology & Nephrology Source Type: research

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Am J Nephrol. 2021 Oct 27;52(10-11):798-807. doi: 10.1159/000518545. Online ahead of print.ABSTRACTINTRODUCTION: The safety and efficacy of extended-release calcifediol (ERC) as a treatment for secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI) has been demonstrated in prospective randomized clinical trials (RCTs). ERC (Rayaldee®) was approved by the Food and Drug Administration in 2016 on the basis of these prospective RCTs. The current retrospective study assessed the postlaunch data available with respect to ERC's efficacy and safety in inc...
Source: American Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
This study reports data from the first evaluation of etelcalcetide treatment in Chinese adults with chronic kidney disease and secondary hyperparathyroidism.METHODS: This phase I, randomized study compared thrice-weekly etelcalcetide (5 mg per dose intravenously) and placebo in 33 Chinese adults (aged 18-70 years) receiving hemodialysis. Patients in both treatment groups received standard-of-care treatment with a total of 12 doses of the investigational product during a 4-week treatment period, followed by 4 weeks of washout and follow-up. Pharmacokinetic (PK) parameters (primary endpoint), tolerability (secondary endpoint...
Source: Clinical Therapeutics - Category: Drugs & Pharmacology Authors: Source Type: research
In conclusion, FHHNC may present with diverse clinical features with mild hypomagnesemia leading to secondary hyperparathyroidism with changing Ca levels from low to high. Early and accurate clinical and molecular genetic diagnosis is important for proper management.
Source: Calcified Tissue International - Category: Orthopaedics Source Type: research
Conclusion: Analysis of postlaunch data confirmed ERC ’s effectiveness in increasing serum 25D and reducing PTH levels without statistically significant or notable impact on serum Ca and P levels. A significant percentage of these subjects achieved 25D levels ≥30 mg/mL and PTH levels which decreased by at least 30% from baseline. Dose titration to 60 mcgs was rarely prescribed. Closer patient monitoring and appropriate dose titration may have led to a higher percentage of subjects achieving an increase in 25D levels to at least 50 ng/mL and a reduction in PTH levels of at least 30%.Am J Nephrol
Source: American Journal of Nephrology - Category: Neurology Source Type: research
Fibroblast growth factor 23 (FGF23) is an endocrine hormone that is mainly produced by osteocytes. In patients with chronic kidney disease (CKD), circulating FGF23 levels increase as kidney function declines. This helps maintain normal phosphate balance by enhancing urinary phosphate excretion. As a trade-off, it suppresses biosynthesis of 1,25-dihydroxyvitamin D, favoring the early development of secondary hyperparathyroidism. Besides these canonical renal actions, FGF23 has been identified as an independent predictor of mortality, cardiovascular disease, and other adverse outcomes.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Controversies in Nephrology Source Type: research
AbstractBackgroundAnemia is one of the main complications of chronic kidney disease especially kidney failure, which includes treatment with erythropoiesis-stimulating agents and iron supplementation, including intravenous and oral iron. However, intravenous iron may pose limitations, such as potential infusion reactions. Oral iron is mainly composed of divalent iron, which can excessively stimulate the gastrointestinal tract. Iron polysaccharide complex capsules are a novel oral iron trivalent supplement with higher iron content and lower gastrointestinal irritation. However, since high-quality evidence-based medicinal su...
Source: Trials - Category: Research Source Type: clinical trials
J Nephrol. 2021 Oct 9. doi: 10.1007/s40620-021-01152-5. Online ahead of print.ABSTRACTA high percentage of patients with chronic kidney disease have hypovitaminosis D, which is a driver of secondary hyperparathyroidism and an important factor in chronic kidney disease-mineral and bone disorder. Vitamin D deficiency (serum total 25-OH vitamin D levels
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Source Type: research
This study aims to assess the level of magnesium in hemodialysis patients and its relation to the vascular stiffness.Patients and methods100 prevalent hemodialysis patients were included in the study and they were clinically stable with absence of cardiovascular complications, all patients underwent the following laboratory investigation including complete blood picture, median of magnesium level over 3 months, electrolytes, ipth, lipid profile and radiological investigations including transthoracic echocardiography and carotid duplex.ResultsThe studied population was divided into two groups, group I included 68 patients w...
Source: QJM - Category: Internal Medicine Source Type: research
AbstractBackgroundSecondary hyperparathyroidism (SHPT) is one of the components of chronic kidney disease –mineral bone disorder (CKD-MBD) with significant contribution to the morbidity and mortality among prevalent hemodialysis (HD) patients.ObjectivesMulticentric experience study to compare the effectiveness of Intravenous (IV) paricalcitol versus oral cinacalcet and oral cinacalcet plus oral alfacalcidol as treatment regimens of secondary hyperparathyroidism (SHPT) among chronic haemodialysis (HD) patients.MethodsRetrospective observational cohort study, 1year time horizon, 130 prevalent HD patients with SHPT were...
Source: QJM - Category: Internal Medicine Source Type: research
ConclusionsThese results show that sHPT is associated with substantially higher costs of both, pharmacological treatments and associated CVEs. Preventing the development of sHPT with early management in the course of CKD could possibly lead to better health outcomes and cost balance for health care systems.
Source: Advances in Therapy - Category: Drugs & Pharmacology Source Type: research
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