Friday, May 22, 2015

Paricalcitol for Secondary Hyperparathyroidism in Renal Transplantation

Journal of the American Society of Nephrology current issue Paricalcitol for Secondary Hyperparathyroidism in Renal Transplantation

Secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone disorder. Paricalcitol, a selective vitamin D receptor activator, decreased serum parathyroid hormone levels and proteinuria in patients with secondary hyperparathyroidism. This single-center, prospective, randomized, crossover, open-label study compared the effect of 6-month treatment with paricalcitol (1 μg/d for 3 months and then uptitrated to 2 µg/d if tolerated) or nonparicalcitol therapy on serum parathyroid hormone levels (primary outcome), mineral metabolism, and proteinuria in 43 consenting recipients of renal transplants with secondary hyperparathyroidism. Participants were randomized 1:1 according to a computer-generated sequence. Compared with baseline, median (interquartile range) serum parathyroid hormone levels significantly declined on paricalcitol from 115.6 (94.8–152.0) to 63.3 (52.0–79.7) pg/ml (P<0.001) but not on nonparicalcitol therapy. At 6 months, levels significantly differed between treatments (P<0.001 by analysis of covariance). Serum bone-specific alkaline phosphatase and osteocalcin decreased on paricalcitol therapy only and significantly differed between treatments at 6 months (P<0.001 for all comparisons). At 6 months, urinary deoxypyridinoline-to-creatinine ratio and 24-hour proteinuria level decreased only on paricalcitol (P<0.05). L3 and L4 vertebral mineral bone density, assessed by dual-energy x-ray absorption, significantly improved with paricalcitol at 6 months (P<0.05 for both densities). Paricalcitol was well tolerated. Overall, 6-month paricalcitol supplementation reduced parathyroid hormone levels and proteinuria, attenuated bone remodeling and mineral loss, and reduced eGFR in renal transplant recipients with secondary hyperparathyroidism. Long-term studies are needed to monitor directly measured GFR, ensure that the bone remodeling and mineral effects are sustained, and determine if the reduction in proteinuria improves renal and cardiovascular outcomes.




http://jasn.asnjournals.org/cgi/content/short/26/5/1205?rss=1

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Alberto Reino Buelvas

Monday, May 11, 2015

Metformin Use in Type 2 Diabetes Mellitus With CKD: Is It Time to Liberalize Dosing Recommendations?

American Journal of Kidney Diseases Metformin Use in Type 2 Diabetes Mellitus With CKD: Is It Time to Liberalize Dosing Recommendations?

Metformin is a very effective drug for type 2 diabetes mellitus (T2DM) with relatively few side effects1 and has other potential benefits, such as lowering of cardiovascular risk2,3 and possible lowering of cancer risk.4 However, there is concern that metformin may increase the risk of lactic acidosis in people with chronic kidney disease (CKD). Considering the number of people with CKD and T2DM,5,6 there are potentially millions of people who are not currently taking metformin who might benefit from this medication.


http://www.ajkd.org/article/S0272-6386(15)00611-3/abstract?rss=yes

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Alberto Reino Buelvas 
Médico Internista Nefrólogo


Hypomagnesaemia in kidney transplantation

Transplantation Reviews Hypomagnesaemia in kidney transplantation

In the era of calcineurin inhibitors, hypomagnesaemia is a very common finding in kidney transplant recipients. Especially the first weeks after transplantation it is the rule rather than the exception. Hypomagnesaemia or low magnesium intake have been associated with a higher mortality or more cardiovascular events in the general population, but this association has never been explored in kidney transplant recipients, despite their increased cardiovascular risk. Kidney transplant recipients with pre- or post-transplant hypomagnesaemia seem to have an aberrant glucose metabolism and develop diabetes mellitus more frequently.


http://www.transplantationreviews.com/article/S0955-470X(15)00036-1/abstract?rss=yes

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Alberto Reino Buelvas 
Médico Internista Nefrólogo