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Rosa M. Moyses
LIM 16, Nephrology Department, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo 05403-000, Brazil

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Journal article
Published: 19 July 2021 in Toxins
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Several factors contribute to renal-function decline in CKD patients, and the role of phosphate content in the diet is still a matter of debate. This study aims to analyze the mechanism by which phosphate, independent of protein, is associated with the progression of CKD. Adult Munich-Wistar rats were submitted to 5/6 nephrectomy (Nx), fed with a low-protein diet, and divided into two groups. Only phosphate content (low phosphate, LoP, 0.2%; high phosphate, HiP, 0.95%) differentiated diets. After sixty days, biochemical parameters and kidney histology were analyzed. The HiP group presented worse renal function, with higher levels of PTH, FGF-23, and fractional excretion of phosphate. In the histological analysis of the kidney tissue, they also showed a higher percentage of interstitial fibrosis, expression of α-actin, PCNA, and renal infiltration by macrophages. The LoP group presented higher expression of beclin-1 in renal tubule cells, a marker of autophagic flux, when compared to the HiP group. Our findings highlight the action of phosphate in the induction of kidney interstitial inflammation and fibrosis, contributing to the progression of renal disease. A possible effect of phosphate on the dysregulation of the renal cell autophagy mechanism needs further investigation with clinical studies.

ACS Style

Irene Duayer; Eduardo Duque; Clarice Fujihara; Ivone de Oliveira; Luciene dos Reis; Flavia Machado; Fabiana Graciolli; Vanda Jorgetti; Roberto Zatz; Rosilene Elias; Rosa Moysés. The Protein-Independent Role of Phosphate in the Progression of Chronic Kidney Disease. Toxins 2021, 13, 503 .

AMA Style

Irene Duayer, Eduardo Duque, Clarice Fujihara, Ivone de Oliveira, Luciene dos Reis, Flavia Machado, Fabiana Graciolli, Vanda Jorgetti, Roberto Zatz, Rosilene Elias, Rosa Moysés. The Protein-Independent Role of Phosphate in the Progression of Chronic Kidney Disease. Toxins. 2021; 13 (7):503.

Chicago/Turabian Style

Irene Duayer; Eduardo Duque; Clarice Fujihara; Ivone de Oliveira; Luciene dos Reis; Flavia Machado; Fabiana Graciolli; Vanda Jorgetti; Roberto Zatz; Rosilene Elias; Rosa Moysés. 2021. "The Protein-Independent Role of Phosphate in the Progression of Chronic Kidney Disease." Toxins 13, no. 7: 503.

Journal article
Published: 01 June 2021 in Brazilian Journal of Nephrology
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Introduction: Body composition is critical for the evaluation of patients with Chronic Kidney Disease (CKD) and can be obtained from either multifrequency bioelectrical impedance analysis (BIA) or dual-energy absorptiometry (DXA). Although the discrepancy between the results obtained from both methods has already been described, reasons are unknown, and might be related to secondary hyperparathyroidism, which is associated with bone loss. Methods: We have evaluated 49 patients (25 males and 24 females): 20 with CKD not on dialysis and 29 on maintenance hemodialysis [18 with severe hyperparathyroidism (HD-SHPT) and 11 submitted to parathyroidectomy (HD-PTX)]. All patients underwent DXA and BIA. Results: The median age and body mass index (BMI) were 49 years and 25.6 kg/m2, respectively. Patients exhibited low bone mineral content (BMC) measured by DXA, particularly those from the HD-SHPT group. The largest BMC measurement disagreement between DXA and BIA was found in the HD-SHPT group (p=0.004). Factors independently associated with this discrepancy in BMC measurement were serum phosphate (p=0.003) and patient group (p=0.027), even after adjustments for age, BMI, and gender (adjusted r2=0.186). PTX attenuated this difference. Discussion: BIA should be interpreted with caution in patients with SHPT due to a loss of accuracy, which can compromise the interpretation of body composition.

ACS Style

Shirley Ferraz Crispilho; Eduardo Jorge Duque; Kalyanna Soares Bezerra; Rosa Maria R. Pereira; Vanda Jorgetti; Rosilene M. Elias; Rosa M. A. Moysés. The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism. Brazilian Journal of Nephrology 2021, 43, 269 -273.

AMA Style

Shirley Ferraz Crispilho, Eduardo Jorge Duque, Kalyanna Soares Bezerra, Rosa Maria R. Pereira, Vanda Jorgetti, Rosilene M. Elias, Rosa M. A. Moysés. The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism. Brazilian Journal of Nephrology. 2021; 43 (2):269-273.

Chicago/Turabian Style

Shirley Ferraz Crispilho; Eduardo Jorge Duque; Kalyanna Soares Bezerra; Rosa Maria R. Pereira; Vanda Jorgetti; Rosilene M. Elias; Rosa M. A. Moysés. 2021. "The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism." Brazilian Journal of Nephrology 43, no. 2: 269-273.

Journal article
Published: 01 February 2021 in Revista da Associação Médica Brasileira
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The parathormone level after parathyroidectomy in dialysis patients are of interest. Low levels may require cryopreserved tissue implantation; however, the resection is necessary in case of recurrence. We analyzed post parathyroidectomy parathormone levels in renal hyperparathyroidism. Prospective observation of postoperative parathormone levels over defined periods in a cohort of dialysis patients that underwent total parathyroidectomy and immediate forearm autograft from 2008 to 2010, at a single tertiary care hospital. Of 33 patients, parathormone levels until 36 months could be divided into four patterns. Patients with stable function (Pattern 1) show relatively constant levels after two months (67% of the cases). Early function and later failure (Pattern 2) were an initial function with marked parathormone reduction before one year (18%). Graft recurrence (Pattern 3) showed a progressive increase of parathormone in four cases (12%). Complete graft failure (Pattern 4) was a nonfunctioning implant at any period, which was observed in one patient (3%). Parathormone levels of Pattern 3 became statistically different of Pattern 1 at 36 months. Patients that underwent the total parathyroidectomy and autograft present four different graft function patterns with a possible varied therapeutic management.

ACS Style

Climério Pereira Nascimento Junior; Sergio Samir Arap; Melani Ribeiro Custodio; Ledo Mazzei Massoni Neto; Marília D’Elboux Guimarães Brescia; Rosa Maria Affonso Moyses; Vanda Jorgetti; Fabio Luiz De Menezes Montenegro. Parathyroid hormone levels after parathyroidectomy for secondary hyperparathyroidism. Revista da Associação Médica Brasileira 2021, 67, 230 -234.

AMA Style

Climério Pereira Nascimento Junior, Sergio Samir Arap, Melani Ribeiro Custodio, Ledo Mazzei Massoni Neto, Marília D’Elboux Guimarães Brescia, Rosa Maria Affonso Moyses, Vanda Jorgetti, Fabio Luiz De Menezes Montenegro. Parathyroid hormone levels after parathyroidectomy for secondary hyperparathyroidism. Revista da Associação Médica Brasileira. 2021; 67 (2):230-234.

Chicago/Turabian Style

Climério Pereira Nascimento Junior; Sergio Samir Arap; Melani Ribeiro Custodio; Ledo Mazzei Massoni Neto; Marília D’Elboux Guimarães Brescia; Rosa Maria Affonso Moyses; Vanda Jorgetti; Fabio Luiz De Menezes Montenegro. 2021. "Parathyroid hormone levels after parathyroidectomy for secondary hyperparathyroidism." Revista da Associação Médica Brasileira 67, no. 2: 230-234.

Journal article
Published: 18 January 2021 in European Journal of Clinical Nutrition
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Loss of renal function may induce secondary hyperparathyroidism (s-HPT), which triggers several complications leading to an extreme decline in quality of life and increased mortality in affected patients. We evaluated whether parathyroidectomy (PTx), as surgical treatment for s-HPT, modifies body composition, and hormones involved in the protein-energy metabolism of affected patients. Overall, 30 s-HPT patients were evaluated at two times, before PTx (pre PTx) and 6 months after PTx (post PTx). Patients were evaluated by biochemistry analysis, anthropometry, electrical bioimpedance (BIA), food intake diary, handgrip strength, and modified global subjective nutritional assessment (SGA). After PTx, patients showed decreased serum levels of total and ionic calcium, as well as decreased alkaline phosphatase and PTH, and increased 25 (OH) vitamin D. These results demonstrate that PTx was efficient to correct part of the mineral disorder. We also observed an increase in caloric intake, body weight, body mass index (BMI), phase angle, handgrip strength, SGA score, and a decreasing in the percentage of weight loss. The osteocalcin concentration of both carboxylated (cOC) and undercarboxylated form was diminished post PTx. The cOC correlated with bone metabolism markers and SGA score. PTx modified body composition improving nutritional status and preventing the progression of weight loss with increased of energy intake, BMI, handgrip strength, phase angle of BIA, and SGA score. The present study also suggests an association of cOC with bone markers and SGA score. Further studies are needed to better clarify these associations with larger sample size.

ACS Style

Flavia Ramos de Siqueira; Karin Carneiro de Oliveira; Wagner Vasques Dominguez; César Augusto Madid Truyts; Rosa Maria Affonso Moysés; Luciene Machado dos Reis; Vanda Jorgetti. Effect of parathyroidectomy on bone tissue biomarkers and body composition in patients with chronic kidney disease and secondary hyperparathyroidism. European Journal of Clinical Nutrition 2021, 1 -8.

AMA Style

Flavia Ramos de Siqueira, Karin Carneiro de Oliveira, Wagner Vasques Dominguez, César Augusto Madid Truyts, Rosa Maria Affonso Moysés, Luciene Machado dos Reis, Vanda Jorgetti. Effect of parathyroidectomy on bone tissue biomarkers and body composition in patients with chronic kidney disease and secondary hyperparathyroidism. European Journal of Clinical Nutrition. 2021; ():1-8.

Chicago/Turabian Style

Flavia Ramos de Siqueira; Karin Carneiro de Oliveira; Wagner Vasques Dominguez; César Augusto Madid Truyts; Rosa Maria Affonso Moysés; Luciene Machado dos Reis; Vanda Jorgetti. 2021. "Effect of parathyroidectomy on bone tissue biomarkers and body composition in patients with chronic kidney disease and secondary hyperparathyroidism." European Journal of Clinical Nutrition , no. : 1-8.

Articles
Published: 26 October 2020 in Brazilian Journal of Nephrology
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Patients on hemodialysis are exposed to calcium via the dialysate at least three times a week. Changes in serum calcium vary according to calcium mass transfer during dialysis, which is dependent on the gradient between serum and dialysate calcium concentration (d[Ca]) and the skeleton turnover status that alters the ability of bone to incorporate calcium. Although underappreciated, the d[Ca] can potentially cause positive calcium balance that leads to systemic organ damage, including associations with mortality, myocardial dysfunction, hemodynamic tolerability, vascular calcification, and arrhythmias. The pathophysiology of these adverse effects includes serum calcium changes, parathyroid hormone suppression, and vascular calcification through indirect and direct effects. Some organs are more susceptible to alterations in calcium homeostasis. In this review, we discuss the existing data and potential mechanisms linking the d[Ca] to calcium balance with consequent dysfunction of the skeleton, myocardium, and arteries.

ACS Style

Rosilene M. Elias; Sharon Moe; Rosa M. A Moysés. Skeletal and cardiovascular consequences of a positive calcium balance during hemodialysis. Brazilian Journal of Nephrology 2020, 1 .

AMA Style

Rosilene M. Elias, Sharon Moe, Rosa M. A Moysés. Skeletal and cardiovascular consequences of a positive calcium balance during hemodialysis. Brazilian Journal of Nephrology. 2020; ():1.

Chicago/Turabian Style

Rosilene M. Elias; Sharon Moe; Rosa M. A Moysés. 2020. "Skeletal and cardiovascular consequences of a positive calcium balance during hemodialysis." Brazilian Journal of Nephrology , no. : 1.

Letter to the editor
Published: 05 October 2020 in Hemodialysis International
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ACS Style

Ketili Alice Dario; Maria Aparecida Dalboni; Bruno C. Da Silva; Carolina Steller Wagner Martins; Luiza Karla R. P. De Araújo; Rosilene M Elias; Rosa M.A. Moysés. Predialysis serum phosphate levels according to hemodialysis shift: Circadian rhythm matters. Hemodialysis International 2020, 1 .

AMA Style

Ketili Alice Dario, Maria Aparecida Dalboni, Bruno C. Da Silva, Carolina Steller Wagner Martins, Luiza Karla R. P. De Araújo, Rosilene M Elias, Rosa M.A. Moysés. Predialysis serum phosphate levels according to hemodialysis shift: Circadian rhythm matters. Hemodialysis International. 2020; ():1.

Chicago/Turabian Style

Ketili Alice Dario; Maria Aparecida Dalboni; Bruno C. Da Silva; Carolina Steller Wagner Martins; Luiza Karla R. P. De Araújo; Rosilene M Elias; Rosa M.A. Moysés. 2020. "Predialysis serum phosphate levels according to hemodialysis shift: Circadian rhythm matters." Hemodialysis International , no. : 1.

Original article
Published: 05 May 2020 in JBMR Plus
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Background and objectives Bone biopsy is still the gold standard to assess bone turnover (T), mineralization (M) and volume (V) in CKD patients, and serum biomarkers are not able to replace histomorphometry. Recently, metabolomics has emerged as a new technique that could allow for the identification of new biomarkers useful for disease diagnosis or understanding of pathophysiologic mechanisms, but it has never been assessed in the CKD‐MBD scenario. In this study, we investigated the association between serum metabolites and the bone TMV classification in ESRD patients. Design, setting, participants, and measurements Serum NMR‐spectroscopy and bone biopsy among 49 hemodialysis patients from a single center in Brazil. High T was identified in 21 patients and was associated with higher levels of dimethylsulfone, glycine, citrate and N‐acetylornithine. The ROC curve for the combination of parathyroid hormone and these metabolites provided an AUC of 0.86 (0.76–0.97). Abnormal M was identified in 30 patients and was associated with lower ethanol. The AUC for age, diabetes mellitus and ethanol was 0.83 (0.71–0.96). Low V was identified in 17 patients and was associated with lower carnitine. The association of age, phosphate and carnitine provided an AUC of 0.83 (0.70–0.96). Although differences among the curves by adding selected metabolites to traditional models were not statistically significant, the accuracy for the diagnosis of TMV classification seemed to be improved. This is the first study to evaluate the TMV classification system in relation to the serum metabolome assessed by NMR spectroscopy, showing that selected metabolites may help in the evaluation of bone phenotypes in CKD‐MBD.

ACS Style

Aline L. Baptista; Kallyandra Padilha; Pamella A. Malagrino; Gabriela Venturini; Ana C. M. Zeri; Luciene M. Dos Reis; Janaina S Martins; Vanda Jorgetti Md; Alexandre C. Pereira Md; Silvia M Titan; Rosa Ma Moyses. Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients. JBMR Plus 2020, 4, e10372 .

AMA Style

Aline L. Baptista, Kallyandra Padilha, Pamella A. Malagrino, Gabriela Venturini, Ana C. M. Zeri, Luciene M. Dos Reis, Janaina S Martins, Vanda Jorgetti Md, Alexandre C. Pereira Md, Silvia M Titan, Rosa Ma Moyses. Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients. JBMR Plus. 2020; 4 (7):e10372.

Chicago/Turabian Style

Aline L. Baptista; Kallyandra Padilha; Pamella A. Malagrino; Gabriela Venturini; Ana C. M. Zeri; Luciene M. Dos Reis; Janaina S Martins; Vanda Jorgetti Md; Alexandre C. Pereira Md; Silvia M Titan; Rosa Ma Moyses. 2020. "Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients." JBMR Plus 4, no. 7: e10372.

Review
Published: 17 March 2020 in Toxins
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Parathyroid hormone (PTH) has an important role in the maintenance of serum calcium levels. It activates renal 1α-hydroxylase and increases the synthesis of the active form of vitamin D (1,25[OH]2D3). PTH promotes calcium release from the bone and enhances tubular calcium resorption through direct action on these sites. Hallmarks of secondary hyperparathyroidism associated with chronic kidney disease (CKD) include increase in serum fibroblast growth factor 23 (FGF-23), reduction in renal 1,25[OH]2D3 production with a decline in its serum levels, decrease in intestinal calcium absorption, and, at later stages, hyperphosphatemia and high levels of PTH. In this paper, we aim to critically discuss severe CKD-related hyperparathyroidism, in which PTH, through calcium-dependent and -independent mechanisms, leads to harmful effects and manifestations of the uremic syndrome, such as bone loss, skin and soft tissue calcification, cardiomyopathy, immunodeficiency, impairment of erythropoiesis, increase of energy expenditure, and muscle weakness.

ACS Style

Eduardo J. Duque; Rosilene M. Elias; Rosa M. A. Moysés. Parathyroid Hormone: A Uremic Toxin. Toxins 2020, 12, 189 .

AMA Style

Eduardo J. Duque, Rosilene M. Elias, Rosa M. A. Moysés. Parathyroid Hormone: A Uremic Toxin. Toxins. 2020; 12 (3):189.

Chicago/Turabian Style

Eduardo J. Duque; Rosilene M. Elias; Rosa M. A. Moysés. 2020. "Parathyroid Hormone: A Uremic Toxin." Toxins 12, no. 3: 189.

Journal article
Published: 10 March 2020
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ACS Style

Emilia M D Soeiro; Lucimary Castro; Rejane Menezes; Rosilene M Elias; Luciene M Dos Reis; Vanda Jorgetti; Rosa M A Moysés. Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race. 2020, 1 .

AMA Style

Emilia M D Soeiro, Lucimary Castro, Rejane Menezes, Rosilene M Elias, Luciene M Dos Reis, Vanda Jorgetti, Rosa M A Moysés. Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race. . 2020; ():1.

Chicago/Turabian Style

Emilia M D Soeiro; Lucimary Castro; Rejane Menezes; Rosilene M Elias; Luciene M Dos Reis; Vanda Jorgetti; Rosa M A Moysés. 2020. "Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race." , no. : 1.

Original article
Published: 10 March 2020 in Pediatric Nephrology
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Studies investigating bone histology in children with chronic kidney disease (CKD) are scarce. Forty-two patients, mean age 11.3 ± 4.3 years with stage 5 CKD on dialysis, underwent double tetracycline labeling bone biopsy and the relationship between clinical features, biochemical markers, and bone densitometry (DXA) was investigated. Low bone turnover was present in 59% of patients, abnormal mineralization in 29%, and low bone volume in 7%. Higher bone formation rate was found in non-Caucasian patients, whereas abnormal mineralization occurred in older and shorter children. We found no impact of gender and etiology of renal disease in our population. Parathormone (PTH) and alkaline phosphatase (AP) showed positive associations with bone turnover. ROC curve analysis showed a fair performance of biomarkers to predict TMV status. PTH < 2 times ULN independently associated with low bone turnover (RR 5.62, 95% CI 1.01–31.24; p = 0.049), in a model adjusted for race, calcitriol dosage, and calcium. It was also associated with abnormal mineralization (RR 1.35, 95% CI 1.04–1.75; p = 0.025), in a model adjusted for BMD scores, AP, age, and calcitriol. PTH and AP significantly predicted turnover and mineralization defect, although with low specificity and sensitivity, reaching a maximum value of 64% and 67%, respectively. While PTH and AP were associated with turnover and mineralization, we recognize the limitation of their performance to clearly distinguish high from low/normal bone turnover and normal from abnormal mineralization. Our results reinforce the need to expand knowledge about renal osteodystrophy in pediatric population through prospective bone biopsy studies. Graphical abstract

ACS Style

Emilia M. D. Soeiro; Lucimary Castro; Rejane Menezes; Rosilene M. Elias; Luciene M. Dos Reis; Vanda Jorgetti; Rosa M. A. Moysés. Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race. Pediatric Nephrology 2020, 35, 1297 -1305.

AMA Style

Emilia M. D. Soeiro, Lucimary Castro, Rejane Menezes, Rosilene M. Elias, Luciene M. Dos Reis, Vanda Jorgetti, Rosa M. A. Moysés. Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race. Pediatric Nephrology. 2020; 35 (7):1297-1305.

Chicago/Turabian Style

Emilia M. D. Soeiro; Lucimary Castro; Rejane Menezes; Rosilene M. Elias; Luciene M. Dos Reis; Vanda Jorgetti; Rosa M. A. Moysés. 2020. "Association of parathormone and alkaline phosphatase with bone turnover and mineralization in children with CKD on dialysis: effect of age, gender, and race." Pediatric Nephrology 35, no. 7: 1297-1305.

Artigo
Published: 01 March 2020 in Brazilian Journal of Nephrology
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Background: Current guidelines recommend assessment of 25-vitamin D status in patients with chronic kidney disease (CKD). Although significant differences among assays have been described, the impact of CKD on this variability has never been tested. Methods: We tested the variability between two 25-vitamin D assays in patients with CKD (eGFR < 60 mL/min/1.73m2) who had consecutive 25-vitamin D measurements in 2015 (Assay 1 - Diasorin LIASON 25 TOTAL - D assay®) and 2016 (Assay 2 - Beckman Coulter Unicel Xl 800®). The cohort consisted of 791 adult patients (122 with normal renal function and 669 with CKD - 33, 30, and 37% in stages 3, 4, and 5 on dialysis, respectively). Results: Levels of 25-vitamin D were lower and the prevalence of hypovitaminosis D using assay 1 was higher than using assay 2 in patients with CKD, regardless of similar levels of calcium, phosphate, and parathyroid hormone. As kidney function decreased, the percentage of disagreement between the assays increased. Conclusion: There is a noteworthy variability between assays in patients with CKD such that the diagnosis of hypovitaminosis D is modified. The mechanism behind this result is still unclear and might be due to a possible interference in the analytical process. However, the clinical significance is unquestionable, as the supplementation of vitamin D can be erroneously prescribed to these patients.

ACS Style

Hanna Karla Andrade Guapyassú Machado; Carolina Steller Wagner Martins; Vanda Jorgetti; Rosilene Motta Elias; Rosa Maria Affonso Moysés. Chronic kidney disease is a main confounding factor for 25-vitamin D measurement. Brazilian Journal of Nephrology 2020, 42, 94 -98.

AMA Style

Hanna Karla Andrade Guapyassú Machado, Carolina Steller Wagner Martins, Vanda Jorgetti, Rosilene Motta Elias, Rosa Maria Affonso Moysés. Chronic kidney disease is a main confounding factor for 25-vitamin D measurement. Brazilian Journal of Nephrology. 2020; 42 (1):94-98.

Chicago/Turabian Style

Hanna Karla Andrade Guapyassú Machado; Carolina Steller Wagner Martins; Vanda Jorgetti; Rosilene Motta Elias; Rosa Maria Affonso Moysés. 2020. "Chronic kidney disease is a main confounding factor for 25-vitamin D measurement." Brazilian Journal of Nephrology 42, no. 1: 94-98.

Original article
Published: 25 February 2020 in JBMR Plus
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A main obstacle to diagnose and manage renal osteodystrophy (ROD) is the identification of intracortical bone turnover‐type (low, normal, high). The gold standard, tetracycline‐labeled transiliac crest bone biopsy, is impractical to obtain in most patients. The Kidney Disease Improving Global Outcomes Guidelines recommend parathyroid hormone (PTH) and bone specific alkaline phosphatase (BSAP) for the diagnosis of turnover‐type. However, PTH and BSAP have insufficient diagnostic accuracy to differentiate low from non‐low turnover and were validated for trabecular turnover. We hypothesized that four circulating microRNAs (miRNAs) that regulate osteoblast (miRNA‐30b, 30c, 125b) and osteoclast development (miRNA‐155) would provide superior discrimination of low from non‐low turnover than biomarkers in clinical use. In twenty‐three patients with CKD 3‐5D, we obtained tetracycline‐labeled transiliac crest bone biopsy and measured circulating levels of intact PTH, BSAP, and miRNA‐30b, 30c, 125b and 155. Spearman correlations assessed relationships between miRNAs and histomorphometry and PTH and BSAP. Diagnostic test characteristics for discriminating low from non‐low intracortical turnover were determined by receiver operator curve analysis; areas under curve (AUC) were compared by χ2‐test. In CKD rat models of low and high turnover ROD, we performed histomorphometry and determined the expression of bone‐tissue miRNAs. Circulating miRNAs moderately correlated with bone formation rate and adjusted apposition rate at the endo‐ and intra‐cortical envelops (ρ 0.43–0.51; p < 0.05). Discrimination of low vs. non‐low turnover was 0.866, 0.813, 0.813 and 0.723 for miRNA‐30b, 30c, 125b and 155 respectively, and 0.509 and 0.589 for PTH and BSAP respectively. For all four miRNAs combined, the AUC was 0.929, which was superior to that of PTH and BSAP alone and together (p < 0.05). In CKD rats, bone tissue levels of the four miRNAs reflected the findings in human serum. These data suggest that a panel of circulating miRNAs provide accurate non‐invasive identification of bone turnover in ROD. This article is protected by copyright. All rights reserved.

ACS Style

Thomas L. Nickolas; Neal Chen; Donald J. McMahon; David Dempster; Hua Zhou; James Dominguez Ii; Maria Alejandra Aponte; Joshua Sung; Pieter Evenepoel; Patrick C. D'haese; Fabrice Mac‐Way; Rosa Moyses; Sharon Moe. A microRNA Approach to Discriminate Cortical Low Bone Turnover in Renal Osteodystrophy. JBMR Plus 2020, 4, 1 .

AMA Style

Thomas L. Nickolas, Neal Chen, Donald J. McMahon, David Dempster, Hua Zhou, James Dominguez Ii, Maria Alejandra Aponte, Joshua Sung, Pieter Evenepoel, Patrick C. D'haese, Fabrice Mac‐Way, Rosa Moyses, Sharon Moe. A microRNA Approach to Discriminate Cortical Low Bone Turnover in Renal Osteodystrophy. JBMR Plus. 2020; 4 (5):1.

Chicago/Turabian Style

Thomas L. Nickolas; Neal Chen; Donald J. McMahon; David Dempster; Hua Zhou; James Dominguez Ii; Maria Alejandra Aponte; Joshua Sung; Pieter Evenepoel; Patrick C. D'haese; Fabrice Mac‐Way; Rosa Moyses; Sharon Moe. 2020. "A microRNA Approach to Discriminate Cortical Low Bone Turnover in Renal Osteodystrophy." JBMR Plus 4, no. 5: 1.

Journal article
Published: 10 January 2020 in Scientific Reports
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Chronic kidney disease (CKD) is characterized by loss of renal function and a consequent increase of serum uremic toxins, which contribute to inflammation status. Deficiency of 25-vitamin D, often found in patients with CKD, has been included as an inflammatory factor since it might modulate the immune system. The aim of this study was to investigate the role of 25-vitamin D on inflammatory pathways in healthy and uremic environment. Toll-like receptor 4 (TLR4), oxidative stress (ROS), vitamin D receptor (VDR), 1-α hydroxylase (CYP27), 24 hydroxylase, cathelicidin, and MCP-1 were evaluated in monocytes exposed to a uremic serum pool compared with healthy pool. The human monocytes lineage (U937) was incubated with or without 25-vitamin D (50 ng/ml for 24 hours). TRL4, VDR, CYP27, CYP24, and ROS were evaluated by flow cytometry. We used ELISA to measure IL-6, TNF-α, IL-10, cathelicidin, and MCP-1 in the cell culture supernatant. We observed a higher expression of TRL-4, IL-6, TNF-α, IL-10, cathelicidin and MCP-1 in monocytes incubated with uremic serum when compared with serum from healthy individuals. Supplementation of 25-vitamin D was able to reduce the expression of TRL4, cathelicidin, and MCP-1 in the uremic environment. There was no difference in the expression of VDR, CYP27 and CYP24 intracellular enzymes. This in vitro study showed that the uremic pool activates inflammatory response in monocytes, which was reversed by 25-vitamin D supplementation; this finding suggests that 25-vitamin D has an anti-inflammatory role in the uremic environment.

ACS Style

Rodrigo Barbosa De Oliveira Brito; Jacqueline Ferritto Rebello; Caren Cristina Grabulosa; Walter Pinto; Armando Morales Jr.; Rosilene Motta Elias; Rosa Maria Affonso Moyses; Maria Aparecida Dalboni. 25-vitamin D reduces inflammation in uremic environment. Scientific Reports 2020, 10, 128 -8.

AMA Style

Rodrigo Barbosa De Oliveira Brito, Jacqueline Ferritto Rebello, Caren Cristina Grabulosa, Walter Pinto, Armando Morales Jr., Rosilene Motta Elias, Rosa Maria Affonso Moyses, Maria Aparecida Dalboni. 25-vitamin D reduces inflammation in uremic environment. Scientific Reports. 2020; 10 (1):128-8.

Chicago/Turabian Style

Rodrigo Barbosa De Oliveira Brito; Jacqueline Ferritto Rebello; Caren Cristina Grabulosa; Walter Pinto; Armando Morales Jr.; Rosilene Motta Elias; Rosa Maria Affonso Moyses; Maria Aparecida Dalboni. 2020. "25-vitamin D reduces inflammation in uremic environment." Scientific Reports 10, no. 1: 128-8.

Journal article
Published: 01 January 2020 in Journal of Renal Nutrition
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Recently, Zhou Y et al.1x1Zhou, Y., Hoglund, P., and Clyne, N. Comparison of DEXA and bioimpedance for body composition measurements in nondialysis patients with CKD. J Ren Nutr. 2019; 29: 33–38Google ScholarSee all References published an interesting study that compared body composition measurements obtained from the gold standard dual-energy absorptiometry (DXA) and bioimpedance (BIA). The authors stated that these two methods were compared in previous studies in patients on hemodialysis (HD)2x2Bross, R., Chandramohan, G., Kovesdy, C.P. et al. Comparing body composition assessment tests in long-term hemodialysis patients. Am J Kidney Dis. 2010; 55: 885–896Google ScholarSee all References and peritoneal dialysis,3x3Popovic, V., Zerahn, B., and Heaf, J.G. Comparison of dual energy X-ray absorptiometry and bioimpedance in Assessing body composition and Nutrition in peritoneal dialysis patients. J Ren Nutr. 2017; 27: 355–363Google ScholarSee all References showing that BIA overestimated fat mass (FM) in patients on HD and underestimated in patients on peritoneal dialysis. However, because there are several commercially available devices, the accuracy of BIA devices to measure the human body composition might vary largely. In this sense, the abovementioned study has applied a single-frequency device BIA on the day after the HD session, which is another bias in the measurement of body composition for the population on HD.4x4Devolder, I., Verleysen, A., Vijt, D., Vanholder, R., and Van Biesen, W. Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int. 2010; 30: 208–214Google ScholarSee all References Zhou et al.1x1Zhou, Y., Hoglund, P., and Clyne, N. Comparison of DEXA and bioimpedance for body composition measurements in nondialysis patients with CKD. J Ren Nutr. 2019; 29: 33–38Google ScholarSee all References demonstrated that DXA and BIA cannot be interchanged in nondialysis patients because of a large limit of agreement found for lean tissue, FM, and water content. Similar to the report of Zhou et al,1x1Zhou, Y., Hoglund, P., and Clyne, N. Comparison of DEXA and bioimpedance for body composition measurements in nondialysis patients with CKD. J Ren Nutr. 2019; 29: 33–38Google ScholarSee all References we have also compared DXA and BIA in nondialysis patients and in patients on HD using a multifrequency BIA device (InBody S10; InBody Co., Ltd, Seoul, Korea). We have postulated that besides the aforesaid biases while measuring body composition, bone mineral content (BMC) can be altered in patients on HD due to bone mineral disease such as hyperparathyroidism. We have applied BIA, respecting a resting period of 15 minutes, in 13 patients with chronic kidney disease who are not on dialysis and 15 patients with secondary hyperparathyroidism who are on HD. In the latter group, BIA was applied immediately before dialysis. Measurements were FM, fat-free mass, and BMC. We found that BIA overestimated the median (range) FM in nondialysis patients by 483 g (−5,691 to 8,609 g) and underestimated FM in patients on HD by −3,519 g (−11,659 to 4,221 g). The median (range) fat-free mass was underestimated in nondialysis patients by −265 g (ranging from −28,701 to 3,391 g), whereas it was overestimated in patients on HD by 2,147 g (−5,050 to 10,231 g). The Bland-Altman plot shows the difference and the average between DXA and BIA measurements for BMC (Fig. 1Fig. 1A). There was a correlation between serum phosphate and the difference between BMC measured by DXA and BIA (r = −0.508, P = .006) such that the higher the serum phosphate, the higher the discrepancy between measurements obtained from both methods (Fig. 1Fig. 1B). We also found a significant correlation between alkaline phosphatase and the difference between BMC measured by DXA and BIA (r = −0.595, P = .0008) and a trend to a correlation between parathyroid hormone and the difference between BMC measured by DXA and BIA (r = −0.317, P = .050). Multivariate analysis adjusted for parathormone, alkaline phosphatase, and gender showed that serum phosphate (P = .002) was independently associated with the difference in BMC measured by DXA and BIA, explaining 29.3% of its variability.

ACS Style

Shirley Ferraz Crispilho; Kalyanna Soares Bezerra; Maria Aparecida Dalboni; Rosa Maria Rodrigues Pereira; Rosilene M. Elias; Rosa M.A. Moyses. Bioimpedance Underestimates Bone Mineral Content in Association With High Levels of Phosphate. Journal of Renal Nutrition 2020, 30, 85 -86.

AMA Style

Shirley Ferraz Crispilho, Kalyanna Soares Bezerra, Maria Aparecida Dalboni, Rosa Maria Rodrigues Pereira, Rosilene M. Elias, Rosa M.A. Moyses. Bioimpedance Underestimates Bone Mineral Content in Association With High Levels of Phosphate. Journal of Renal Nutrition. 2020; 30 (1):85-86.

Chicago/Turabian Style

Shirley Ferraz Crispilho; Kalyanna Soares Bezerra; Maria Aparecida Dalboni; Rosa Maria Rodrigues Pereira; Rosilene M. Elias; Rosa M.A. Moyses. 2020. "Bioimpedance Underestimates Bone Mineral Content in Association With High Levels of Phosphate." Journal of Renal Nutrition 30, no. 1: 85-86.

Journal article
Published: 01 November 2019 in Kidney International
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In an attempt to clarify the mechanisms of post-transplant bone disease we investigated the bone content and gene expression of several bone-related proteins. After a successful kidney transplant, the content of sclerostin in bone biopsies was found to be increased as measured by immunohistochemistry, multiplex assay, and gene expression despite a concomitant decrease of sclerostin in the serum. The phosphorylation of beta-catenin was increased, confirming Wnt pathway inhibition, an effect accompanied by an increase of the receptor activator of nuclear factor kappa-Β ligand (RANKL) and a decrease of osteoprotegerin protein levels in both serum and bone. Thus, changes in circulating biomarkers after kidney transplantation cannot be easily extrapolated to concomitant changes occurring in the bone. Hence, overall treatment decisions post kidney transplant should not be based on serum biochemistry alone.

ACS Style

Maria Júlia Correia Lima Nepomuceno Araújo; Igor Denizarde Bacelar Marques; Fabiana Giorgetti Graciolli; Luzia Fukuhara; Luciene Machado dos Reis; Melani Custódio; Vanda Jorgetti; Rosilene Mota Elias; Elias David-Neto; Rosa M.A. Moysés. Comparison of serum levels with bone content and gene expression indicate a contradictory effect of kidney transplantation on sclerostin. Kidney International 2019, 96, 1100 -1104.

AMA Style

Maria Júlia Correia Lima Nepomuceno Araújo, Igor Denizarde Bacelar Marques, Fabiana Giorgetti Graciolli, Luzia Fukuhara, Luciene Machado dos Reis, Melani Custódio, Vanda Jorgetti, Rosilene Mota Elias, Elias David-Neto, Rosa M.A. Moysés. Comparison of serum levels with bone content and gene expression indicate a contradictory effect of kidney transplantation on sclerostin. Kidney International. 2019; 96 (5):1100-1104.

Chicago/Turabian Style

Maria Júlia Correia Lima Nepomuceno Araújo; Igor Denizarde Bacelar Marques; Fabiana Giorgetti Graciolli; Luzia Fukuhara; Luciene Machado dos Reis; Melani Custódio; Vanda Jorgetti; Rosilene Mota Elias; Elias David-Neto; Rosa M.A. Moysés. 2019. "Comparison of serum levels with bone content and gene expression indicate a contradictory effect of kidney transplantation on sclerostin." Kidney International 96, no. 5: 1100-1104.

Case report
Published: 28 August 2019 in Blood Purification
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Immobilization and prolonged bed rest are harmful to the skeleton, which suffers increased resorption, and contribute to reducing survival rates among patients in critical care units. We report a patient who presented hypercalcemia 10 days after continuous venovenous hemofiltration has ended. Investigative tests showed an increase of serum C-terminal telopeptide of type I collagen (CTx), with suppressed parathormone and calcitriol. Denosumab was administered with a significant response, decreasing ionized calcium and CTx levels. The calcium infusion rate during dialysis procedures, used for citrate anticoagulation compensation, has progressively decreased, suggesting that endogenous calcium was taking part in the citrate chelation. In this report, we highlight the challenges in early diagnosis of immobilization-induced hypercalcemia among patients who are on continuous renal replacement therapy undergoing citrate anticoagulation.

ACS Style

Ricardo Mondoni Madureira; Silvia Helena Callas; Renato Antunes Caires; Shirley Ferraz Crispilho; Paulo César Ayroza Galvão; Rosa Maria Affonso Moysés. Continuous Renal Replacement Therapy Might Mask Immobilization-Induced Hypercalcemia in Critically Ill Patients. Blood Purification 2019, 49, 129 -131.

AMA Style

Ricardo Mondoni Madureira, Silvia Helena Callas, Renato Antunes Caires, Shirley Ferraz Crispilho, Paulo César Ayroza Galvão, Rosa Maria Affonso Moysés. Continuous Renal Replacement Therapy Might Mask Immobilization-Induced Hypercalcemia in Critically Ill Patients. Blood Purification. 2019; 49 (1-2):129-131.

Chicago/Turabian Style

Ricardo Mondoni Madureira; Silvia Helena Callas; Renato Antunes Caires; Shirley Ferraz Crispilho; Paulo César Ayroza Galvão; Rosa Maria Affonso Moysés. 2019. "Continuous Renal Replacement Therapy Might Mask Immobilization-Induced Hypercalcemia in Critically Ill Patients." Blood Purification 49, no. 1-2: 129-131.

Original article
Published: 03 July 2019 in Journal of Bone and Mineral Research
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Bone mineral density (BMD) loss is a known complication of human immunodeficiency virus (HIV) infection and its treatment, particularly with tenofovir disoproxil fumarate (TDF)‐containing antiretroviral regimens. Although renal proximal tubular dysfunction and phosphaturia is common with TDF, it is unknown whether BMD loss results from inadequate mineralization. We evaluated change in BMD by dual‐energy X‐ray absorptiometry (DXA) and bone histomorphometry by tetracycline double‐labeled transiliac crest biopsies in young men living with HIV before (n = 20) and 12 months after ( n = 16) initiating TDF/lamivudine/efavirenz. We examined relationships between calciotropic hormones, urinary phosphate excretion, pro‐inflammatory and pro‐resorptive cytokines, and bone remodeling‐related proteins with changes in BMD and histomorphometry. Mean age was 29.6 ± 5.5 years, with mean CD4 + T cell count of 473 ± 196 cells/mm 3. At baseline, decreased bone formation rate and increased mineralization lag time were identified in 16 (80%) and 12 (60%) patients, respectively. After 12 months, we detected a 2% to 3% decrease in lumbar spine and hip BMD by DXA. By histomorphometry, we observed no change in bone volume/total volume (BV/TV) and trabecular parameters, but rather, increases in cortical thickness, osteoid volume, and osteoblast and osteoclast surfaces. We did not observe significant worsening of renal phosphate excretion or mineralization parameters. Increases in PTH correlated with decreased BMD but not histomorphometric parameters. Overall, these data suggest abnormalities in bone formation and mineralization occur with HIV infection and are evident at early stages. With TDF‐containing antiretroviral therapy (ART), there is an increase in bone remodeling, reflected by increased osteoblast and osteoclast surfaces, but a persistence in mineralization defect, resulting in increased osteoid volume. © 2019 American Society for Bone and Mineral Research

ACS Style

Janaina Ramalho; Carolina Steller Wagner Martins; Juliana Galvão; Luzia N Furukawa; Wagner V Domingues; Ivone B Oliveira; Luciene M Dos Reis; Rosa Mr Pereira; Thomas L Nickolas; Michael T Yin; Margareth Eira; Vanda Jorgetti; Rosa Ma Moyses. Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate – Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry. Journal of Bone and Mineral Research 2019, 34, 1574 -1584.

AMA Style

Janaina Ramalho, Carolina Steller Wagner Martins, Juliana Galvão, Luzia N Furukawa, Wagner V Domingues, Ivone B Oliveira, Luciene M Dos Reis, Rosa Mr Pereira, Thomas L Nickolas, Michael T Yin, Margareth Eira, Vanda Jorgetti, Rosa Ma Moyses. Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate – Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry. Journal of Bone and Mineral Research. 2019; 34 (9):1574-1584.

Chicago/Turabian Style

Janaina Ramalho; Carolina Steller Wagner Martins; Juliana Galvão; Luzia N Furukawa; Wagner V Domingues; Ivone B Oliveira; Luciene M Dos Reis; Rosa Mr Pereira; Thomas L Nickolas; Michael T Yin; Margareth Eira; Vanda Jorgetti; Rosa Ma Moyses. 2019. "Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate – Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry." Journal of Bone and Mineral Research 34, no. 9: 1574-1584.

Articles
Published: 01 June 2019 in Brazilian Journal of Nephrology
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Introduction: Mineral and bone metabolism disorders in chronic kidney disease (CKD-MBD) constitute a syndrome defined by changes in calcium, phosphorus (P), vitamin D and parathormone, fibroblast growth factor 23 (FGF-23) and its specific cofactor, Klotho. CKD-MBD, as well as smoking, are associated with an increased risk of cardiovascular disease. However, it is not known whether or not smoking impacts the cardiovascular risk in CKD- MBD. Objective: To analyze the relationship between smoking and CKD-MBD markers. Methods: We evaluated 92 patients divided into: 1) Control Group: non-smokers without CKD; 2) CKD group in stages III and IV under conservative treatment (20 non-smokers and 17 smokers); 3) CKD group on dialysis (21 non-smokers and 19 smokers). Clinical, demographic, and biochemical markers were compared between the groups. Results: FGF-23 and Klotho levels were not different between smokers and non-smokers. Patients in the CKD group on conservative treatment had higher serum P than non-smokers (p = 0.026) even after adjusted for renal function (p = 0.079), gender (p = 0.145) and age (p = 0.986). Conclusion: Smoking confers a higher cardiovascular risk to CKD patients under conservative treatment as it is associated with higher levels of P. Further studies are needed to confirm and better elucidate this finding.

ACS Style

Geuza Dutra Dos Santos; Rosilene Motta Elias; Maria Aparecida Dalboni; Giovânio Vieira Da Silva; Rosa Maria Affonso Moysés. Chronic kidney disease patients who smoke have higher serum phosphorus. Brazilian Journal of Nephrology 2019, 41, 288 -292.

AMA Style

Geuza Dutra Dos Santos, Rosilene Motta Elias, Maria Aparecida Dalboni, Giovânio Vieira Da Silva, Rosa Maria Affonso Moysés. Chronic kidney disease patients who smoke have higher serum phosphorus. Brazilian Journal of Nephrology. 2019; 41 (2):288-292.

Chicago/Turabian Style

Geuza Dutra Dos Santos; Rosilene Motta Elias; Maria Aparecida Dalboni; Giovânio Vieira Da Silva; Rosa Maria Affonso Moysés. 2019. "Chronic kidney disease patients who smoke have higher serum phosphorus." Brazilian Journal of Nephrology 41, no. 2: 288-292.

Journal article
Published: 27 November 2018 in Surgery
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The authors regret that the name of one of the co-authors was misspelled in the final published article. Dr Shelto Kruijff has two “f”s instead of one (Kruijff, instead of Kruijf). The authors would like to apologise for any inconvenience caused.

ACS Style

Wellington Alves Filho; Willemijn Y. Van Der Plas; Marilia D.G. Brescia; Climerio P. Nascimento; Patricia T. Goldenstein; Ledo M. Massoni Neto; Sergio S. Arap; Melani R. Custodio; Rodrigo O. Bueno; Rosa M.A. Moyses; Vanda Jorgetti; Schelto Kruijff; Fabio L.M. Montenegro. Corrigendum to "Quality of life after surgery in secondary hyperparathyroidism comparing subtotal parathyroidectomy to total parathyroidectomy with immediate parathyroid autograft - a prospective randomized trial" [Surgery 164 (2018) 978-985]. Surgery 2018, 165, 497 .

AMA Style

Wellington Alves Filho, Willemijn Y. Van Der Plas, Marilia D.G. Brescia, Climerio P. Nascimento, Patricia T. Goldenstein, Ledo M. Massoni Neto, Sergio S. Arap, Melani R. Custodio, Rodrigo O. Bueno, Rosa M.A. Moyses, Vanda Jorgetti, Schelto Kruijff, Fabio L.M. Montenegro. Corrigendum to "Quality of life after surgery in secondary hyperparathyroidism comparing subtotal parathyroidectomy to total parathyroidectomy with immediate parathyroid autograft - a prospective randomized trial" [Surgery 164 (2018) 978-985]. Surgery. 2018; 165 (2):497.

Chicago/Turabian Style

Wellington Alves Filho; Willemijn Y. Van Der Plas; Marilia D.G. Brescia; Climerio P. Nascimento; Patricia T. Goldenstein; Ledo M. Massoni Neto; Sergio S. Arap; Melani R. Custodio; Rodrigo O. Bueno; Rosa M.A. Moyses; Vanda Jorgetti; Schelto Kruijff; Fabio L.M. Montenegro. 2018. "Corrigendum to "Quality of life after surgery in secondary hyperparathyroidism comparing subtotal parathyroidectomy to total parathyroidectomy with immediate parathyroid autograft - a prospective randomized trial" [Surgery 164 (2018) 978-985]." Surgery 165, no. 2: 497.

Review
Published: 05 October 2018 in Current Osteoporosis Reports
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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. 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. This review will revisit general concepts on the pathophysiology of CKD-MBD and discuss new perspectives for its treatment.

ACS Style

Rosilene Motta Elias; Maria Aparecida Dalboni; Ana Carolina E. Coelho; Rosa M. A. Moysés. CKD-MBD: from the Pathogenesis to the Identification and Development of Potential Novel Therapeutic Targets. Current Osteoporosis Reports 2018, 16, 693 -702.

AMA Style

Rosilene Motta Elias, Maria Aparecida Dalboni, Ana Carolina E. Coelho, Rosa M. A. Moysés. CKD-MBD: from the Pathogenesis to the Identification and Development of Potential Novel Therapeutic Targets. Current Osteoporosis Reports. 2018; 16 (6):693-702.

Chicago/Turabian Style

Rosilene Motta Elias; Maria Aparecida Dalboni; Ana Carolina E. Coelho; Rosa M. A. Moysés. 2018. "CKD-MBD: from the Pathogenesis to the Identification and Development of Potential Novel Therapeutic Targets." Current Osteoporosis Reports 16, no. 6: 693-702.