RODRIGO AZEVEDO DE OLIVEIRA
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- Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease(2015) OLIVEIRA, Rodrigo A. de; BARRETO, Fellype C.; MENDES, Monique; REIS, Luciene M. dos; CASTRO, Joao Henrique; BRITTO, Zita Maria L.; MARQUES, Igor D. B.; CARVALHO, Aluizio B.; MOYSES, Rosa M.; JORGETTI, VandaChronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins, and dialysis modality. Although extensively studied in hemodialysis (HD) patients, only a few studies exist for peritoneal dialysis (PD) patients. Since most of these older studies contain no bone biopsy data, we studied the pattern of renal osteodystrophy in 41 prevalent PD patients. The most common presentation was adynamic bone disease (49%). There was a significant inverse association between serum sclerostin (a Wnt/beta-catenin pathway inhibitor that decreases osteoblast action and bone formation) and the bone formation rate. Bone alkaline phosphatase had the best sensitivity and specificity to detect both high-and low-turnover diseases. The comparison between nondiabetic PD and HD patients, matched by age, gender, parathyroid hormone level, and length of dialysis, revealed low 25-hydroxyvitamin D levels, worse bone mineralization, and low bone turnover in the nondiabetic PD group. Thus, adynamic bone disease was the most frequent type of renal osteodystrophy in PD patients. Sclerostin seems to participate in the pathophysiology of adynamic bone disease and bone alkaline phosphatase was the best serum marker of bone turnover in these patients.
- Pharmacotherapy of chronic kidney disease and mineral bone disorder(2011) BARRETO, Fellype Carvalho; OLIVEIRA, Rodrigo Azevedo de; OLIVEIRA, Rodrigo Bueno; JORGETTI, VandaIntroduction: Disturbances of the bone and mineral metabolism are a common complication of chronic kidney disease (CKD); these disturbances are known as CKD-mineral bone disorder (CKD-MBD). A better understanding of the pathophysiological mechanisms of CKD-MBD, along with its negative impact on other organs and systems, as well as on survival, has led to a shift in the treatment paradigm of this disorder. The use of phosphate binders changed dramatically over the last decade when noncalcium-containing phosphate binders, such as sevelamer and lanthanum carbonate, became possible alternative treatments to avoid calcium overload. Vitamin D receptor activators, such as paricalcitol and doxercalciferol, with fewer calcemic and phosphatemic effects, have also been introduced to control parathormone production and the interest in native vitamin D supplementation has grown. Furthermore, a new drug class, the calcimimetics, has recently been introduced into the therapeutic arsenal for treating secondary hyperparathyroidism. Areas covered: This review discusses the advantages and disadvantages of the above pharmacological options to treat CKD-MBD. Expert opinion: The individual-based use of phosphate binders, vitamin D and calcimimetics, separately or in combination, constitute a reasonable approach to treat CKD-MBD. These treatments aim to achieve a rigorous control of phosphorus and parathormone levels, while avoiding calcium overload.
conferenceObject CHRONIC KIDNEY DISEASE - MINERAL BONE DISORDER EVALUATION IN PERITONEAL DIALYSIS PATIENTS(2012) OLIVEIRA, Rodrigo Azevedo de; BARRETO, Fellype Carvalho; MENDES, Monique; REIS, Luciene Dos; FERREIRA, Juliana Cunha; BRITTO, Zita Maria Leme; MOYSES, Rosa Maria; JORGETTI, Vanda