**6. References**


The New Kidney and Bone Disease:

Biol.;25(4):686-91.

1985; 39(2): 122-9.

1740

18(2):613-20.

16(1):109-16.

JASN. 18, 122–130.

normal adults. Calcif Tiss Res; 26: 99–102.

1650-8.

Kidney Int.; 73(9): 1024-30.

failure." *Kidney Int;* 51:1678-1695

hemodialysis." Kidney Int.; 65(5): 1943-6.

klotho." J Biol Chem; 281: 6120–6123.

Chronic Kidney Disease – Mineral and Bone Disorder (CKD–MBD) 43

Ivanovski O, Szumilak D, et al. (2008). "Effect of simvastatin in apolipoprotein E deficient mice with surgically induced chronic renal failure. " J Urol.; 179(4):1631-6. Imanishi Y, Inaba M, et al., (2004). "FGF-23 in patients with end-stage renal disease on

Johnson K, Polewski M et al. (2005). "Chondrogenesis mediated by PPi depletion promotes

Kurosu H, Ogawa Y, et al. (2006). "Regulation of fibroblast growth factor-23 signaling by

Lindergård B, Johnell O et al. (1985). "Studies of bone morphology, bone densitometry and

Liu S, Tang W, et al. (2006) "Fibroblast growth factor 23 is a counter-regulatory phosphaturic hormone for vitamin D. " J Am Soc Nephrol.;17(5):1305-15. Lomashvili KA, Garg P et al. (2008). "Upregulation of alkaline phosphatase and

London GM and Drueke TB (1997). "Atherosclerosis and arteriosclerosis in chronic renal

London GM, Guerin AP *et al. (2003).* "Arterial media calcification in end-stage renal disease:

London GM, Marchais SJ, et al., (2008). "Association of bone activity, calcium load, aortic

London GM, Guérin AP et al. (2007). "Mineral metabolism and arterial functions in end-

Lopez I, Mendoza FJ et al. (2008). "The effect of calcitriol, paricalcitol, and a calcimimetic on

Massy, Z.A., O. Ivanovski, et al. (2005). "Uremia accelerates both atherosclerosis and

Malluche HH, Mawad H, et al. (2003). "Parathyroid hormone assays--evolution and revolutions in the care of dialysis patients." Clin Nephrol.; 59(5):313-8. Mathew, S., Lund R.J., et al. (2007). "Reversal of the adynamic bone disorder and decreased

Matias PJ, Ferreira C et al. (2009). "25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients."; 24(2): 611-8. Melamed ML, Eustace JA et al. (2008). "Third-generation parathyroid hormone assays and

Melsen F and Moselkilde L. (1978). Tetracycline double labeling of iliac trabecular bone in 41

extraosseous calcifications in uremic rats.", Kidney Int.; 73(3):300-7.

stiffness, and calcifications in ESRD."; JASN; 19(9): 1827-35.

spontaneous aortic calcification in NPP1-/- mice." Arterioscler Thromb Vasc

laboratory data in patients on maintenance hemodialysis treatment. ", Nephron.

pyrophosphate hydrolysis: potential mechanism for uremic vascular calcification."

impact on all-cause and cardiovascular mortality." *Nephrol Dial Transplant;* 18:1731-

stage renal disease: potential role of 25-hydroxyvitamin D deficiency."; JASN.;

arterial calcification in apolipoprotein E knockout mice". J Am Soc Nephrol.

vascular calcification in chronic kidney disease by sevelamer carbonate therapy."

all-cause mortality in incident dialysis patients: the CHOICE study. ", NDT; 23(5):


Davies, M. R., Lund, R. J., et al. (2005). Low turnover osteodystrophy and vascular

Drüeke TB, McCarron DA. (2003). "Paricalcitol as compared with calcitriol in patients

Drüeke, TB., (2008) "Arterial intima and media calcification: distinct entities with different

Drüeke TB, Massy ZA. (2010). "Atherosclerosis in CKD: differences from the general

Eknoyan G, Lameire N, et al., (2004). The burden of kidney disease: improving global

Felsenfeld AJ, Rodríguez M et al. (2007). "Dynamics of parathyroid hormone secretion in health and secondary hyperparathyroidism." CJASN; 2(6):1283-305. Floege J. (2008). "Calcium-containing phosphate binders in dialysis patients with

Foley RN, Parfrey PS et al. (1998). "Clinical epidemiology of cardiovascular disease in

Fukagawa, M., Y. Hamada, et al. (2006). "The kidney and bone metabolism: Nephrologists'

Ganesh SK, Stack AG et al. (2001). "Association of elevated serum PO(4), Ca x PO(4)

Gao P, and D'Amour P (2005). "Evolution of the parathyroid hormone (PTH) assay--

Giachelli CM. (2004). "Vascular calcification mechanisms." J Am Soc Nephrol.;15(12): 2959-

Hollis BW and Napoli JL. (1985). "Improved radioimmunoassay for vitamin D and its use in

Huan J, Olgaard K, et al. (2006). "Parathyroid hormone 7-84 induces hypocalcemia and

Iba K, Takada J et al. (2004). "The serum level of bone-specific alkaline phosphatase activity

Ivaska KK, Gerdhem P et al. (2007). "Effect of fracture on bone turnover markers: a

Ivanovski, O., I.G. Nikolov, et al. (2009). "The calcimimetic R-568 retards uremia-enhanced

Ivanovski O, Szumilak D, et al., (2005). "The antioxidant N-acetylcysteine prevents

chronic renal disease. Am J Kidney Dis; 32 (5 Suppl 3):S112-9.

hemodialysis patients." J Am Soc Nephrol.;12(10): 2131-8.

assessing vitamin D status." Clin Chem.; 31(11): 1815-9.

with intact parathyroid glands." JASN;17(7):1923-30.

women." J Bone Miner Res.; 22(8):1155-64.

mice." Atherosclerosis. 205(1):55-62.

point of view". J Bone Miner Metab. 24(6): 434-8.

cardiovascular calcifications: should we CARE-2 avoid them?" NDT.; 23(10):3050-2.

product, and parathyroid hormone with cardiac mortality risk in chronic

importance of circulating PTH immunoheterogeneity and of its regulation.", Clin

inhibits the parathyroid hormone 1-84 secretory response to hypocalcemia in rats

is associated with aortic calcification in osteoporosis patients." J Bone Miner

longitudinal study comparing marker levels before and after injury in 113 elderly

vascular calcification and atherosclerosis in apolipoprotein E deficient (apoE-/-)

accelerated atherosclerosis in uremic apolipoprotein E knockout mice. " Kidney Int.

kidney disease and the metabolic syndrome. *JASN.* 16, 917–928.

pathogenesis or all the same?" Clin J Am Soc Nephrol. 3(6):1583-4.

undergoing hemodialysis." N Engl J Med. 31; 349(5): 496-9.

population". Nat Rev Nephrol.; 6: 723-35.

outcomes. Kidney Int.; 66(4): 1310-4.

Lab.; 51(1-2): 21-9.

Metab.; 22(6): 594-6.

2005 Jun;67(6):2288-94.

64.

calcification are amenable to skeletal anabolism in an animal model of chronic


The New Kidney and Bone Disease:

20.

J Clin Endocrinol Metab.; 90(11):6323-31.

Am J Pathol.; 158(2): 543-54.

Am J Kidney Dis.; 23(2):229-36.

Adv Clin Chem. 2008;46:217-62.

study." J Am Soc Nephrol.;16(6): 1788-93.

spectrometry." Anal Chem.; 77(9): 3001-7.

Kidney Int; 58(2): 753-61

JASN; 15(3):770-9.

Stroke.;33(2):462-5.

Chronic Kidney Disease – Mineral and Bone Disorder (CKD–MBD) 45

Rogers A and Eastell R. (2005). "Circulating osteoprotegerin and receptor activator for

Rutsch F, Vaingankar S et al. (2001). "PC-1 nucleoside triphosphate

Russo D, Miranda I et al. (2007). "The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer." KI; 72(10): 1255-61. Saenger AK, Laha TJ, et al. (2006). "Quantification of serum 25-hydroxyvitamin D(2)

Schwarz U, Buzello M et al. (2000). "Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure."Nephrol Dial Transplant.; 15(2): 218-23. Schoppet M, Shroff RC, et al. (2008). "Exploring the biology of vascular calcification in chronic kidney disease: what's circulating? " Kidney Int.; 73(4): 384-90. Slatopolsky E and Delmez JA. (1994). "Pathogenesis of secondary hyperparathyroidism."

Slatopolsky E, Finch J et al. (2000). "A novel mechanism for skeletal resistance in uremia."

Slinin Y, Foley RN et al. (2005). "Calcium, phosphorus, parathyroid hormone, and

Stevens LA, Djurdjev O, et al. (2004). "Calcium, phosphate, and parathyroid hormone levels

Suliman ME, García-López E, et al., (2008). Vascular calcification inhibitors in relation to

Tentori F, Blayney MJ et al. (2008). "Mortality risk for dialysis patients with different levels

Tsugawa N, Suhara Y, et al. (2005). "Determination of 25-hydroxyvitamin D in human

Ureña P and De Vernejoul MC. (1999). "Circulating biochemical markers of bone

Vassalotti JA, Uribarri J, et al. (2008). "Trends in mineral metabolism: Kidney Early

Survey (NHANES) 1999-2004." Am J Kidney Dis.; 51(4 Suppl 2): S56-68. Vliegenthart R, Hollander M et al. (2002). "Stroke is associated with coronary calcification as

Patterns Study (DOPPS)." Am J Kidney Dis.;52(3): 519-30.

remodeling in uremic patients." Kidney Int.; 55(6): 2141-56.

cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4

in combination and as a function of dialysis duration predict mortality: vidence for the complexity of the association between mineral metabolism and outcomes."

cardiovascular disease with special emphasis on fetuin-A in chronic kidney disease.

of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice

plasma using high-performance liquid chromatography--tandem mass

Evaluation Program (KEEP) and the National Health and Nutrition Examination

detected by electron-beam CT: the Rotterdam Coronary Calcification Study."

nuclear factor kappaB ligand: clinical utility in metabolic bone disease assessment."

pyrophosphohydrolase deficiency in idiopathic infantile arterial calcification."

and D(3) using HPLC-tandem mass spectrometry and examination of reference intervals for diagnosis of vitamin D deficiency."Am J Clin Pathol.; 125(6): 914-


Moe, S., T. Drüeke, et al. (2006). "Definition, evaluation, and classification of renal

Moe SM, Drüeke TB, et al. (2009). "KDIGO clinical practice guideline for the diagnosis,

Moe SM, Duan D et al. (2003). "Uremia induces the osteoblast differentiation factor Cbfa1 in

Miyamoto K, Segawa H et al. (2004). "Physiological regulation of renal sodium-dependent

Neves KR, Graciolli FG et al. (2007). "Vascular calcification: contribution of parathyroid

Nikolov, I.G., N. Joki, et al. (2010). "Chronic kidney disease bone and mineral disorder

Nikolov I.G, N. Joki et al., (2011). Lanthanum carbonate, like sevelamer-HCl, retards the

Nissen SE, Tuzcu EM et al. (2004). "Effect of intensive compared with moderate lipid-

Palmer SC, Strippoli GF et al. (2005). "Interventions for preventing bone disease in kidney

Parfitt AM, Drezner MK et al. (1987). "Bone histomorphometry: standardization of

Phan, O., O. Ivanovski, et al. (2005). "Sevelamer prevents uremia-enhanced atherosclerosis progression in apolipoprotein E-deficient mice". Circulation. 1;112(18):2875-82. Phan, O., O. Ivanovski, et al. (2008). "Effect of oral calcium carbonate on aortic calcification

Portale AA, Halloran BP et al. (1987). "Dietary intake of phosphorus modulates the

Riser BL, Barreto FC, et al., (2011). Daily peritoneal administration of sodium pyrophosphate

production of 1,25-dihydroxyvitamin D." J Clin Invest.; 80(4): 1147-54. Qunibi W, Moustafa M, et al. (2008). "A 1-year randomized trial of calcium acetate versus

Nomenclature Committee. J Bone Miner Res.;2 (6): 595-610.

model of uraemia. Nephrol Dial Transplant. 2011, in press.

(CKD-MBD) in apolipoprotein E-deficient mice with chronic renal failure". Bone.

progression of vascular calcification and atherosclerosis in uremic apolipoprotein

lowering therapy on progression of coronary atherosclerosis: a randomized

transplant recipients: a systematic review of randomized controlled trials." Am J

nomenclature, symbols, and units". Report of the ASBMR Histomorphometry

in apolipoprotein E-deficient (apoE-/-) mice with chronic renal failure." Nephrol

circadian rhythm in serum concentration of phosphorus. Implications for the renal

sevelamer on progression of coronary artery calcification in hemodialysis patients with comparable lipid control: the Calcium Acetate Renagel Evaluation-2 (CARE-2)

in a dialysis solution prevents the development of vascular calcification in a mouse

Bone Disorder (CKD-MBD).". Kidney Int Suppl.; (113): S1-130.

Outcomes (KDIGO)". Kidney Int. 69(11): 1945-53.

human blood vessels."; Kidney Int.; 63(3):1003-11.

hormone in renal failure." *Kidney Int;* 71:1262-1270

E-deficient mice. Nephrol Dial Transplant. In press.

controlled trial." JAMA. 3; 291(9): 1071-80.

Kidney Dis.;45(4): 638-49.

Dial Transplant. 23(1):82-90.

study." AJKD.; 51(6): 952-65.

47(1):156-63.

phosphate cotransporters." Jpn J Physiol.; 54(2): 93-102.

osteodystrophy: a position statement from Kidney Disease: Improving Global

evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and


**4**

*Nigeria* 

**The Prevalence of Renal Osteodystrophy in** 

U. R. Onyemekeihia1, C. O. Esume2, E. Unuigbe3, E. Oviasu3, L. Ojogwu3

Chronic renal failure (CRF) is defined as a progressive and persistent deterioration in renal function with serum creatinine consistently greater than 175µmol (Adelakun and Akinsola, 1988). It occurs as the termination of many chronic renal diseases, and is an important cause of morbidity and mortality in Africa (Kadiri, 2001). End stage renal failure may be defined as creatinine clearance of less than 10mls/minute or sustained plasma creatinine

In United Kingdom the prevalence of chronic renal failure is approximately 600 individuals per million population per year (0.06%). The incidence of end-stage renal failure is of the

In Nigeria, although accurate figures are not available, the size of the problem has been estimated using hospital admission records (Kadiri, 2001). Hospital admission rates of CRF in South West Nigeria were reported as between 6.7%-8% (Akinsola et al, 1989; Kadiri and Arije, 1999). However, much earlier reports by Adetuyibi *et al* showed that CRF accounted for 11.4% of deaths on the medical wards of a major teaching hospital in the region

Chronic glomerulonephritis and hypertension account for majority of CRF cases in Nigeria, with diabetes mellitus, obstructive uropathy and autosomal dominant polycystic kidney disease accounting for smaller proportions (Akinsola et al, 1989). Chronic interstitial nephritis is thought not to be a common cause of CRF in Nigeria and other parts of Africa (Gold et al 1990, Ojogwu 1990, Mate-Kole et al 1990). Once established, chronic renal impairment tends to progress inexorably to end-stage renal failure, but the rate of progression depends on the underlying aetiology: for example chronic glomerulonephritis leads to a more rapid deterioration compared with chronic tubulointerstitial nephropathies (Baker, 1999). Chronic renal failure is associated with widespread complications, and renal osteodystrophy (ROD) is one of such complications (Hartmut and Marie-Claude 1990). ROD develops in the early stages of loss of the excretory functions of the kidney, and can begin many years before its symptoms and radiological changes appear in adults (Hartmut and

**1. Introduction** 

(Adetuyibi et al, 1976).

concentration above 500pmol/l (Ojogwu, 2001).

order of 200 per million population per year (0.02%) (Baker, 1999).

*1Renal Unit, Department of Medicine, Central Hospital Warri, Delta State 2Department of Pharmacology and Therapeutics, Delta State University, Abraka 3Department of Medicine, University of Benin Teaching Hospital, Benin City* 

**Chronic Renal Failure Patients in**

**Urban Niger Delta of Nigeria** 

Vliegenthart R, Oudkerk M et al. (2002). Coronary calcification detected by electron-beam computed tomography and myocardial infarction. The Rotterdam Coronary Calcification Study. Eur Heart J.; 23(20): 1596-1603.
