Important abnormalities of bone mineral metabolism are present in patients with coronary artery disease with a mild decrease of the estimated glomerular filtration rate

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dc.contributor.author González-Parra, Emilio
dc.contributor.author Aceña, Álvaro
dc.contributor.author Lorenzo, Óscar
dc.contributor.author Tarín, Nieves
dc.contributor.author González-Casaus, María Luisa
dc.contributor.author Cristóbal, Carmen
dc.contributor.author Huelmos, Ana
dc.contributor.author Mahillo, Ignacio
dc.contributor.author Pello, Ana María
dc.contributor.author Carda, Rocío
dc.contributor.author Hernández-González, Ignacio
dc.contributor.author Alonso, Joaquín
dc.contributor.author Rodríguez-Artalejo, Fernando
dc.contributor.author López-Bescós, Lorenzo
dc.contributor.author Ortiz, Alberto
dc.contributor.author Egido, Jesús
dc.contributor.author Tuñón, José
dc.contributor.other UAM. Departamento de Medicina es_ES
dc.contributor.other Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD) es_ES
dc.contributor.other Centro de Investigación Biomédica en Red (CIBER) es_ES
dc.date.accessioned 2016-06-01T13:49:24Z
dc.date.available 2016-06-01T13:49:24Z
dc.date.issued 2015-08-23
dc.identifier.citation Journal of Bone and Mineral Metabolism 30.9 (2015): 1-34 es_ES
dc.identifier.issn 0914-8779 es_ES
dc.identifier.issn 1435-5604 (on line) es_ES
dc.identifier.uri http://hdl.handle.net/10486/671183
dc.description The final publication is avilable at: Journal of Bone and Mineral Metabolism 30.9 (2015): 1-34 en_US
dc.description.abstract Chronic kidney disease (CKD)–mineral and bone disorder (MBD) is characterized by increased circulating levels of parathormone (PTH) and fibroblast growth factor 23 (FGF23), bone disease, and vascular calcification, and is associated with adverse outcomes. We studied the prevalence of mineral metabolism disorders, and the potential relationship between decreased estimated glomerular filtration rate (eGFR) and CKD-MBD in coronary artery disease patients in a cross-sectional study of 704 outpatients 7.5 ± 3.0 months after an acute coronary syndrome. The mean eGFR (CKD Epidemiology Collaboration formula) was 75.8 ± 19.1 ml/min/1.73 m2. Our patients showed lower calcidiol plasma levels than a healthy cohort from the same geographical area. In the case of men, this finding was present despite similar creatinine levels in both groups and older age of the healthy subjects. Most patients (75.6 %) had an eGFR below 90 ml/min/1.73 m2 (eGFR categories G2–G5), with 55.3 % of patients exhibiting values of 60–89 ml/min/1.73 m2 (G2). PTH (r = −0.3329, p < 0.0001) and FGF23 (r = −0.3641, p < 0.0001) levels inversely correlated with eGFR, whereas calcidiol levels and serum phosphate levels did not. Overall, PTH levels were above normal in 34.9 % of patients. This proportion increased from 19.4 % in G1 category patients, to 33.7 % in G2 category patients and 56.6 % in G3–G5 category patients (p < 0.001). In multivariate analysis, eGFR and calcidiol levels were the main independent determinants of serum PTH. The mean FGF23 levels were 69.9 (54.6–96.2) relative units (RU)/ml, and 33.2 % of patients had FGF23 levels above 85.5 RU/ml (18.4 % in G1 category patients, 30.0 % in G2 category patients, and 59.2 % in G3–G5 category patients; p < 0.001). In multivariate analysis, eGFR was the main predictor of FGF23 levels. Increased phosphate levels were present in 0.7 % of the whole sample: 0 % in G1 category patients, 0.3 % in G2 category patients, and 2.8 % in G3–G5 category patients (p = 0.011). Almost 90 % of patients had calcidiol insufficiency without significant differences among the different degrees of eGFR. In conclusion, in patients with coronary artery disease there is a large prevalence of increased FGF23 and PTH levels. These findings have an independent relationship with decreased eGFR, and are evident at an eGFR of 60–89 ml/min/1.73 m2. Then, mild decreases in eGFR must be taken in consideration by the clinician because they are associated with progressive abnormalities of mineral metabolism en_US
dc.description.sponsorship Fondo de Investigaciones Sanitarias (PI10/00072, PI14/00386, PIE13/00051, PI05/0451, PI05/1497, PI05/52475, PI05/1043, PS09/01405, PI14/1567) y FRIAT, Spanish Society of Cardiology, Spanish Heart Foundation, Spanish Society of Arteriosclerosis, REDINREN (RD012/0021), Biobank grants from Instituto de Salud Carlos III FEDER, RD09/0076/00101 (FJD Biobank) and Abbvie Laboratories. PN I+D+I 2008-2011 and ISCIII co-financed by FEDER, CIBERDEM and e-PREDICE es_ES
dc.format.extent 34 pag. es_ES
dc.format.mimetype application/pdf en
dc.language.iso eng en
dc.publisher Springer Verlag en_US
dc.relation.ispartof Journal of Bone and Mineral Metabolism en_US
dc.rights © 2015 Elsevier en_US
dc.subject.other Coronary artery disease en_US
dc.subject.other Fibroblast growth factor 23 en_US
dc.subject.other Glomerular filtration rate en_US
dc.subject.other Parathormone en_US
dc.subject.other Vitamin D en_US
dc.title Important abnormalities of bone mineral metabolism are present in patients with coronary artery disease with a mild decrease of the estimated glomerular filtration rate en_US
dc.type article en
dc.subject.eciencia Medicina es_ES
dc.relation.publisherversion http://dx.doi.org/10.1007/s00774-015-0706-y es_ES
dc.identifier.doi 10.1007/s00774-015-0706-y es_ES
dc.identifier.publicationfirstpage 1 es_ES
dc.identifier.publicationissue 30 es_ES
dc.identifier.publicationlastpage 12 es_ES
dc.identifier.publicationvolume 9 es_ES
dc.relation.projectID Gobierno de España. PI10/00072 es_ES
dc.relation.projectID Gobierno de España. PI14/00386 es_ES
dc.relation.projectID Gobierno de España. PIE13/00051 es_ES
dc.relation.projectID Gobierno de España. PI05/0451 es_ES
dc.relation.projectID Gobierno de España. PI05/1497 es_ES
dc.relation.projectID Gobierno de España. PI05/52475 es_ES
dc.relation.projectID Gobierno de España. PI05/1043 es_ES
dc.relation.projectID Gobierno de España. PS09/01405 es_ES
dc.relation.projectID Gobierno de España. PI14/1567 es_ES
dc.type.version info:eu-repo/semantics/submittedVersion en_US
dc.rights.accessRights openAccess en
dc.authorUAM Aceña Navarro, Álvaro (279732)
dc.authorUAM Tuñón Fernández, José Luis (258858)


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