Chapters authored
Disorders in the System of Mineral and Bone Metabolism Regulators—FGF-23, Klotho and Sclerostin—in Chronic Kidney Disease: Clinical Significance and Possibilities for Correction
The chapter discusses the current understanding of the system of mineral and bone metabolism regulators—FGF-23, Klotho and sclerostin—disturbances in chronic kidney disease (CKD). In the chapter we presented the date, including our own results, which allow to suggest the change in the ratio of FGF-23-Klotho-sclerostin in CKD as an early biomarker not only for the chronic kidney damage but also for high cardiovascular (CV) risk. Results of studies show that disorders in FGF-23-Klotho-sclerostin ratio correlate with the frequency and severity of hypertension, vascular calcification, cardiac remodelling, anaemia, malnutrition, inflammation and strong aggravate CV risk in CKD. It was found independent from blood pressure (BP) action of increased serum FGF-23 on the myocardium as well as the correlation of serum high-sensitive troponin I with increased serum FGF-23 and low Klotho levels in CKD patients. At the same time, it was shown that renoprotective therapy, including renin-angiotensin blockers, low-protein diet with amino/keto acid supplementation and phosphate binders, erythropoiesis stimulators, vitamin D metabolites used to get the target levels of BP, serum phosphorus, haemoglobin, parathyroid hormone and nutritional status disorders correction can reduce the risk of CV events, as the major cause of death in CKD patients.
Part of the book: Chronic Kidney Disease
Anemia in Chronic Kidney Disease and After Kidney Allotransplantation (Systematic Review)
Anemia in chronic kidney disease (CKD) has been recognized as a separate independent risk factor of cardiovascular (CV) events. The aim of the review is to provide a literature summary concerning early diagnosis and treatment of anemia in CKD that may be useful for clinicians and contribute to decrease CV mortality. Literature searches were made in such major databases as: PubMed, Medline, Embase, Cochrane Library, CINAHL, Wiley Online Library, Scopus, Web of Science, e-library, and website of WHO. This search encompassed original articles, systematic reviews, and meta-analyses relevant to CKD and anemia over recent 15 years. A total of 54 references from 562 reviewed articles were selected as they met to the search criteria (anemia and CKD, including diabetes mellitus, systemic diseases and post-transplant anemia). The publications included 27 randomized controlled trials, 20 experimental studies representing new data on the links of CKD anemia and cardiovascular risk markers (cytokines, Klotho, fibroblast growth factor (FGF-23), hyperglycemia, hypoalbuminemia and some others), 4 systematic reviews and 3 clinical practice guidelines. The main attention was devoted to the analysis of the studies provided an early diagnosis of anemia, an ability to minimize the factors contributing to its severity that have allowed to improve CV and total outcomes and to reduce costs of hospital treatment of CKD patients with anemia.
Part of the book: Current Topics in Anemia