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Abnormalities of Calcium, Phosphate, and Magnesium Metabolism

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Nutritional Treatment of Chronic Renal Failure

Part of the book series: Topics in Renal Medicine ((TIRM,volume 7))

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Abstract

It has been known for decades that abnormalities of calcium balance and of calcium-regulating hormones are hallmarks of uremia. This brief review emphasizes recent progress in the field as well as points relating to nutritional management of patients.

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References

  1. Ogura Y, Kawaguchi Y, Sakai S, Yamamoto M, Kimura Y, Oda Y, Imanura N, Tsukui N, Tsukui I: (1980) Plasma levels of vitamin D metabolites in renal disease. Contr Nephrol 22: 18–27.

    CAS  Google Scholar 

  2. Lucas PA, Brown RC, Jones CR, Woodhead JS, Coles GA: (1985) Reduced 1,25(OH)2D3 may be responsible for the development of hyperparathyroidism in early chronic renal failure. Proc EDTA-ERA 22:1124–1128.

    Google Scholar 

  3. Werner E, Malluche HH, Ritz E: (1978) Intestinal absorption of calcium in incipient and advanced renal failure. Miner Electrolyte Metab 1:263.

    Google Scholar 

  4. Silver J, Naveh-Many T, Mayer H, Schmelzer HJ, Popovtzer MM: (1986) Regulation by vitamin D metabolites of parathyroid hormone gene transcription in vivo in the rat. J Clin Invest 78:1296–1301.

    Article  PubMed  CAS  Google Scholar 

  5. Merke J, Szabo A, Beier E, Ritz E: (1987) 1,25(OH)2D3 prevents parathyroid cell proliferation in uremic rats (abstr) 20th Ann Meeting of the Am Soc Nephrol, 1987.

    Google Scholar 

  6. Lopez-Hilker S, Galceran T, Chan Yuk-Luen, Rapp N, Martin KJ, Slatopolsky E: (1986) Hypocalcemia may not be essential for the development of secondary hyperparathyroidism in chronic renal failure. J Clin Invest 78:1097–1102.

    Article  PubMed  CAS  Google Scholar 

  7. Slatopolsky E, Gray R, Adams ND, Lewis J, Hruska K, Martin K, Klahr S, DeLuca H, Lemann J: (1978) Low serum levels of 1,25(OH)2D3 are not responsible for the development of secondary hyperparathyroidism in early renal failure. Kidney Int 14:177–181, 1978.

    Google Scholar 

  8. Taylor CM, Caverzasio J, Jung A, Trechsel U, Fleisch H, Bonjour JP: (1983) Unilateral nephrectomy and 1,25-dihydroxy vitamin D3. Kidney Int 24:37–42.

    Article  PubMed  CAS  Google Scholar 

  9. Lucas PA, Brown RC, Woodhead JS: (1986) Acute response of parathyroid hormone and 1,25-dihydroxy vitamin D3 to unilateral nephrectomy in healthy donors. Nephrol Dial Transpl 1:199–203.

    CAS  Google Scholar 

  10. Llach F, Massry SG: (1985) On the mechanism of secondary hyperparathyroidism in moderate renal insufficiency. J Clin Endocrinol and Metab 61:601–606.

    Article  CAS  Google Scholar 

  11. Portale AA, Booth EB, Tsai HC, Morris RC: (1982) Reduced plasma concentration of 1,25-dihydroxyvitamin D in children with moderate renal insufficiency. Kidney Int 21:627–632.

    Article  PubMed  CAS  Google Scholar 

  12. Llach F, Massry SG: (1985) On the mechanism of secondary hyperparathyroidism in moderate renal insufficiency. J Clin Endocrinol Metab 61:601.

    Article  PubMed  CAS  Google Scholar 

  13. Cremer B, Lübbers E, Klooker P, Schmidt-Gayk H, Ritz E: (1985) Calciuric response to 1,25(OH)2D3 in early renal failure. Miner Electrolyte Metab 11:182–185.

    PubMed  CAS  Google Scholar 

  14. Korkor AB: (1987) Reduced binding of 3H 1,25-dihydroxy vitamin D3 in the parathyroid glands of patients with renal failure. N Engl J Med 316:1573–1577.

    Article  PubMed  CAS  Google Scholar 

  15. Merke J, Hügel U, Zlotkowski A, Szabo A, Bommer J, Mall G, Ritz E: (1987) Diminished parathyroid 1,25(OH)2D3 receptors in experimental uremia. Kidney Int 32:350–353.

    Article  PubMed  CAS  Google Scholar 

  16. Fraser DR, Kodicek E: (1970) Unique biosynthesis by kidney of a biologically active vitamin D metabolite. Nature 228:764–771.

    Article  PubMed  CAS  Google Scholar 

  17. Stern PH, Phillips PE, Mavreas T: (1980) Bioassay of 1,25-dihydroxy vitamin D in human plasma purified by partition, alkaline extraction, and high pressure chromatography. Anal Biochem 102:22–30.

    Article  PubMed  CAS  Google Scholar 

  18. Jongen MJM, van der Vijgh WJF, Willems HJJ, Netelenbos JC: (1981) Analysis for 1,25-dihydroxyvitamin D in human plasma, after a liquid chromatographic purification procedure, with a modified competitive protein binding assay. Clin Chem 27:444–450.

    PubMed  CAS  Google Scholar 

  19. Merke J, Ritz E, Boland R: (1986) Are recent findings on 1,25-dihydroxycholecalciferol metabolism relevant for the pathogenesis of uremia? Nephron 42:277–284.

    Article  PubMed  Google Scholar 

  20. Barbour GL, Coburn JW, Slatopolsky E, Norman AW: (1981) Hypercalcemia in an anephric patient with sarcoidosis: Evidence for extrarenal generation of 1,25-dihydroxy vitamin D. N Engl J Med 305:440–443.

    Article  PubMed  CAS  Google Scholar 

  21. Ritz E, Mehls O, Krempien B: (1980) Calcium and phosphorous metabolism in maintenance hemodialysis. Adv Nephrol 9:71.

    CAS  Google Scholar 

  22. Hollis BW, Jacob AI, Sallman A, Santiz Z, Lambert PW: (1982) Circulating vitamin D and its photoproduction in uremia. In: Norman AW (ed) Vitamin D: Chemical, Biochemical and Clinical Endocrinology of Calcium Metabolism. Berlin: Walter de Gruyter, pp 1157–1161.

    Google Scholar 

  23. Schmidt-Gayk KH, Schmitt W, Grawunder C, Ritz E, Tschöpe E, Pietsch V, Andrassy K, Bouillon R: (1977) 25-hydroxy vitamin D in nephrotic syndrome. Lancet 11:105.

    Article  Google Scholar 

  24. Pierides AM, Ellis HA, Ward M, Simpson W, Peart KM, Alvarez-Ude F, Udall PR, Kerr DNS: (1976) Barbiturate and anticonvulsant treatment in relation to osteomalacia with hemodialysis and renal transplantation. Br Med J 1:190.

    Article  PubMed  CAS  Google Scholar 

  25. Clements MR, Johnson L, Fraser DR: (1987) A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature 325:62.

    Article  PubMed  CAS  Google Scholar 

  26. Ritz E, Drüeke T, Merke J, Lucas PA: (1987) Genesis of bone disease in uremia. In: Peck WA (ed) Bone and Mineral Research 15, Amsterdam: Elsevier, pp 309–374.

    Google Scholar 

  27. Wilmink JM, van Boven WPL: (1987) Proximal myopathy in renal osteodystrophy not responding to calcitriol or dihydrotachysterol. Xth International Congress of Nephrology, London, 1987.

    Google Scholar 

  28. Ritz E, Merke J, Mehls O: (1985) In: Norman AW, Schaefer K, Grigoleit HG, v. Herrath D (eds) Vitamin D. Chemical Biochemical and Clinical Update. Berlin: Walter de Gruyter.

    Google Scholar 

  29. Sharman VL, Abrams SML, Adams S, Cattell WR, Chaput de Saitonge DM, Greenwood RN, Goodwin FJ, Mately W, et al.: (1982) Controlled trial of calcitriol in the prevention of bone disease in haemodialysed patients. In: Davison, AM, Guillon, PJ (eds) Proceedings of the European Dialysis and Transplant Association, London: Pitman, pp 287–292.

    Google Scholar 

  30. Memmos DE, Eastwood JB, Talner LB, Gower PE, Curtis JR, Alaghbaud-Zadeh J, Roberts AP, De Wardener HE: (1981) Double-blind trial of oral 1,25-dihydroxy vitamin D3 vs. placebo in asymptomatic hyperparathyroidism in patients receiving maintenance haemodialysis. Br Med J 282:1919–1924.

    Article  CAS  Google Scholar 

  31. Coen G, Mazzaferro S, Bonucci E, Ballanti P, Massimetti C, Donato G, Landi A, Smacchi A, Delia Rocca C, Cinotti GA, Taggi F: (1986) Treatment of secondary hyperparathyroidism of predialysis chronic renal failure with low doses of 1,25(OH)2D3: Humoral and histomor-phometric results. Min Electrol Metab 12:375–382.

    CAS  Google Scholar 

  32. Baker LRI, Muir JW, Sharman VL, Abrams SML, Greenwood RN, Cattell WR, Goodwin FJ, Marsh FP, Adami S, Hately W, Hattersley LA, Morgan AG, Papapoulos SE, Reveil PA, Tucker AK, Chaput de Saintonge DM, O’Riordan JLH: (1986) Controlled trial of calcitriol in hemodialysis patients. Clin Nephrol 26:185–191.

    PubMed  CAS  Google Scholar 

  33. Wilson L, Felsenfeld A, Drezner MK, Llach F: (1985) Altered divalent ion metabolism in early renal failure: Role of 1,25(OH)2D. Kidney Int 27:565–573.

    Article  PubMed  CAS  Google Scholar 

  34. Massry SG: (1985) Assessment of 1,25(OH)2D3 on the correction and precention of renal osteodystrophy in patients with mild to moderate renal failure. Sixth Workshop on Vitamin D, Merano, 1985.

    Google Scholar 

  35. Christiansen C, Rodbro P, Christensen MS, Hartnack B: (1981) Is 1,25-dihydroxycholecal-ciferol harmful to renal function in patients with chronic renal failure? Clin Endocrinol 15:229.

    Article  CAS  Google Scholar 

  36. Coburn JW, Hartenbower DL, Brickman AS, Massry SG, Kopple JD: (1977) In: David DS (ed) Calcium Metabolism in Renal Failure and Nephrolithiasis. New York: John Wiley & Sons, pp. 77–111.

    Google Scholar 

  37. Letteri JM, Cohn SH: (1977) Total body neutron activation analysis in the study of mineral homeostasis in chronic renal disease. In: David DS (ed) Calcium Metabolism in Renal Failure and Nephrolithiasis. New York: John Wiley & Sons.

    Google Scholar 

  38. Alvestrad A, Dalen AN: (1977) X-ray spectrophotometry in evaluation of renal osteodystrophy. In: David DS (ed) Calcium Metabolism in Renal Failure and Nephrolithiasis. New York: John Wiley & Sons.

    Google Scholar 

  39. Halloran BP, DeLuca HF: (1981) Intestinal calcium transport: Evidence for two distinct mechanisms of action of 1,25-dihydroxyvitamin D3. Arch Biochem Biophys 208:477–486.

    Article  PubMed  CAS  Google Scholar 

  40. Sheikh MS, Santa Ana CA, Nicar MJ, Schiller LR, Fordtran JS: (1987) Gastrointestinal absorption of calcium from milk and calcium salts. N Engl J Med 317:532–536.

    Article  PubMed  CAS  Google Scholar 

  41. Fröhling P, Kokot F, Schmicker R, Kaschube E, Lindenau K, Vetter K: (1983) Influence of ketoacids on serum parathyroid hormone levels in patients with chronic renal failure. Clin Nephrol 20:212–215.

    PubMed  Google Scholar 

  42. Schaefer K, von Herrath D: (1986) The striking effect of ketoacids on the serum phosphate and parathyroid hormone in patients with chronic uremia (abstr). Annual Meeting of the American Society of Nephrology, Washington, 1986.

    Google Scholar 

  43. Jones RWA, Dalton N, Turner C: (1983) Oral essential amino and ketoacid supplements in children with advanced chronic renal failure. Kidney Int 24:95.

    Article  PubMed  CAS  Google Scholar 

  44. Fournier A, Miriniere P, Sebert JL, Dkhissi H, Atik A, Leflon P, Renaud H, Gueris J, Gregoire I, Idrisse A, Garabedian M: (1986) Calcium carbonate, an aluminium-free agent for control of hyperphosphatemia, hypocalcemia, and hyperparathyroidism in uremia. Kidney Int 29: 114–119.

    Google Scholar 

  45. Hercz G, Kraut JA, Andress DA, Howard N, Roberts C, Hinaberger JH, Sherrard DJ, Coburn JA: (1986) Use of calcium carbonate as a phosphate binder in dialysis patients. Min Electr Metab 12:314–319.

    CAS  Google Scholar 

  46. Slatopolsky E, Weerrts C, Lopez-Hilker S: (1986) Calcium carbonate as a phosphate binder in patients with chronic renal failure undergoing dialysis. N Engl J Med 315:157–161.

    Article  PubMed  CAS  Google Scholar 

  47. Coburn JW, Brickman AS, Hartenbower DL: Intestinal phosphate absorption in normal and uremic man: Effects of 1,25(OH)2 vitamin D3 and 1-alpha-vitamin D3. In: Massry SG, Ritz E (eds) Phosphate Metabolism.

    Google Scholar 

  48. Stanbury SW, Lumb GA: (1962) Metabolic studies of renal osteodystrophy. I. Calcium, phosphorus and nitrogen metabolism in rickets, osteomalacia and hyperparathyroidism complicating chronic uremia and in osteomalacia of the adult Fanconi Syndrome. Medicine 41:1.

    Article  PubMed  CAS  Google Scholar 

  49. Coburn JW, Hartenbower DL, Brickman AS, Massry SG, Kopple JD: (1977) Intestinal absorption of calcium, magnesium and phosphorus in chronic renal insufficiency. In: David DS (ed) Calcium Metabolism in Renal Disease. New York: John Wiley & Sons.

    Google Scholar 

  50. Walling MW: (1978) Intestinal inorganic phosphate transport. In: Massry SG, Ritz E, Rapado A (eds) Homeostasis of Phosphate and Other Minerals. In: Advances in Experimental Medicine and Biology, New York: Plenum Press.

    Google Scholar 

  51. Slatopolsky E, Caglar S, Pennell JP, Tagart DB, Canterbury JM, Reiss E, Bricker NS: (1971) On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog. J Clin Invest 50:492–499.

    Article  PubMed  CAS  Google Scholar 

  52. Swenson RS, Weishinger JR, Ruggi JL, Reaven GM: (1975) Evidence that parathyroid hormone is not required for phosphate homeostasis in renal failure. Metabolism 24:199.

    Article  PubMed  CAS  Google Scholar 

  53. Caverzasio J, Gloor HJ, Fleischa H, Bonjour JP: (1982) Parathyroid hormone-independent adaptation of the renal handling of phosphate in response to renal mass production. Kidney Int 21:417–476.

    Article  Google Scholar 

  54. Ritz E, Malluche HH, Krempien B, Tschöpe W, Massry SG: (1978) Pathogenesis of renal osteodystrophy: Role of phosphate and skeletal resistance to PTH. In: Massry SG, Ritz E, Rapado A (eds) Advances in Experimental Medicine and Biology, Vol 130. New York: Plenum Press, pp 423–430.

    Google Scholar 

  55. Fournier AE, Johnson WJ, Taves DR, Beabout J, Arnaud CD, Goldsmith RS: (1971) Etiology of hyperparthyroidism and bone disease during chronic hemodialysis. I. Association of bone disease with potentially etiologic factors. J Clin Inest 50:592

    Article  CAS  Google Scholar 

  56. Fournier AE, Johnson WJ, Taves DR, Beabout J, Arnaud CD, Goldsmith RS: (1971) II. Factors affecting serum immunoreactive parathyroid hormone. J Clin Invest 50:599.

    Article  PubMed  CAS  Google Scholar 

  57. Adler AJ, Ferran N, Berlyne GM: (1985) Effect of inorganic phosphate on serum ionized calcium concentration in vitro: A reassessment of the “trade-off hypothesis.” Kidney Int 28: 962–965.

    Article  Google Scholar 

  58. Nesser HJ, Baumgartner G, Danzer E, Davogg S, Watschinger B: (1984) Mitralringverkalkung bei dialysepatienten. DMW 109:170–174.

    Article  CAS  Google Scholar 

  59. Hercz G, Coburn JW: (1987) Prevention of phosphate retention and hyperphosphatemia in uremia. Kidney Int 32:S215–S220.

    Google Scholar 

  60. Maschio G, Oldrizzi L, Tessitore N, D’Angelo A, Valvo E, Lupo A, Loschiavo C, Fabris A, Gammaro L, Ruggio C, Panzetta G: (1982) Effects of dietary protein and phosphorus restriction on the progression of early renal failure. Kidney Int 22:371–376.

    Article  PubMed  CAS  Google Scholar 

  61. Fröhling PT, Kokot F, Schmicker R, Kashube I, Lindenau K, Vetter K: (1983) Influence of ketoacids on serum parathyroid hormone levels in patients with chronic renal failure. Clin Nephrol 20:212–215.

    PubMed  Google Scholar 

  62. Tessitore N, Venturi A, Adami S, Roncari C, Rugin C, Corgnati A, Bonucci E, Maschio G: (1987) Relationship between serum vitamin D metabolites and dietary intake of phosphate in patients with early renal failure. Min Electr Metab 13:38–44.

    CAS  Google Scholar 

  63. Lucas PA, Brown RC, Woodhead JS, Cloes GA: (1986) 1,25-dihydroxycholecalciferol and parathyroid hormone in advanced chronic renal failure: Effects of simultaneous protein and phosphorus restriction. Clin Nephrol 25:7–10.

    PubMed  Google Scholar 

  64. Massry SG, Friedler RM, Coburn JW: (1977) Renal handling of calcium, magnesium, and phosphate in renal failure. In: David DS (ed) Calcium Metabolism in Renal Failure and Nephrolithiasis. New York: John Wiley & Son.

    Google Scholar 

  65. Ritz E, Lenhard V, Bommer J, Hackeng W: (1974) The effect of dialysate magnesium concentration on serum PTH levels in patients on maintenance hemodialysis. Klin Wschr 52:51.

    Article  PubMed  CAS  Google Scholar 

  66. Mordes JP, Wacker WE: (1978) Excess magnesium. Pharmacol Rev 29:273.

    Google Scholar 

  67. Meema E, Oreopoulos DG, Rapaport A: (1987) Serum magnesium level and arterial calcification in end-stage renal disease. Kidney Int 32:388–394.

    Article  PubMed  CAS  Google Scholar 

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© 1989 Kluwer Academic Publishers, Boston

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Ritz, E., Mehls, O. (1989). Abnormalities of Calcium, Phosphate, and Magnesium Metabolism. In: Giovannetti, S. (eds) Nutritional Treatment of Chronic Renal Failure. Topics in Renal Medicine, vol 7. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1583-4_11

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  • DOI: https://doi.org/10.1007/978-1-4613-1583-4_11

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