Vascular calcification and mineral bone disorder in chronic kidney disease

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dc.check.chapterOfThesis4,5,6
dc.check.embargoformatE-thesis on CORA onlyen
dc.check.opt-outNot applicableen
dc.check.reasonThis thesis is due for publication or the author is actively seeking to publish this materialen
dc.contributor.advisorEustace, Joeen
dc.contributor.authorKinsella, Sinéad
dc.contributor.funderMedicine, College of Medicine and Health, University College Corken
dc.contributor.funderIrish Nephrology Societyen
dc.date.accessioned2014-01-09T12:44:43Z
dc.date.available2015-01-10T05:00:05Z
dc.date.issued2013
dc.date.submitted2013
dc.description.abstractChronic Kidney Disease (CKD), osteoporosis and mild hyponatremia are all prevalent chronic conditions that may coexist and are often under-recognized. Mineral-Bone Disorder begins early in the natural history of CKD and results in complex abnormalities of bone which ultimately confers a well-established increased risk of fragility fractures in End Stage Kidney Disease. Hyponatremia is a novel, usually renal mediated metabolic perturbation, that most commonly occurs independently of the stage of renal dysfunction but which may also predispose to increased fracture risk. The extent -if any- to which either early stages of renal dysfunction or the presence of hyponatremia contribute to fracture occurrence in the general population, independently of osteoporosis, is unclear. Renal transplantation is the treatment of choice for ESKD and although it restores endogenous renal function it typically fails to normalize either the long term cardiovascular or fracture risk. One potential mechanism contributing to these elevated long-term risks and to diminished Health Related Quality of Life is persistent, post-transplant hyperparathyroidism. In this study we retrospectively examine the association of renal function and serum sodium with Bone Mineral Density and fracture occurrence in a retrospective cohort of 1930 female members of the general population who underwent routine DXA scan. We then prospectively recruited a cohort of 90 renal transplant recipients in order to examine the association of post transplant parathyroid hormone (PTH) level with measures of CKD Mineral Bone Disorder, including, DXA Bone Mineral Density, Vascular Calcification (assessed using both abdominal radiography and CT techniques, as well as indirectly by carotid-femoral Pulse Wave Velocity) and Quality of Life (using the Short Form-12 and a PTH specific symptom score). In the retrospective DXA cohort, moderate CKD (eGFR 30-59ml/min/1.73m2) and hyponatremia (<135mmol/L) were associated with fracture occurrence, independently of BMD, with an adjusted Odds Ratio (95% Confidence Interval), of 1.37 (1.0, 1.89) and 2.25 (1.24, 4.09) respectively. In the renal transplant study, PTH was independently associated with the presence of osteoporosis, adjusted Odds Ratio (95% Confidence Interval), 1.15 (per 10ng/ml increment), (1.04, 1.26). The presence of osteoporosis but not PTH was independently associated with measures of vascular calcification, adjusted ß (95% Confidence Interval), 12.45, (1.16, 23.75). Of the eight quality-of-life domains examined, post-transplant PTH (per 10ng/ml increment), was only significantly and independently associated with reduced Physical Functioning, (95% Confidence Interval), 1.12 (1.01, 1.23). CKD and hyponatremia are both common health problems that may contribute to fracture occurrence in the general population, a major on-going public health concern. PTH and decreased Bone Mineral Density may signal sub-optimal long-term outcomes post renal transplantation, influencing bone and vascular health and to a limited extent long term Health Related Quality of Lifeen
dc.description.sponsorshipIrish Nephrology Society (Research Bursary); Medicine, College of Medicine and Health, University College Cork (Professor Denis O Sullivan Clinical Research Fellowship)en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationKinsella, S. 2013. Vascular calcification and mineral bone disorder in chronic kidney disease. PhD Thesis, University College Cork.en
dc.identifier.endpage252
dc.identifier.urihttps://hdl.handle.net/10468/1299
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2013, Sinéad Kinsellaen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectVascular calcificationen
dc.subjectRenal transplantationen
dc.subjectMineral bone disorderen
dc.subjectChronic kidney diseaseen
dc.subject.lcshHyperparathyroidismen
dc.subject.lcshKidneys--Diseasesen
dc.subject.lcshKidneys--Transplantationen
dc.thesis.opt-outfalse
dc.titleVascular calcification and mineral bone disorder in chronic kidney diseaseen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorj.eustace@ucc.ie
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