F. Barreto - Academia.edu (original) (raw)

Papers by F. Barreto

Clinical Journal of the American Society of Nephrology, 2009

Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerrit... more Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerritin) has also been shown to be a marker of inflammation in hemodialysis (HD) patients. The aim of this study was to analyze whether sFerritin is a reliable marker of the iron stores present in bone marrow of HD patients.

Kidney International, 2006

Osteoporosis in hemodialysis patients is associated with high morbidity and mortality and, althou... more Osteoporosis in hemodialysis patients is associated with high morbidity and mortality and, although extensively studied by noninvasive methods, has never been assessed through bone biopsy. The aim of this study was to use histomorphometry to evaluate osteoporosis and identify factors related to its development in hemodialysis patients. We conducted a cross-sectional study involving 98 patients (35 women and 63 men; mean age: 48.4713 years) on hemodialysis for 36.9724.7 months. Patients were submitted to transiliac bone biopsy with double tetracycline labeling. The bone metabolism factors ionized calcium, phosphorus, bone alkaline phosphatase, deoxypyridinoline, intact parathyroid hormone, and 25(OH) vitamin D were evaluated, as were the bone remodeling cytokines osteoprotegerin (OPG), soluble receptor-activator of NF-jb ligand (sRANKL) and tumor necrosis factor-a (TNF)a. Osteoporosis was defined as trabecular bone volume (BV/TV) greater than 1 s.d. below normal (men o17.4%; women o14.7%). Forty-five patients (46%) presented osteoporosis, which was correlated with white race. We found BV/TV to correlate with age, OPG/ sRANKL ratio, TNFa levels, and length of amenorrhea. In multiple regression analysis adjusted for sex and age, length of amenorrhea, white race, and OPG/sRANKL ratio were independent determinants of BV/TV. Histomorphometric analysis demonstrated that osteoporotic patients presented normal eroded surface and low bone formation rate (BFR/BS). Osteoporosis is prevalent in hemodialysis patients. Low BFR/ BS could be involved in its development, even when bone resorption is normal. Cytokines may also play a role as may traditional risk factors such as advanced age, hypogonadism, and white race.

Jornal Brasileiro de Nefrologia, 2010

No dia 14 de novembro de 2009, a Sociedade Brasileira de Nefrologia promoveu um fórum de discussã... more No dia 14 de novembro de 2009, a Sociedade Brasileira de Nefrologia promoveu um fórum de discussão das novas diretrizes do KDIGO (Kidney Disease: Improving Global Outcomes). O objetivo desse encontro, onde estiveram presentes 64 participantes, foi discutir estas novas diretrizes diante da realidade brasileira. Esse encontro teve o patrocínio da Empresa de Biotecnologia Genzyme, que não teve acesso à sala de discussão e tampouco aos temas tratados durante o evento. Este artigo traz um resumo das diretrizes do KDIGO e das discussões realizadas pelos participantes. Palavras-chave: osteodistrofia renal, distúrbios do metabolismo do fósforo, hormônio paratireóideo, doenças ósseas metabólicas, insuficiência renal crônica. [J Bras Nefrol 2010;32(3): 229-236 ]©Elsevier Editora Ltda.

Jornal Brasileiro de Nefrologia, 2014

Keywords: renal insufficiency, chronic; indoxyl sulfate; renal osteodystrophy; uremia.

Kidney International, 2005

Background. Coronary artery calcification is a common feature of atherosclerosis, occurring in 90... more Background. Coronary artery calcification is a common feature of atherosclerosis, occurring in 90% of angiographically significant lesions. There is recent evidence that coronary artery calcification is frequent in hemodialysis patients and it has been suggested that this increased incidence may be associated to uremia-related factors. The development and progression of coronary artery calcification is similar to osteogenesis. The aim of this study was to evaluate the relationship between coronary artery calcification, uremia-related factors, and bone histomorphometry in hemodialysis patients.

American Journal of Kidney Diseases, 2006

Background: Adynamic bone disease is a type of renal osteodystrophy characterized by low bone tur... more Background: Adynamic bone disease is a type of renal osteodystrophy characterized by low bone turnover and paucity of bone cells. It was proposed that a new type of this disease featuring high osteoclastic resorption without parathyroid hormone stimulus and designated adynamic bone disease variant occurs in hemodialysis patients. The present study is designed to evaluate the frequency and characteristics of both diseases in a large series of bone biopsy specimens. Methods: We reviewed 1,160 bone biopsy specimens from hemodialysis patients. Specimens in which adynamic bone disease was diagnosed were selected and categorized as classic or variant based on osteoclastic surface. Results: In 218 bone biopsy specimens (18.8%), adynamic bone disease was identified, whereas the variant form was identified in 35 specimens (38.8%). Biopsy specimens categorized as the variant form were from patients who were younger and had greater phosphorus and parathyroid hormone levels. Histologically, the variant form presented greater osteoid volume, fibrosis volume, osteoid surface, osteoblast surface, and eroded surface. Similarly, values for all dynamic parameters were greater in the variant group. Osteoclastic surface correlated with phosphorus level, parathyroid hormone level, and osteoblast surface. Age and osteoblast surface were identified as independent determinants of the variant form. Conclusion: Adynamic bone disease variant seems to occur in younger hemodialysis patients with greater levels of parathyroid hormone, which acts on cell-covered bone surfaces. It probably is a transitional phase from low-to high-turnover status, rather than a true entity within the spectrum of renal osteodystrophy. Am J Kidney Dis 48:430-436.

Nephron Clinical Practice, 2008

Calcium-containing phosphate binders have been shown to increase the progression of vascular calc... more Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology. 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months. The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm(3)/microm(2)/day, p = 0.010 for sevelamer). There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.

Bone, 2016

Although it is recognized that cortical bone contributes significantly to the mechanical strength... more Although it is recognized that cortical bone contributes significantly to the mechanical strength of the skeleton, little is known about this compartment from bone biopsy studies, particularly in CKD patients. In addition, there is no prospective data on the effects of CKD-MBD therapy on cortical porosity (Ct.Po). This is a post hoc analysis on data from a randomized controlled trial on the effects of different phosphate binders on bone remodelling. Therapy was adjusted according to the first biopsy, and included sevelamer or calcium acetate, calcitriol and changes in calcium dialysate concentration. We measured Ct.Po at baseline and one year after. Fifty-two patients (46±13years old, 67% women and 60% white) were enrolled. Ct.Po was already high at baseline in 85% of patients [30% (17, 46)] and correlated with PTH (p=0.001). Low bone turnover was seen in 28 patients (54.9%). After one-year treatment, PTH increased in patients with low turnover, as intended. However, increased Ct.Po was seen in 49 patients (94%). This increase correlated with the delta of phosphate (p=0.015) and the delta of PTH (p=0.03); it was also higher among non-white patients than in white patients (p=0.039). The risk of increase in Ct.Po was 4.5 higher among non-white patients. Adjusted multiple regression analysis showed that the delta of Ct.Po was dependent on delta PTH and race (r(2)=0.193). We concluded that in an attempt to increase bone turnover, the increase in PTH levels might be associated with higher cortical porosity, particularly in non-white patients. Whether this finding leads to a high risk of fracture deserves further investigation.

Jornal Brasileiro de Nefrologia, 2012

American Journal of Kidney Diseases, 2008

Background: Vascular calcification is common and constitutes a prognostic marker of mortality in ... more Background: Vascular calcification is common and constitutes a prognostic marker of mortality in the hemodialysis population. Derangements of mineral metabolism may influence its development. The aim of this study is to prospectively evaluate the association between bone remodeling disorders and progression of coronary artery calcification (CAC) in hemodialysis patients.

Kidney International, 2014

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome influenced by variou... more Chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins, and dialysis modality. Although extensively studied in hemodialysis (HD) patients, only a few studies exist for peritoneal dialysis (PD) patients. Since most of these older studies contain no bone biopsy data, we studied the pattern of renal osteodystrophy in 41 prevalent PD patients. The most common presentation was adynamic bone disease (49%). There was a significant inverse association between serum sclerostin (a Wnt/β-catenin pathway inhibitor that decreases osteoblast action and bone formation) and the bone formation rate. Bone alkaline phosphatase had the best sensitivity and specificity to detect both high- and low-turnover diseases. The comparison between nondiabetic PD and HD patients, matched by age, gender, parathyroid hormone level, and length of dialysis, revealed low 25-hydroxyvitamin D levels, worse bone mineralization, and low bone turnover in the nondiabetic PD group. Thus, adynamic bone disease was the most frequent type of renal osteodystrophy in PD patients. Sclerostin seems to participate in the pathophysiology of adynamic bone disease and bone alkaline phosphatase was the best serum marker of bone turnover in these patients.Kidney International advance online publication, 10 December 2014; doi:10.1038/ki.2014.372.

Kidney International, 2003

The renal osteodystrophy pattern in Brazil and Uruguay: ent types of ROD in the diverse geographi... more The renal osteodystrophy pattern in Brazil and Uruguay: ent types of ROD in the diverse geographical areas [2] An overview. has changed during the past two decades. Several condi-Background. The prevalence of the types of renal osteodystions, including demographic and geographical factors, trophy (ROD) has changed in the last two decades. This study different preventive measures, and therapeutic manageevaluates the prevalence and determining factors of the types ment of the dialyzed patients, in addition to no uniforof ROD in two countries in South America.

Kidney International, 2008

Clinical Journal of the American Society of Nephrology, 2009

Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerrit... more Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerritin) has also been shown to be a marker of inflammation in hemodialysis (HD) patients. The aim of this study was to analyze whether sFerritin is a reliable marker of the iron stores present in bone marrow of HD patients.

Nephron Clinical Practice, 2011

related positively with serum phosphate. After 1 year, serum FGF23 decreased significantly. Repea... more related positively with serum phosphate. After 1 year, serum FGF23 decreased significantly. Repeated measures ANOVA analysis showed that the use of a 3.5-mEq/l calcium concentration in the dialysate, as well as the administration of calcitriol and a calcium-based phosphate binder were associated with higher final serum FGF23 levels. Conclusions: Taken together, our results confirm that the current CKD-MBD therapies have an effect on serum levels of FGF23. Since FGF23 is emerging as a potential treatment target, our findings should be taken into account in the decision on how to manage CKD-MBD therapy.

Jornal Brasileiro de Nefrologia, 2014

Cardiovascular Research, 2012

Increased serum phosphorus levels are associated with cardiovascular disease in patients with chr... more Increased serum phosphorus levels are associated with cardiovascular disease in patients with chronic kidney disease (CKD) and in the general population. High phosphate levels may play a direct role in vascular dysfunction. We investigated here the effects of phosphate loading and of the phosphate binder sevelamer-HCl on vascular function.

Clinical Journal of the American Society of Nephrology, 2009

Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerrit... more Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerritin) has also been shown to be a marker of inflammation in hemodialysis (HD) patients. The aim of this study was to analyze whether sFerritin is a reliable marker of the iron stores present in bone marrow of HD patients.

Kidney International, 2006

Osteoporosis in hemodialysis patients is associated with high morbidity and mortality and, althou... more Osteoporosis in hemodialysis patients is associated with high morbidity and mortality and, although extensively studied by noninvasive methods, has never been assessed through bone biopsy. The aim of this study was to use histomorphometry to evaluate osteoporosis and identify factors related to its development in hemodialysis patients. We conducted a cross-sectional study involving 98 patients (35 women and 63 men; mean age: 48.4713 years) on hemodialysis for 36.9724.7 months. Patients were submitted to transiliac bone biopsy with double tetracycline labeling. The bone metabolism factors ionized calcium, phosphorus, bone alkaline phosphatase, deoxypyridinoline, intact parathyroid hormone, and 25(OH) vitamin D were evaluated, as were the bone remodeling cytokines osteoprotegerin (OPG), soluble receptor-activator of NF-jb ligand (sRANKL) and tumor necrosis factor-a (TNF)a. Osteoporosis was defined as trabecular bone volume (BV/TV) greater than 1 s.d. below normal (men o17.4%; women o14.7%). Forty-five patients (46%) presented osteoporosis, which was correlated with white race. We found BV/TV to correlate with age, OPG/ sRANKL ratio, TNFa levels, and length of amenorrhea. In multiple regression analysis adjusted for sex and age, length of amenorrhea, white race, and OPG/sRANKL ratio were independent determinants of BV/TV. Histomorphometric analysis demonstrated that osteoporotic patients presented normal eroded surface and low bone formation rate (BFR/BS). Osteoporosis is prevalent in hemodialysis patients. Low BFR/ BS could be involved in its development, even when bone resorption is normal. Cytokines may also play a role as may traditional risk factors such as advanced age, hypogonadism, and white race.

Jornal Brasileiro de Nefrologia, 2010

No dia 14 de novembro de 2009, a Sociedade Brasileira de Nefrologia promoveu um fórum de discussã... more No dia 14 de novembro de 2009, a Sociedade Brasileira de Nefrologia promoveu um fórum de discussão das novas diretrizes do KDIGO (Kidney Disease: Improving Global Outcomes). O objetivo desse encontro, onde estiveram presentes 64 participantes, foi discutir estas novas diretrizes diante da realidade brasileira. Esse encontro teve o patrocínio da Empresa de Biotecnologia Genzyme, que não teve acesso à sala de discussão e tampouco aos temas tratados durante o evento. Este artigo traz um resumo das diretrizes do KDIGO e das discussões realizadas pelos participantes. Palavras-chave: osteodistrofia renal, distúrbios do metabolismo do fósforo, hormônio paratireóideo, doenças ósseas metabólicas, insuficiência renal crônica. [J Bras Nefrol 2010;32(3): 229-236 ]©Elsevier Editora Ltda.

Jornal Brasileiro de Nefrologia, 2014

Keywords: renal insufficiency, chronic; indoxyl sulfate; renal osteodystrophy; uremia.

Kidney International, 2005

Background. Coronary artery calcification is a common feature of atherosclerosis, occurring in 90... more Background. Coronary artery calcification is a common feature of atherosclerosis, occurring in 90% of angiographically significant lesions. There is recent evidence that coronary artery calcification is frequent in hemodialysis patients and it has been suggested that this increased incidence may be associated to uremia-related factors. The development and progression of coronary artery calcification is similar to osteogenesis. The aim of this study was to evaluate the relationship between coronary artery calcification, uremia-related factors, and bone histomorphometry in hemodialysis patients.

American Journal of Kidney Diseases, 2006

Background: Adynamic bone disease is a type of renal osteodystrophy characterized by low bone tur... more Background: Adynamic bone disease is a type of renal osteodystrophy characterized by low bone turnover and paucity of bone cells. It was proposed that a new type of this disease featuring high osteoclastic resorption without parathyroid hormone stimulus and designated adynamic bone disease variant occurs in hemodialysis patients. The present study is designed to evaluate the frequency and characteristics of both diseases in a large series of bone biopsy specimens. Methods: We reviewed 1,160 bone biopsy specimens from hemodialysis patients. Specimens in which adynamic bone disease was diagnosed were selected and categorized as classic or variant based on osteoclastic surface. Results: In 218 bone biopsy specimens (18.8%), adynamic bone disease was identified, whereas the variant form was identified in 35 specimens (38.8%). Biopsy specimens categorized as the variant form were from patients who were younger and had greater phosphorus and parathyroid hormone levels. Histologically, the variant form presented greater osteoid volume, fibrosis volume, osteoid surface, osteoblast surface, and eroded surface. Similarly, values for all dynamic parameters were greater in the variant group. Osteoclastic surface correlated with phosphorus level, parathyroid hormone level, and osteoblast surface. Age and osteoblast surface were identified as independent determinants of the variant form. Conclusion: Adynamic bone disease variant seems to occur in younger hemodialysis patients with greater levels of parathyroid hormone, which acts on cell-covered bone surfaces. It probably is a transitional phase from low-to high-turnover status, rather than a true entity within the spectrum of renal osteodystrophy. Am J Kidney Dis 48:430-436.

Nephron Clinical Practice, 2008

Calcium-containing phosphate binders have been shown to increase the progression of vascular calc... more Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology. 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months. The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm(3)/microm(2)/day, p = 0.010 for sevelamer). There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.

Bone, 2016

Although it is recognized that cortical bone contributes significantly to the mechanical strength... more Although it is recognized that cortical bone contributes significantly to the mechanical strength of the skeleton, little is known about this compartment from bone biopsy studies, particularly in CKD patients. In addition, there is no prospective data on the effects of CKD-MBD therapy on cortical porosity (Ct.Po). This is a post hoc analysis on data from a randomized controlled trial on the effects of different phosphate binders on bone remodelling. Therapy was adjusted according to the first biopsy, and included sevelamer or calcium acetate, calcitriol and changes in calcium dialysate concentration. We measured Ct.Po at baseline and one year after. Fifty-two patients (46±13years old, 67% women and 60% white) were enrolled. Ct.Po was already high at baseline in 85% of patients [30% (17, 46)] and correlated with PTH (p=0.001). Low bone turnover was seen in 28 patients (54.9%). After one-year treatment, PTH increased in patients with low turnover, as intended. However, increased Ct.Po was seen in 49 patients (94%). This increase correlated with the delta of phosphate (p=0.015) and the delta of PTH (p=0.03); it was also higher among non-white patients than in white patients (p=0.039). The risk of increase in Ct.Po was 4.5 higher among non-white patients. Adjusted multiple regression analysis showed that the delta of Ct.Po was dependent on delta PTH and race (r(2)=0.193). We concluded that in an attempt to increase bone turnover, the increase in PTH levels might be associated with higher cortical porosity, particularly in non-white patients. Whether this finding leads to a high risk of fracture deserves further investigation.

Jornal Brasileiro de Nefrologia, 2012

American Journal of Kidney Diseases, 2008

Background: Vascular calcification is common and constitutes a prognostic marker of mortality in ... more Background: Vascular calcification is common and constitutes a prognostic marker of mortality in the hemodialysis population. Derangements of mineral metabolism may influence its development. The aim of this study is to prospectively evaluate the association between bone remodeling disorders and progression of coronary artery calcification (CAC) in hemodialysis patients.

Kidney International, 2014

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome influenced by variou... more Chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins, and dialysis modality. Although extensively studied in hemodialysis (HD) patients, only a few studies exist for peritoneal dialysis (PD) patients. Since most of these older studies contain no bone biopsy data, we studied the pattern of renal osteodystrophy in 41 prevalent PD patients. The most common presentation was adynamic bone disease (49%). There was a significant inverse association between serum sclerostin (a Wnt/β-catenin pathway inhibitor that decreases osteoblast action and bone formation) and the bone formation rate. Bone alkaline phosphatase had the best sensitivity and specificity to detect both high- and low-turnover diseases. The comparison between nondiabetic PD and HD patients, matched by age, gender, parathyroid hormone level, and length of dialysis, revealed low 25-hydroxyvitamin D levels, worse bone mineralization, and low bone turnover in the nondiabetic PD group. Thus, adynamic bone disease was the most frequent type of renal osteodystrophy in PD patients. Sclerostin seems to participate in the pathophysiology of adynamic bone disease and bone alkaline phosphatase was the best serum marker of bone turnover in these patients.Kidney International advance online publication, 10 December 2014; doi:10.1038/ki.2014.372.

Kidney International, 2003

The renal osteodystrophy pattern in Brazil and Uruguay: ent types of ROD in the diverse geographi... more The renal osteodystrophy pattern in Brazil and Uruguay: ent types of ROD in the diverse geographical areas [2] An overview. has changed during the past two decades. Several condi-Background. The prevalence of the types of renal osteodystions, including demographic and geographical factors, trophy (ROD) has changed in the last two decades. This study different preventive measures, and therapeutic manageevaluates the prevalence and determining factors of the types ment of the dialyzed patients, in addition to no uniforof ROD in two countries in South America.

Kidney International, 2008

Clinical Journal of the American Society of Nephrology, 2009

Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerrit... more Background and objectives: As well as being a marker of body iron stores, serum ferritin (sFerritin) has also been shown to be a marker of inflammation in hemodialysis (HD) patients. The aim of this study was to analyze whether sFerritin is a reliable marker of the iron stores present in bone marrow of HD patients.

Nephron Clinical Practice, 2011

related positively with serum phosphate. After 1 year, serum FGF23 decreased significantly. Repea... more related positively with serum phosphate. After 1 year, serum FGF23 decreased significantly. Repeated measures ANOVA analysis showed that the use of a 3.5-mEq/l calcium concentration in the dialysate, as well as the administration of calcitriol and a calcium-based phosphate binder were associated with higher final serum FGF23 levels. Conclusions: Taken together, our results confirm that the current CKD-MBD therapies have an effect on serum levels of FGF23. Since FGF23 is emerging as a potential treatment target, our findings should be taken into account in the decision on how to manage CKD-MBD therapy.

Jornal Brasileiro de Nefrologia, 2014

Cardiovascular Research, 2012

Increased serum phosphorus levels are associated with cardiovascular disease in patients with chr... more Increased serum phosphorus levels are associated with cardiovascular disease in patients with chronic kidney disease (CKD) and in the general population. High phosphate levels may play a direct role in vascular dysfunction. We investigated here the effects of phosphate loading and of the phosphate binder sevelamer-HCl on vascular function.