title: Chronic Kidney Disease-Mineral Bone Disorder in Korean Patients: a Report from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD).
abstract: This study examined the characteristics of biochemical parameters, bone diseases, and vascular calcification in Korean patients with chronic kidney disease (CKD) not yet on dialysis. Serum levels of fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 (25D), and 1,25-dihydroxyvitamin D3 (1,25D); lumbar spine, total hip, and femur neck bone mineral densities; and brachial-to-ankle pulse wave velocity (baPWV) representing vascular calcification were measured at baseline for 2,238 CKD patients in the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Increases in serum FGF23 and iPTH preceded changes in serum calcium and phosphate, similar to Western populations. However, the 25D and 1,25D levels decreased earlier than serum FGF23 or iPTH increased, with a decreased estimated glomerular filtration rate (eGFR) in Korean CKD patients. Vitamin D deficiency occurred in 76.7% of patients with CKD stage 1. Bone mineral densities were lowest in CKD stage 5 (lumbar spine, -0.64 ± 1.67; total hip, -0.49 ± 1.21; femur neck, -1.02 ± 1.25). Osteoporosis was more prevalent in patients with higher CKD stages. The mean baPWV, abdominal aortic calcification (AAC), and coronary calcium score also increased, with declined eGFR. In conclusion, a decline in serum vitamin D levels was observed in early CKD stages before significant increases of FGF23 and iPTH in the Korean CKD population compared with that in Western populations. Increased bone disease and vascular calcification occurred in early-stage CKD.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chang Seong
authors.identifier: http://orcid.org/0000-0001-8753-7641
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Eun Hui
authors.identifier: http://orcid.org/0000-0003-1727-2822
authors.initials: EH
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seong Kwon
authors.identifier: http://orcid.org/0000-0002-5758-8189
authors.initials: SK
authors.lastname: Ma
authors.affiliation: Depatment of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Hyeok
authors.identifier: http://orcid.org/0000-0001-7923-5635
authors.initials: SH
authors.lastname: Han
authors.affiliation: Division of Nephrology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyu Beck
authors.identifier: http://orcid.org/0000-0002-3904-5404
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Joongyub
authors.identifier: http://orcid.org/0000-0003-2784-3772
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kook Hwan
authors.identifier: http://orcid.org/0000-0001-9525-2179
authors.initials: KH
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: Dong Wan
authors.identifier: http://orcid.org/0000-0001-9401-892X
authors.initials: DW
authors.lastname: Chae
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. skimw@chonnam.ac.kr.
authors.forename: Soo Wan
authors.identifier: http://orcid.org/0000-0002-3540-9004
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D015519:Bone Density; D001847:Bone Diseases / Q000150:complications / Q000473:pathology*; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000473:pathology*; D056910:Republic of Korea; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000453:epidemiology
chemical_list: C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; C118756:dihydroxy-vitamin D3; D014807:Vitamin D; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002117:Calcitriol; D002118:Calcium
keywords: Bone Diseases; Chronic Kidney Disease; Korean; Vascular Calcification