Strontium in diabetic kidney disease: a cross-sectional study on associations between serum strontium and altered calcium-phosphatemetabolism in patients with type 2 diabetes mellitus.

Berkhof, Y.S. van den (2017) Strontium in diabetic kidney disease: a cross-sectional study on associations between serum strontium and altered calcium-phosphatemetabolism in patients with type 2 diabetes mellitus. thesis, Medicine.

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Abstract

Background: Diabetic kidney disease is accompanied by calcium-phosphate metabolism alterations. Changes in estimated glomerular filtration rate (eGFR), serum fibroblast growth factor 23 (FGF23), phosphate and parathormone (PTH) lead to hypocalcaemia and hyperphosphatemia and eventually vascular calcification and mineral bone disease (MBD) develop. Although strontium has many similarities with calcium, little is known about strontium and its role in the altered calcium-phosphate metabolism. Objective: To study possible changes in serum strontium in altered calcium-phosphate metabolism observed in diabetic kidney disease. Material and Methods: We measured plasma strontium in a cross-sectional cohort study in 450 patients with T2DM. Demographic and diabetes related characteristics, anthropometrics, medication use and calcium-phosphate metabolism were analyzed using linear regression and multivariate analysis. Results: In the total population, the median serum strontium was 269 nmol/L, which is within the normal range (228-354 nmol/L). Median serum strontium was progressively increased according to stage of CKD, i.e. 246 nmol/L in stage 1-2, 347 nmol/L in stage 3 and 419 nmol/L in stage 4-5. In the multivariate analyses, independent correlations were found between serum strontium and both eGFR (p=0.004) and serum FGF23 (p=0.013). Conclusion: The increase of serum strontium observed in progressive stages of CKD is related to the alterations in calcium-phosphate metabolism and could be caused by release from bone tissue. Therefore, strontium is a potential marker of the bone remodeling process in CKD. Whether the increase in plasma strontium is implicated in the pathophysiology of vascular calcification and/or MBD needs to be addressed in future research.

Item Type:	Thesis (Thesis)
Supervisor name:	Begeleider: and Laverman, dr. G. D. and Locatie: ZGT Almelo: afdeling interne geneeskunde, nefrologi
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:54
Last Modified:	25 Jun 2020 10:54
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1502

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