• chronic kidney disease
• diabetes
• keto-analogues
• low-protein diet
• malnutrition
• mineral and bone disorders
• very low-protein diet

• Humans
• Diet, Protein-Restricted/methods
• Renal Insufficiency, Chronic/diet therapy
• Renal Insufficiency, Chronic/complications
• Malnutrition
• Bone and Bones/metabolism
• Nutritional Status
• Dietary Supplements

• Vietnam
• chronic kidney disease
• nutritional counselling
• nutritional intervention

• Humans
• Renal Insufficiency, Chronic/diet therapy
• Renal Insufficiency, Chronic/therapy
• Male
• Female
• Vietnam
• Middle Aged
• Nutritional Status
• Malnutrition/diet therapy
• Aged
• Adult
• Nutrition Therapy/methods

• Calcium
• chronic kidney disease 3b-4
• mineral metabolism
• parathyroid hormone
• phosphate
• survival analysis

• Aged
• Biomarkers
• Calcium
• Female
• Humans
• Male
• Minerals
• Parathyroid Hormone
• Renal Insufficiency, Chronic/epidemiology
• Vitamin D

Secondary hyperparathyroidism is commonly seen in patients with chronic kidney disease (CKD) due to hypocalcemia, hyperphosphatemia and low vitamin D levels and is associated with high-turnover bone disease. In contrast, some patients with advanced CKD, including those requiring dialysis (end-stage renal disease [ESRD]), develop adynamic bone disease with features of low-turnover bone disease. Low serum parathyroid hormone (PTH) has been used as a biochemical marker of adynamic bone disease. Low PTH levels may not necessarily be due to adynamic bone disease but could be a manifestation of the malnutrition inflammation complex syndrome (MICS). The optimal management of hypoparathyroidism associated with MICS is not well known. Currently, there is insufficient evidence to suggest if there is any role in improving nutritional and inflammatory status among patients with CKD and MICS. Furthermore, it also remains unclear whether these changes will help address low PTH levels seen in these patients. We report three patients with advanced CKD who had very low PTH levels possibly attributed to MICS. In addition, we briefly discuss other characteristics and pathophysiology of MICS.

• Calcium
• Chronic kidney disease
• Hyperparathyroidism
• Phosphate
• Survival analysis

• Calcium
• Cohort Studies
• Humans
• Minerals
• Parathyroid Hormone
• Prospective Studies
• Renal Dialysis
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/therapy

• Alkaline treatment
• Bicarbonate
• Chronic kidney disease
• End-stage renal disease
• Metabolic acidosis

To describe the step-by-step person-centered, theory-based development of the KELA.AE app for Arabic speaking hemodialysis patients.

A step-by-step person-driven theory-based approach was conducted to develop a self-monitoring and educational dietary app for hemodialysis patients. The development follows the Integration, Design, Assessment, and Sharing (IDEAS) framework. Qualitative, semi-structured interviews with 6 hemodialysis patients and 6 healthcare practitioners (dietitians and nephrologists) were performed to assess the need for an app, the willingness to use an app, and features desired in an app.

The KELA.AE app, which includes a self-monitoring feature, CKD-friendly recipes, and a theory-based, evidence-based educational feature was developed. Qualitative analysis of interviews revealed two predominant themes from patient interviews ‘Experience with the diet’, ‘App evaluation’, and one theme from interviews with healthcare practitioners ‘App evaluation’. Patients expressed frustration with current accessibility of dietary information along with the need for educational materials in the app. The review of the KELA.AE prototype was positive overall, and patients reported a willingness to use the app. Healthcare practitioners considered the app accurate, simple, and culturally sensitive but expressed concerns about app misuse and the replacement of healthcare practitioners.

The KELA.AE app was found to be satisfactory and supportive of the participants' needs. Changes were made to the app as suggested during the interviews.

• Chronic Kidney Failure
• Diet
• Health Behavior
• Mobile Applications
• Telemedicine

Evocalcet is a novel calcimimetic agent with potential to improve the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. This study aimed to determine the pharmacokinetics, pharmacodynamics, and safety of evocalcet in healthy Japanese subjects.

This was a single-blind, placebo-controlled, single-dose study and an 8-day multiple-dose study of evocalcet (MT-4580/KHK7580) in 66 healthy Japanese subjects.

After a single dose of evocalcet 1–20 mg, the time to maximum plasma concentration was attained in 1.5–2 h (median), and the elimination half-life was 12.98–19.77 h (mean). Within this dose range, the maximum plasma concentration and area under plasma concentration-time curve increased dose proportionally, confirming linearity. The trough plasma concentrations were relatively unchanged after multiple administration of evocalcet 6 and 12 mg. Evocalcet decreased intact parathyroid hormone and corrected calcium and phosphorus levels in a dose-proportional manner. Regarding its safety, no upper gastrointestinal adverse event occurred after the single and multiple administration of evocalcet at doses up to 12 mg. Tetany was detected in 1 subject (17%) after multiple administration of evocalcet 12 mg. In healthy subjects, the tolerability and safety of evocalcet were observed for a single dose of evocalcet at doses up to 20 mg, and for multiple doses up to 12 mg.

These results suggest that evocalcet may have a comparable efficacy and better safety profile than that of cinacalcet, one of the current treatments for secondary hyperparathyroidism in patients with chronic kidney disease.

The online version of this article (10.1007/s40261-018-0687-4) contains supplementary material, which is available to authorized users.