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Karagiannidis AG, Iatridi F, Sarafidis PA. Feel the rhythm of the beat: rhythmic components in ambulatory blood pressure monitoring for predicting cardiovascular risk in CKD patients. J Hum Hypertens 2024; 38:629-630. [PMID: 39191910 DOI: 10.1038/s41371-024-00950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/15/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024]
Affiliation(s)
- Artemios G Karagiannidis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis A Sarafidis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Solis-Herrera C, Triplitt C. Non-steroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease and type 2 diabetes. Diabetes Obes Metab 2024; 26:417-430. [PMID: 37885354 DOI: 10.1111/dom.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is a major health challenge associated with a disproportionately high burden of end-stage renal disease, cardiovascular disease and death. This review summarizes the rationale, clinical evidence and practical implementation for non-steroidal mineralocorticoid receptor antagonists (nsMRAs), a drug class now approved and recommended for patients with T2D and CKD at risk of cardiorenal disease progression. Three nsMRAs (finerenone, esaxerenone and apararenone) have been evaluated but finerenone is currently the only approved nsMRA for this indication. Two large-scale, placebo-controlled, Phase 3 studies evaluated finerenone added to a maximally tolerated dose of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker. Over >2 years of treatment, finerenone was associated with a significant reduction in composite endpoints of renal and cardiovascular outcomes versus placebo. Esaxerenone or apararenone have both shown significant improvements in albuminuria versus placebo. In general, nsMRAs were well tolerated. Hyperkalaemia was the most notable treatment-related adverse event and could generally be managed through serum potassium monitoring and dose adjustments. The nsMRAs are now an important component of recommended treatment for CKD associated with T2D, providing a significant reduction in the risk of cardiorenal progression beyond what can be achieved with glucose and blood pressure control.
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Affiliation(s)
- Carolina Solis-Herrera
- Division of Endocrinology, Department of Medicine, University of Texas Health, San Antonio, Texas, USA
| | - Curtis Triplitt
- Division of Diabetes, Department of Medicine, University of Texas Health, San Antonio, Texas, USA
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3
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Moiseev S, Bulanov N, Crnogorac M, Direskeneli H, Galesic K, Gazel U, Geetha D, Guillevin L, Hrušková Z, Little MA, O'Neill L, Makarov E, McAdoo SP, Mohammad AJ, Moran S, Novikov P, Pusey CD, Rahmattulla C, Satrapová V, Silva J, Suvorov A, Tesar V, Terrier B, Willeit P, Zhao MH, Kronbichler A, Jayne DRW. Traditional and Disease-Specific Risk Factors for Cardiovascular Events in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multinational Retrospective Study. J Rheumatol 2023; 50:1145-1151. [PMID: 36642436 DOI: 10.3899/jrheum.220851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the occurrence of cardiovascular events (CVEs) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, China, Turkey, Russia, the United Kingdom, and the USA. METHODS Patients with a definite diagnosis of AAV who were followed for ≥ 3 months and had sufficient documentation were included. Data on myocardial infarction (MI) and stroke were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS Over a median follow-up of 62.0 months (IQR 22.6-100.0), CVEs (mostly MIs) occurred in 245 (10.7%) of 2286 patients with AAV, with a higher frequency in China and the UK. On multivariate regression analysis, older age (55-64.9 yrs, HR 2.93, 95% CI 1.99-4.31), smoking (HR 1.98, 95% CI 1.48-2.64), Chinese origin (HR 4.24, 95% CI 3.07-5.85), and pulmonary (HR 1.50, 95% CI 1.09-2.06) and kidney (HR 3.02, 95% CI 2.08-4.37) involvement were independent variables associated with a higher occurrence of CVEs. CONCLUSION We showed that geographic region and both traditional and disease-specific (kidney involvement in particular) factors were independently associated with CVEs. Proper assessment and management of modifiable cardiovascular (CV) risk factors are essential for prevention of CV morbidity in patients with AAV.
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Affiliation(s)
- Sergey Moiseev
- S. Moiseev, MD, Professor, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, and Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Bulanov
- N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matija Crnogorac
- M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Haner Direskeneli
- H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kresimir Galesic
- M. Crnogorac, MD, K. Galesic, MD, Professor, Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Ummugulsum Gazel
- H. Direskeneli, MD, Professor, U. Gazel, MD, Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Duvuru Geetha
- D. Geetha, MD, Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Loic Guillevin
- L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Zdenka Hrušková
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mark A Little
- M.A. Little, MD, Professor, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, and Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland
| | - Liam O'Neill
- L. O'Neill, MD, University Hospital Galway, Dublin, Ireland
| | - Egor Makarov
- E. Makarov, MD, Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Stephen P McAdoo
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Aladdin J Mohammad
- A.J. Mohammad, MD, Department of Rheumatology, Clinical Sciences-Lund, Lund University, Lund, Sweden, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Sarah Moran
- S. Moran, MD, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Pavel Novikov
- N. Bulanov, MD, P. Novikov, MD, Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Charles D Pusey
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Chinar Rahmattulla
- C. Rahmattulla, PhD, Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Veronika Satrapová
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Joana Silva
- S.P. McAdoo, PhD, C.D. Pusey, MD, Professor, J. Silva, MD, Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Alexander Suvorov
- A. Suvorov, MD, Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vladimír Tesar
- Z. Hrušková, MD, V. Satrapová, MD, V. Tesar, MD, Professor, Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Benjamin Terrier
- L. Guillevin, MD, Professor, B. Terrier, PhD, Professor, Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Peter Willeit
- P. Willeit, PhD, Professor, Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria, and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ming-Hui Zhao
- M.H. Zhao, MD, Professor, Renal Division, Peking University First Hospital, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Andreas Kronbichler
- A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK.
| | - David R W Jayne
- A. Kronbichler, PhD, D.R.W. Jayne, MD, Professor, Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, and Department of Medicine, University of Cambridge, Cambridge, UK
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Holden RM, Booth SL, Zimmerman D, Moist L, Norman PA, Day AG, Menard A, Fu X, Shea MK, Babiolakis CS, Nolan R, Turner ME, Ward E, Kaufmann M, Adams MA, Heyland DK. Inhibit progression of coronary artery calcification with vitamin K in hemodialysis patients (the iPACK-HD study): a randomized, placebo-controlled multi-center, pilot trial. Nephrol Dial Transplant 2022; 38:746-756. [PMID: 35641194 PMCID: PMC9976736 DOI: 10.1093/ndt/gfac191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vitamin K activates matrix Gla protein (MGP), a key inhibitor of vascular calcification. There is a high prevalence of sub-clinical vitamin K deficiency in patients with end-stage kidney disease. METHODS A parallel randomized placebo-controlled pilot trial was designed to determine whether 10 mg of phylloquinone thrice weekly versus placebo modifies coronary artery calcification progression over 12 months in patients requiring hemodialysis with a coronary artery calcium score (CAC) ≥30 Agatston Units (ClinicalTrials.gov identifier NCT01528800). The primary outcome was feasibility (recruitment rate, compliance with study medication, study completion and adherence overall to study protocol). CAC score was used to assess calcification at baseline and 12 months. Secondary objectives were to explore the impact of phylloquinone on vitamin K-related biomarkers (phylloquinone, dephospho-uncarboxylated MGP and the Gla-osteocalcin to Glu-osteocalcin ratio) and events of clinical interest. RESULTS A total of 86 patients with a CAC score ≥30 Agatston Units were randomized to either 10 mg of phylloquinone or a matching placebo three times per week. In all, 69 participants (80%) completed the trial. Recruitment rate (4.4 participants/month) and medication compliance (96%) met pre-defined feasibility criteria of ≥4.17 and ≥90%, respectively. Patients randomized to phylloquinone for 12 months had significantly reduced levels of dephospho-uncarboxylated MGP (86% reduction) and increased levels of phylloquinone and Gla-osteocalcin to Glu-osteocalcin ratio compared with placebo. There was no difference in the absolute or relative progression of coronary artery calcification between groups. CONCLUSION We demonstrated that phylloquinone treatment improves vitamin K status and that a fully powered randomized trial may be feasible.
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Affiliation(s)
| | - Sarah L Booth
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Deborah Zimmerman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Louise Moist
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Patrick A Norman
- Kingston General Health Research Institute, Kingston Health Sciences Center, Kingston, Ontario, Canada,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston Health Sciences Center, Kingston, Ontario, Canada,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada,Clinical Evaluation Research Unit, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Alex Menard
- Department of Radiology, Queen's University, Kingston, Ontario, Canada
| | - Xueyan Fu
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - M Kyla Shea
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | | | - Robert Nolan
- Department of Radiology, Queen's University, Kingston, Ontario, Canada
| | - Mandy E Turner
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Emilie Ward
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Martin Kaufmann
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
| | - Daren K Heyland
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada,Clinical Evaluation Research Unit, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada,Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
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Shubrook JH, Neumiller JJ, Wright E. Management of chronic kidney disease in type 2 diabetes: screening, diagnosis and treatment goals, and recommendations. Postgrad Med 2021; 134:376-387. [PMID: 34817311 DOI: 10.1080/00325481.2021.2009726] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) are at high risk of CKD progression and cardiovascular (CV) disease. Prevalence of CKD in patients with T2D is currently around 40% and continues to grow. The increasing number of people with CKD and T2D will ultimately have a significant impact upon health resource use and costs of care for people with T2D. Management of CKD in patients with T2D aims to preserve kidney function to reduce the risk of end-stage kidney disease, CV events, and mortality. Evidence-based recommendations for the treatment of patients with CKD and T2D are provided by several international and national organizations and recommend several lifestyle and pharmacological approaches to help prevent or delay the progression of CKD in patients with T2D. Guidelines include regular screening of patients with T2D for CKD using spot urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (at least annually and at least twice a year if UACR >300 mg/g). Additionally, assessment of vascular complications, together with interventions designed to improve glycemic control and lipid levels, maintain healthy body weight, and optimize blood pressure should be performed. Medications shown to slow progression of CKD include renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and, more recently, selective, non-steroidal mineralocorticoid receptor antagonists. This review highlights the ongoing challenges facing primary care providers in the management of CKD in patients with T2D including the consideration of comorbidities, adoption of new treatment options, and implementation of individualized care. Achieving consensus for optimal treatment of this disease is critical in providing consistent and appropriate care for all patients. Strategies to improve outcomes should also include use of clear referral criteria, use of a multi-disciplinary approach, and patient education.
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Affiliation(s)
- Jay H Shubrook
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
| | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Eugene Wright
- Performance Improvement at Charlotte Area Health Education Center, Charlotte, NC, USA
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6
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Kutkut I, Jovin TG, Jovin IS. Chronic kidney disease as a risk factor for poor outcomes after endovascular stroke intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:126-127. [PMID: 34764030 DOI: 10.1016/j.carrev.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Issa Kutkut
- VCU Pauley Heart Center, Richmond, VA, United States of America
| | - Tudor G Jovin
- Department of Neurology, Cooper University Hospital, Camden, NJ, United States of America
| | - Ion S Jovin
- VCU Pauley Heart Center, Richmond, VA, United States of America; McGuire VAMC, Richmond, VA, United States of America.
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Abstract
BACKGROUND Acute coronary syndrome (ACS) is prevalent in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the association between the apoprotein profile and ACS is not well known. Therefore, we aimed to investigate the relationship between apoproteins and ACS in CAPD patients. METHODS Eighty-one CAPD patients were included in this retrospective study. The primary endpoint was ACS. Predictors were baseline apoprotein levels, particularly the ratio of apoprotein A1 (Apo A1)/apoprotein B (Apo B). Cox regression was used to determine the relationship between Apo A1/Apo B and ACS. RESULTS During follow-up, 34 (41.98%) CAPD patients experienced an ACS. ACS patients had higher levels of total cholesterol (p = 0.03), low-density lipoprotein cholesterol (LDL-C) (p = 0.04), C-reactive protein (p = 0.01), and Apo B (p < 0.01). However, hemoglobin (p = 0.01) and Apo A1/Apo B (p < 0.01) were lower in the ACS group than the non-ACS group. Patients with Apo A1/Apo B ≥ 1.105 experienced fewer ACS compared with those with Apo A1/Apo B < 1.105 (33.33% vs. 75.56%, p = 0.03). In Cox regression, Apo A1/Apo B (RR, 0.06; 95% CI, 0.00-0.77; p = 0.03) was independently associated with ACS. CONCLUSIONS Apo A1/Apo B was strongly associated with ACS and may be considered as a predictor of future ACS in CAPD patients.
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Affiliation(s)
- Tianlei Chen
- Department of Nephrology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
| | - Min Yang
- Department of Nephrology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, PR China
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8
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Detection of pro angiogenic and inflammatory biomarkers in patients with CKD. Sci Rep 2021; 11:8786. [PMID: 33888746 PMCID: PMC8062467 DOI: 10.1038/s41598-021-87710-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
Cardiovascular disease (CVD) is the most common cause of death in patients with native and post-transplant chronic kidney disease (CKD). To identify new biomarkers of vascular injury and inflammation, we analyzed the proteome of plasma and circulating extracellular vesicles (EVs) in native and post-transplant CKD patients utilizing an aptamer-based assay. Proteins of angiogenesis were significantly higher in native and post-transplant CKD patients versus healthy controls. Ingenuity pathway analysis (IPA) indicated Ephrin receptor signaling, serine biosynthesis, and transforming growth factor-β as the top pathways activated in both CKD groups. Pro-inflammatory proteins were significantly higher only in the EVs of native CKD patients. IPA indicated acute phase response signaling, insulin-like growth factor-1, tumor necrosis factor-α, and interleukin-6 pathway activation. These data indicate that pathways of angiogenesis and inflammation are activated in CKD patients' plasma and EVs, respectively. The pathways common in both native and post-transplant CKD may signal similar mechanisms of CVD.
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Déri MT, Kiss ÁF, Tóth K, Paulik J, Sárváry E, Kóbori L, Monostory K. End-stage renal disease reduces the expression of drug-metabolizing cytochrome P450s. Pharmacol Rep 2020; 72:1695-1705. [PMID: 32638224 PMCID: PMC7704481 DOI: 10.1007/s43440-020-00127-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND End-stage renal disease is an irreversible status of kidney dysfunction that reduces both renal and non-renal drug clearance. Accumulation of uremic toxins seems to modify the activities of drug-metabolizing cytochrome P450 (CYP) enzymes. The aim of the present work was to refine gene expression analysis for efficient and accurate quantification of CYP mRNAs in patients' leukocytes. METHODS We compared six liquid-liquid extraction reagents for RNA isolation and five reverse transcriptase kits for RNA-to-cDNA conversion, and developed quantitative polymerase chain reaction methods for duplex measurements of CYP target genes and the reference gene. The expression of CYP1A2, CYP2C9, CYP2C19 and CYP3A4 in patients with end-stage kidney disease (N = 105) and in organ donors with healthy kidney function (N = 110) was compared. RESULTS Regarding the RNA yield and purity, TRIzol, Trizolate and TRI reagents were equal; however, TRI reagent was the most advantageous in terms of financial cost. Reverse transcription using Maxima First Strand cDNA Synthesis kit appeared to be the most efficient with the widest range for quantification of the target transcript. The refined method with the detection of various CYPs and the reference gene in duplex PCR efficiently quantified even the low-level CYP expression. In leukocytes of patients with end-stage renal disease, all four CYPs were expressed at significantly lower level than in organ donors with normal kidney function (p < 0.0001). CONCLUSIONS Reduced CYP expression was a direct evidence of transcriptional down-regulation of CYP genes in patients with impaired kidney function.
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Affiliation(s)
- Máté Tamás Déri
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary
| | - Ádám Ferenc Kiss
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary
| | - Katalin Tóth
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary
| | - József Paulik
- Nucleotest Bio Ltd., Tündérliget 3/2, 1038, Budapest, Hungary
| | - Enikő Sárváry
- Department of Transplantation and Surgery, Semmelweis University, Baross 23, 1082, Budapest, Hungary
| | - László Kóbori
- Department of Transplantation and Surgery, Semmelweis University, Baross 23, 1082, Budapest, Hungary
| | - Katalin Monostory
- Institute of Enzymology, Research Centre for Natural Sciences, Magyar tudósok 2, 1117, Budapest, Hungary.
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10
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Progression of Aortic Arch Calcification Is Associated with Overall and Cardiovascular Mortality in Hemodialysis. DISEASE MARKERS 2020; 2020:6293185. [PMID: 32685055 PMCID: PMC7330648 DOI: 10.1155/2020/6293185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/05/2020] [Accepted: 06/09/2020] [Indexed: 01/15/2023]
Abstract
Background Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). Nevertheless, little is known whether the progression of vascular calcification outweighs the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients. Methods This study included 140 maintenance HD patients. Vascular calcification was assessed using the aortic arch calcification (AoAC) score measured from chest radiographs at the baseline and the second year of follow-up. Progression of vascular calcification (ΔAoAC) was defined as the difference between the two measurements of AoAC. The association of ΔAoAC with overall and CV mortality was evaluated using multivariate Cox regression analysis. Results During the mean follow-up period of 5.8 years, there were 49 (35%) overall mortality and 27 (19.3%) CV mortality. High brachial-ankle pulse wave velocity was positively correlated with ΔAoAC, whereas old age was negatively correlated with ΔAoAC. In multivariate adjusted Cox analysis, increased ΔAoAC (per 1 unit), but not baseline AoAC, was significantly associated with overall mortality (HR, 1.183; 95% CI, 1.056–1.327; p = 0.004) and CV mortality (HR, 1.194; 95% CI, 1.019–1.398; p = 0.028). Conclusion Progression of AoAC outperformed the baseline AoAC in association with increased risk of overall and CV mortality in HD patients. A regular follow-up of chest radiograph and AoAC score assessments are simple and cost-effective to identify the high-risk individuals of unfavorable outcomes in maintenance HD patients.
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Wu S, Yuan H, Zhou Y, Long Z, Peng Y, Peng F. [Thromboelastography-based assessment of coagulation function in patients with chronic kidney disease and the risk factors of hypercoagulability]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:556-561. [PMID: 32895144 DOI: 10.12122/j.issn.1673-4254.2020.04.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the changes in the coagulation profiles of patients with chronic kidney disease (CKD) using thromboelastography (TEG) and identify the risk factors of hypercoagulation in CKD patients. METHODS A total of 128 patients with CKD admitted in Hunan Provincial People's Hospital between August, 2018 and May, 2019 were recruited. The results of conventional coagulation test and TEG were compared between patients with CKD and 21 healthy control adults. The patients with CKD were divided into hypercoagulation group with a maximum amplitude (MA) > 68 mm (n=66) and non-hypercoagulation group (MA≤68 mm, n=62). The laboratory indicators were compared between the groups, and the factors affecting the hypercoagulable state in patients with CKD were analyzed. RESULTS The levels of fibrinogen and D-Dimer increased significantly in patients with CKD at different stages as compared with the control subjects (P < 0.05). In the patients with CKD, the reaction time and K time decreased while MA, α-angle and coagulation index increased significantly in patients in stage 3-4 and those in stage 5 either with or without hemodialysis compared with the control group (P < 0.05). The estimated glomerular filtration rate (eGFR), percentage of patients with diabetes mellitus, history of stroke, percentage of neutrophils, neutrophil-lymphocyte ratio, red blood cell count, hemoglobin levels, platelet count, serum creatinine, serum cystatin-C, serum albumin, and lipoprotein (a) all differed significantly between hypercoagulation group and non-hypercoagulation group (P < 0.05). The eGFR, platelet count and hemoglobin levels were identified as independent factors affecting hypercoagulability in patients with CKD (P < 0.05). CONCLUSIONS s The hypercoagulable state of patients with CKD worsens gradually with the disease progression, and eGFR, platelet count and hemoglobin levels are all risk factors for the hypercoagulable state in patients with CKD.
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Affiliation(s)
- Sixian Wu
- Clinical Laboratory, First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
| | - Hao Yuan
- Clinical Laboratory, First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
| | - Yifeng Zhou
- Operating Room, First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
| | - Zhenyi Long
- Clinical Laboratory, First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
| | - Yameng Peng
- Clinical Laboratory, First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
| | - Fang Peng
- Clinical Laboratory, First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
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Vidal-Petiot E, Greenlaw N, Kalra PR, Garcia-Moll X, Tardif JC, Ford I, Zamorano J, Ferrari R, Tendera M, Fox KM, Steg PG. Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry. J Clin Med 2019; 9:E4. [PMID: 31861379 PMCID: PMC7019870 DOI: 10.3390/jcm9010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/01/2022] Open
Abstract
: Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower-although overall high-rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m2) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0.81-1.18), 1.31 (1.05-1.63), 1.77 (1.38-2.27), and 3.12 (2.25-4.33) for eGFR 60-89, 45-59, 30-44, and <30 mL/min/1.73 m2, compared with eGFR ≥90 mL/min/1.73 m2. A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.
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Affiliation(s)
- Emmanuelle Vidal-Petiot
- Université de Paris, Paris, France;
- Physiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, 75018 Paris, France
- Institut nationale de la santé et de la recherché médicale (INSERM) U1149, Centre de Recherche sur l’Inflammation, 75018 Paris, France
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK; (N.G.); (I.F.)
| | - Paul R. Kalra
- Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK;
| | | | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montreal, Montreal, QC H1T1C8, Canada;
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK; (N.G.); (I.F.)
| | - Jose Zamorano
- University Hospital Ramon y Cajal, 28040 Madrid, Spain;
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, 44124 Cona, FE, Italy;
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, RA, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Kim M. Fox
- National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Philippe Gabriel Steg
- Université de Paris, Paris, France;
- National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London SW3 6NP, UK;
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, French Alliance for Cardiovascular Trials, INSERM U1148, 75018 Paris, France
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Suassuna PGDA, Cherem PM, de Castro BB, Maquigussa E, Cenedeze MA, Lovisi JCM, Custódio MR, Sanders-Pinheiro H, de Paula RB. αKlotho attenuates cardiac hypertrophy and increases myocardial fibroblast growth factor 21 expression in uremic rats. Exp Biol Med (Maywood) 2019; 245:66-78. [PMID: 31847589 DOI: 10.1177/1535370219894302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In chronic kidney disease (CKD), evidence suggests that soluble αKlotho (sKlotho) has cardioprotective effects. Contrariwise, high circulating levels of fibroblast growth factor 23 (FGF23) are related to uremic cardiomyopathy development. Recently, it has been demonstrated that sKlotho can act as a soluble FGF23 co-receptor, allowing sKlotho to modulate FGF23 actions in the myocardium, leading to the activation of cardioprotective pathways. Fibroblast growth factor 21 (FGF21) is a cardiomyokine with sKlotho-like protective actions and has never been evaluated in uremic cardiomyopathy. Here, we aimed to evaluate whether recombinant αKlotho (rKlotho) replacement can attenuate cardiac remodeling in an established uremic cardiomyopathy, and to explore its impact on myocardial FGF21 expression. Forty-six male Wistar rats were divided into three groups: control, CKD-untreated, and CKD treated with rKlotho (CKD + KL). CKD was induced by 5/6 nephrectomy. From weeks 4–8, the control and CKD-untreated groups received vehicle, whereas the CKD + KL group received subcutaneous rKlotho replacement (0.01 mg/kg) every 48 h. Myocardial remodeling was evaluated by heart weight/tibia length (HW/TL) ratio, echocardiographic parameters, myocardial histomorphometry, and myocardial expression of β-myosin heavy chain (MHCβ), alpha smooth muscle actin (αSMA), transient receptor potential cation channel 6 (TRPC6), and FGF21. As expected, CKD animals had reduced levels of sKlotho and increased serum FGF23 levels. Compared to the control group, manifest myocardial remodeling was present in the CKD-untreated group, while it was attenuated in the CKD + KL group. Furthermore, cardiomyocyte diameter and interstitial fibrotic area were reduced in the CKD + KL group compared to the CKD-untreated group. Similarly, rKlotho replacement was associated with reduced myocardial expression of TRPC6, MHCβ, and αSMA and a higher expression of FGF21. rKlotho showed cardioprotective effects by attenuating myocardial remodeling and reducing TRPC6 expression. Interestingly, rKlotho replacement was also associated with increased myocardial FGF21 expression, suggesting that an interaction between the two cardioprotective pathways needs to be further explored. Impact statement This study aimed to evaluate whether rKlotho replacement can attenuate cardiac remodeling in a post-disease onset therapeutic reasoning and explore the impact on myocardial FGF21 expression. This study contributes significantly to the literature, as the therapeutic effects of rKlotho replacement and FGF21 myocardial expression have not been widely evaluated in a setting of uremic cardiomyopathy. For the first time, it has been demonstrated that subcutaneous rKlotho replacement may attenuate cardiac remodeling in established uremic cardiomyopathy and increase myocardial expression of FGF21, suggesting a correlation between αKlotho and myocardial FGF21 expression. The possibility of interaction between the αKlotho and FGF21 cardioprotective pathways needs to be further explored, but, if confirmed, would point to a therapeutic potential of FGF21 in uremic cardiomyopathy.
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Affiliation(s)
- Paulo Giovani de Albuquerque Suassuna
- Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais 36036-900, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais 36036-900, Brazil
| | - Paula Marocolo Cherem
- Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais 36036-900, Brazil
| | - Bárbara Bruna de Castro
- Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais 36036-900, Brazil
| | - Edgar Maquigussa
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04024-002, Brazil
| | - Marco Antonio Cenedeze
- Nephrology Division, Department of Medicine, Federal University of São Paulo, São Paulo 04024-002, Brazil
| | - Júlio Cesar Moraes Lovisi
- Interdisciplinary Center for Studies, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais 36036-900, Brazil
| | - Melani Ribeiro Custódio
- Nephrology Division, Department of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Helady Sanders-Pinheiro
- Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais 36036-900, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais 36036-900, Brazil
| | - Rogério Baumgratz de Paula
- Laboratory of Experimental Nephrology (LABNEX) and Interdisciplinary Nucleus of Laboratory Animal Studies (NIDEAL), Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais 36036-900, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais 36036-900, Brazil
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14
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Chronic Kidney Disease and the Pathophysiology of Valvular Heart Disease. Can J Cardiol 2019; 35:1195-1207. [DOI: 10.1016/j.cjca.2019.05.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/03/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023] Open
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15
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Wang Z, Yu D, Cai Y, Zhao B, Zhang X, Zhao Z. Optimal cut-off threshold in pulse pressure predicting cardiovascular death among newly diagnosed end-stage renal disease patients: A prospective cohort study. Medicine (Baltimore) 2019; 98:e16340. [PMID: 31277187 PMCID: PMC6635176 DOI: 10.1097/md.0000000000016340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage renal disease (ESRD) treated by dialysis. Pulse pressure (PP) as an independent prognostic factor of cardiovascular risk might be clinically implicated in predicting the short-term deaths due to cardiovascular diseases in ESRD patients. This study aimed to investigate the dose-response association between PP and risk of cardiovascular mortality in patients initializing peritoneal dialysis (PD). All patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2014 were incorporated in the current cohort study. PP was assessed by the date of initialisation of PD and cardiovascular mortality in 2 years after the initialisation of PD was defined as the outcome. All accessible clinical measurements were screened as covariables. Further dose-response relationships between PP and risks were explored using spline models. There was a non-linear relationship between PP and the risk of 2-year death for a cardiovascular diseases (P <.001 for linearity test). The PP associated with the lowest risk of cardiovascular mortality was 61 (95% CI 56-64) mmHg. In ESRD patients initializing PD, PP is a good prognostic factor of risk of short-term cardiovascular mortality. The risk is lowest with a PP of 56 to 64 mmHg.
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Affiliation(s)
- Zheng Wang
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Bin Zhao
- The Second Division of Internal Medicine, Kejing Community Health Centre, Jiyuan, China
| | - Xiaoxue Zhang
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
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16
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The difference of risk factors predicting cardiac events in patients with chronic kidney disease between with and without diabetes. Ann Nucl Med 2019; 33:532-540. [DOI: 10.1007/s12149-019-01361-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
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17
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Shen-Shuai-Ning granule decreased serum concentrations of indoxyl sulphate in uremic patients undergoing peritoneal dialysis. Biosci Rep 2018; 38:BSR20171694. [PMID: 29921575 PMCID: PMC6137246 DOI: 10.1042/bsr20171694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/23/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
Clearance of protein-bound uremic toxins (PBUTs) by dialysis is a challenge in the treatment of uremic patients. Shen-Shuai-Ning (SSN), a traditional Chinese medicine formulation, has been used commonly in China to retard kidney disease progression and decrease uremic toxins in chronic kidney disease (CKD) patients, but the effects of SSN on serum PBUTs in dialysis patients were not investigated. We conducted a randomized controlled trial in patients on peritoneal dialysis (PD) at dialysis center of Changzheng Hospital to evaluate the effects of SSN on serum PBUTs. Participants with SSN intervention took 5 g SSN granule three times daily for 12 weeks, while the baseline medications and dialysis prescriptions remained during the study in all patients. The serum concentrations of indoxyl sulphate (IS) and p-cresol sulphate (PCS) were determined by HPLC/MS/MS and biochemical parameters were assessed during the study. Sixty PD patients were enrolled and randomly allocated into SSN group and control group. Total IS level was significantly lower in SSN group than in control group at week 4, 8, and 12 (27.28 ± 18.19, 29.73 ± 19.10, and 29.41 ± 17.61 mg/l compared with 39.25 ± 20.23, 44.86 ± 23.91, and 45.34 ± 33.52 mg/l, respectively). However, there were no statistical difference of total PCS, free forms of IS and PCS concentrations between SSN group and control group during 12 weeks follow-up. Administration of SSN granule orally decreased serum total IS level effectively in uremic patients on PD with good tolerance. Benefits of PD patients’ outcomes from IS reduction by SSN awaits further large size and long duration clinical trials to verify.
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18
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Turner ME, Adams MA, Holden RM. The Vitamin K Metabolome in Chronic Kidney Disease. Nutrients 2018; 10:E1076. [PMID: 30103541 PMCID: PMC6115832 DOI: 10.3390/nu10081076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022] Open
Abstract
The purpose of this review is to summarize the research to date on the impact of chronic kidney disease (CKD) on the vitamin K metabolome. Vitamin K-dependent proteins contribute to cardiovascular disease (CVD) prevention via the prevention of ectopic mineralization. Sub-clinical vitamin K deficiency is common in CKD patients, and evidence suggests that it may contribute to the CVD burden in this population. Research from animal models suggests that CKD alters tissue measures of the two predominant forms of vitamin K: KI and MK-4. The expression and/or activity of enzymes that regulate the recycling of vitamin K and the carboxylation of vitamin K-dependent proteins also appear to be altered in CKD. Evidence suggests that statins, a common pharmaceutical prescribed to CKD patients to prevent cardiovascular events, may impact the metabolism of vitamin K and therefore contribute to its relative inefficiency at preventing CVD in this population as kidney disease progresses. Human research on the tissue vitamin K metabolome in CKD patients is lacking.
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Affiliation(s)
- Mandy E Turner
- Department of Biomedical and Molecular Science, Queen's University, Kingston, ON K7L 3V6, Canada.
| | - Michael A Adams
- Department of Biomedical and Molecular Science, Queen's University, Kingston, ON K7L 3V6, Canada.
| | - Rachel M Holden
- Department of Biomedical and Molecular Science, Queen's University, Kingston, ON K7L 3V6, Canada.
- Department of Medicine, Queen's University, Kingston, ON K7L 3V6, Canada.
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19
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de Albuquerque Suassuna PG, Sanders-Pinheiro H, de Paula RB. Uremic Cardiomyopathy: A New Piece in the Chronic Kidney Disease-Mineral and Bone Disorder Puzzle. Front Med (Lausanne) 2018; 5:206. [PMID: 30087898 PMCID: PMC6066558 DOI: 10.3389/fmed.2018.00206] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases are the main cause of death in chronic kidney disease (CKD) patients. In dialysis patients, sudden cardiac death accounts for 40% of all deaths. In these patients, sudden cardiac death is usually secondary to an underlying cardiomyopathy, which is clinically identified by the high prevalence of left ventricular hypertrophy and the resultant mechanical and electrical dysfunction. CKD-related cardiomyopathy has a multifactorial pathophysiology. Recent evidence has highlighted the central pathophysiological role of chronic kidney disease-mineral and bone disorder (CKD-MBD) with hyperphosphatemia and high fibroblast growth factor 23 (FGF23) levels in these patients. Further, since CKD is known to be an αKlotho deficiency state, experimental studies have demonstrated that the deleterious effects of FGF23 can be minimized by reestablishing adequate soluble Klotho levels. Herein, we present a review that addresses not only the development of the understanding of CKD-related cardiomyopathy pathophysiology, but also explores the recent data that identify the triad of hyperphosphatemia, high FGF23 levels and αKlotho deficiency as playing a central role on it. Taken together, the data suggest that the uremic cardiomyopathy can be considered a new piece in the CKD-DMO puzzle.
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Affiliation(s)
- Paulo G de Albuquerque Suassuna
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Helady Sanders-Pinheiro
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rogério B de Paula
- Laboratory of Experimental Nephrology and Interdisciplinary Nucleus of Laboratory Animal Studies, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies, Research and Treatment in Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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20
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Bello AK, Alrukhaimi M, Ashuntantang GE, Basnet S, Rotter RC, Douthat WG, Kazancioglu R, Köttgen A, Nangaku M, Powe NR, White SL, Wheeler DC, Moe O. Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action. Kidney Int Suppl (2011) 2017; 7:122-129. [DOI: 10.1016/j.kisu.2017.07.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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21
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Afshinnia F, Zeng L, Byun J, Gadegbeku CA, Magnone MC, Whatling C, Valastro B, Kretzler M, Pennathur S. Myeloperoxidase Levels and Its Product 3-Chlorotyrosine Predict Chronic Kidney Disease Severity and Associated Coronary Artery Disease. Am J Nephrol 2017; 46:73-81. [PMID: 28668952 DOI: 10.1159/000477766] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/09/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The role of myeloperoxidase in chronic kidney disease (CKD) and its association with coronary artery disease (CAD) is controversial. In this study, we compared myeloperoxidase and protein-bound 3-chlorotyrosine (ClY) levels in subjects with varying degrees of CKD and tested their associations with CAD. METHODS From Clinical Phenotyping Resource and Biobank Core, 111 patients were selected from CKD stages 1 to 5. Plasma myeloperoxidase level was measured using enzyme-linked-immunosorbent assay. Plasma protein-bound 3-ClY, a specific product of hypochlorous acid generated by myeloperoxidase was measured by liquid chromatography mass spectrometry. RESULTS We selected 29, 20, 24, 22, and 16 patients from stages 1 to 5 CKD, respectively. In a sex-adjusted general linear model, mean ± SD of myeloperoxidase levels decreased from 18.1 ± 12.3 pmol in stage 1 to 10.9 ± 4.7 pmol in stage 5 (p = 0.011). In patients with and without CAD, the levels were 19.1 ± 10.1 and 14.8 ± 8.7 pmol (p = 0.036). There was an increase in 3-ClY mean from 0.81 ± 0.36 mmol/mol-tyrosine in stage 1 to 1.42 ± 0.41 mmol/mol-tyrosine in stage 5 (p < 0.001). The mean 3-ClY levels in patients with and without CAD were 1.25 ± 0.44 and 1.04 ± 0.42 mmol/mol-tyrosine (p = 0.023), respectively. C-statistic of ClY when added to myeloperoxidase level to predict CKD stage 5 was 0.86, compared to 0.79 for the myeloperoxidase level alone (p = 0.0097). CONCLUSION The myeloperoxidase levels decrease from stages 1 to 5, whereas activity increases. In contrast, both myeloperoxidase and ClY levels rise in the presence of CAD at various stages of CKD. Measuring both plasma myeloperoxidase and 3-CLY levels provide added value to determine the burden of myeloperoxidase-mediated oxidative stress.
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Affiliation(s)
- Farsad Afshinnia
- University of Michigan, Department of Internal Medicine-Nephrology, Ann Arbor, MI, USA
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22
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Gungor O, Unal HU, Guclu A, Gezer M, Eyileten T, Guzel FB, Altunoren O, Erken E, Oguz Y, Kocyigit I, Yilmaz MI. IL-33 and ST2 levels in chronic kidney disease: Associations with inflammation, vascular abnormalities, cardiovascular events, and survival. PLoS One 2017; 12:e0178939. [PMID: 28614418 PMCID: PMC5470678 DOI: 10.1371/journal.pone.0178939] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/22/2017] [Indexed: 02/07/2023] Open
Abstract
Objective Increased inflammation, associated with the increase in chronic kidney disease (CKD) stage, has a very important influence in vascular injury and cardiovascular diseases. In this study, we aimed to investigate the levels of IL-33 and ST2 in the different stages of CKD and to determine their effect on vascular damage and cardiovascular events (CVE). Methods This was an observational cohort study in which serum IL-33 and ST2 were obtained from 238 CKD (stages 1–5) patients. We examined the changes in IL-33/ST2 levels in CKD patients, as well as the association with a surrogate of endothelial dysfunction. Fatal and non-fatal CVE were recorded for a mean of 24 months. We also performed a COX regression analysis to determine the association of IL-33/ST2 levels with CVE and survival. Results IL-33 and ST2 levels were significantly increased and estimated glomerular filtration rates (eGFR) were decreased. Flow-mediated dilatation (FMD) was significantly decreased from stage 1 to stage 5 CKD. IL-33 and ST2 levels were associated with FMD, and ST2 was a predictor. Multivariate Cox analysis showed that the presence of diabetes mellitus, smoking, and proteinuria and haemoglobin, Hs-CRP, IL-33, and ST2 were associated with the risk of CVE. Kaplan-Meier survival curves showed that patients with IL-33 and ST2 levels below the median value (IL-33 = 132.6 ng/L, ST2 = 382.9 pg/mL) had a higher cumulative survival compared with patients who had IL-33 and ST2 levels above the median value (log-rank test, p = 0.000). Conclusion This is the first study that demonstrates that serum IL-33 and ST2 are associated with vascular injury, cardiovascular events, and survival in CKD patients.
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Affiliation(s)
- Ozkan Gungor
- Department of Nephrology, Sütçü İmam University, Kahramanmaras, Turkey
- * E-mail:
| | - Hilmi Umut Unal
- Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey
| | - Aydin Guclu
- Department of Nephrology, Ahi Evran University, Kirsehir, Turkey
| | - Mustafa Gezer
- Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey
| | - Tayfun Eyileten
- Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey
| | - Fatma Betül Guzel
- Department of Nephrology, Sütçü İmam University, Kahramanmaras, Turkey
| | - Orcun Altunoren
- Department of Nephrology, Sütçü İmam University, Kahramanmaras, Turkey
| | - Ertugrul Erken
- Department of Nephrology, Sütçü İmam University, Kahramanmaras, Turkey
| | - Yusuf Oguz
- Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey
| | - Ismail Kocyigit
- Department of Nephrology, Erciyes University, Kayseri, Turkey
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23
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Ichihara N, Miyamura M, Maeda D, Fujisaka T, Fujita SI, Morita H, Takeda Y, Ito T, Sohmiya K, Hoshiga M, Ishizaka N. Association between serum soluble urokinase-type plasminogen activator receptor and atrial fibrillation. J Arrhythm 2017; 33:469-474. [PMID: 29021852 PMCID: PMC5634684 DOI: 10.1016/j.joa.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/21/2017] [Accepted: 05/16/2017] [Indexed: 12/19/2022] Open
Abstract
Background Circulating soluble urokinase-type plasminogen activator receptor (suPAR), which can reflect immune activation and low-grade inflammation, may be a novel biomarker of cardiovascular disease. Methods We investigated the potential association between suPAR and the prevalence of atrial fibrillation (AF) by analyzing patients with either sinus rhythm, paroxysmal atrial fibrillation (PAF), or non-paroxysmal atrial fibrillation (NPAF), which indicates either permanent or persistent AF. Results Among 426 patients enrolled (mean age 71.4±9.2 years; 110 (25.8%) female), 310, 62, and 54 were diagnosed with sinus rhythm, PAF, and NPAF, respectively. NPAF was >10-fold more prevalent in the highest suPAR quartile (>3534 pg/mL; 32 (30.2%) of 106 patients) than in the lowest suPAR quartile (<1802 pg/mL; 3 (2.8%) of 107 patients). Logistic regression analysis showed that, as compared with the lowest suPAR quartile, the highest suPAR quartile was associated with NPAF with an odds ratio of 6.48 (95% confidence interval, 1.71–24.5) after adjustment for sex, age, log(eGFR), C-reactive protein, and systolic blood pressure. In multivariate receiver operating characteristic analysis to predict NPAF, the area under the curve (AUC) for the combination of age, sex, log(eGFR), and C-reactive protein was 0.777 (standard error [SE], 0.036); the addition of log(suPAR) slightly improved the prediction (AUC, 0.812; SE, 0.034, P=0.084). Conclusions Serum suPAR was associated with AF, particularly NPAF, as demonstrated by multivariate logistic regression analysis. Whether suPAR promotes or maintains AF should be investigated in further studies.
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Affiliation(s)
- Noboru Ichihara
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | - Daichi Maeda
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | - Shu-Ichi Fujita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Hideaki Morita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | - Takahide Ito
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Osaka, Japan
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Erythrocyte Alterations and Increased Cardiovascular Risk in Chronic Renal Failure. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.45866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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