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Feng X, Xiao Y, Guo Q, Peng H, Zhou HY, Wang JP, Xia ZY. Parathyroid hormone alleviates non-alcoholic liver steatosis via activating the hepatic cAMP/PKA/CREB pathway. Front Endocrinol (Lausanne) 2022; 13:899731. [PMID: 36060945 PMCID: PMC9428460 DOI: 10.3389/fendo.2022.899731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), hallmarked by liver steatosis, is becoming a global concern, but effective and safe drugs for NAFLD are still lacking at present. Parathyroid hormone (PTH), the only FDA-approved anabolic treatment for osteoporosis, is important in calcium-phosphate homeostasis. However, little is known about its potential therapeutic effects on other diseases. Here, we report that intermittent administration of PTH ameliorated non-alcoholic liver steatosis in diet-induced obese (DIO) mice and db/db mice, as well as fasting-induced hepatic steatosis. In vitro, PTH inhibits palmitic acid-induced intracellular lipid accumulation in a parathyroid hormone 1 receptor (PTH1R)-dependent manner. Mechanistically, PTH upregulates the expression of genes involved in lipid β-oxidation and suppresses the expression of genes related to lipid uptake and de novo lipogenesis by activating the cAMP/PKA/CREB pathway. Taken together, our current finding proposes a new therapeutic role of PTH on NAFLD.
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Affiliation(s)
- Xu Feng
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Ye Xiao
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Qi Guo
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Hui Peng
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Hai-Yan Zhou
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
| | - Jian-Ping Wang
- Department of Endocrinology, The Second Affiliated Hospital of University of South China, Hengyang, China
- *Correspondence: Zhu-Ying Xia, ; Jian-Ping Wang,
| | - Zhu-Ying Xia
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- *Correspondence: Zhu-Ying Xia, ; Jian-Ping Wang,
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2
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Abstract
Cardiovascular (CV) disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and with end-stage renal disease. CKD has a strong association with dyslipidemia. Dyslipidemias can affect kidney function and increase the risk for CVD development, so it is an important risk factor. Statin therapy can decrease CV events in patients with pre-end-stage CKD and in renal transplant patients, but not in those already on dialysis. This article focuses on epidemiology of CKD, how dyslipidemias confer a higher risk for CVD, the approach to management and treatment of dyslipidemias, and recent guidelines.
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Affiliation(s)
- Aneesha Thobani
- Department of Cardiovascular Disease, Emory University School of Medicine, Cardiovascular Disease Fellowship Training Program, 101 Woodruff Circle, WMB 2125, Atlanta, GA 30322, USA
| | - Terry A Jacobson
- Department of Medicine, Lipid Clinic and Cardiovascular Disease Prevention Program, Emory University School of Medicine, Faculty Office Building, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA.
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Chen Y, Zelnick LR, Wang K, Katz R, Hoofnagle AN, Becker JO, Hsu CY, Go AS, Feldman HI, Mehta RC, Lash JP, Waikar SS, Hamm L, Chen J, Shafi T, Kestenbaum BR. Association of tubular solute clearances with the glomerular filtration rate and complications of chronic kidney disease: the Chronic Renal Insufficiency Cohort study. Nephrol Dial Transplant 2020; 36:gfaa057. [PMID: 33330914 PMCID: PMC8237987 DOI: 10.1093/ndt/gfaa057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The secretion of organic solutes by the proximal tubules is an essential intrinsic kidney function. The degree to which secretory solute clearance corresponds with the glomerular filtration rate (GFR) and potential metabolic implications of net secretory clearance are largely unknown. METHODS We evaluated 1240 participants with chronic kidney disease (CKD) from the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study. We used targeted mass-spectrometry to quantify candidate secretory solutes in paired 24-h urine and plasma samples. CRIC study personnel measured GFR using 125I-iothalamate clearance (iGFR). We used correlation and linear regression to determine cross-sectional associations of secretory clearances with iGFR and common metabolic complications of CKD. RESULTS Correlations between iGFR and secretory solute clearances ranged from ρ = +0.30 for hippurate to ρ = +0.58 for kynurenic acid. Lower net clearances of most secretory solutes were associated with higher serum concentrations of parathyroid hormone (PTH), triglycerides and uric acid. Each 50% lower kynurenic acid clearance was associated with a 21% higher serum PTH concentration [95% confidence interval (CI) 15-26%] and a 10% higher serum triglyceride concentration (95% CI 5-16%) after adjustment for iGFR, albuminuria and other potential confounders. Secretory solute clearances were not associated with statistically or clinically meaningful differences in serum calcium, phosphate, hemoglobin or bicarbonate concentrations. CONCLUSIONS Tubular secretory clearances are modestly correlated with measured GFR among adult patients with CKD. Lower net secretory clearances are associated with selected metabolic complications independent of GFR and albuminuria, suggesting potential clinical and biological relevance.
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Affiliation(s)
- Yan Chen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Kidney Research Institute, Seattle, WA, USA
| | - Leila R Zelnick
- Kidney Research Institute, Seattle, WA, USA
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA, USA
| | - Ke Wang
- Kidney Research Institute, Seattle, WA, USA
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA, USA
| | - Ronit Katz
- Kidney Research Institute, Seattle, WA, USA
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA, USA
| | - Andrew N Hoofnagle
- Kidney Research Institute, Seattle, WA, USA
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Jessica O Becker
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Chi-Yuan Hsu
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Harold I Feldman
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rupal C Mehta
- Department of Medicine, Division of Nephrology and Hypertension, Jesse Brown Veterans Administration Medical Center & Northwestern University, Chicago, IL, USA
| | - James P Lash
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - L Hamm
- Division of Nephrology and Hypertension, Tulane University Department of Medicine, New Orleans, LA, USA
| | - Jing Chen
- Division of Nephrology and Hypertension, Tulane University Department of Medicine, New Orleans, LA, USA
| | - Tariq Shafi
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bryan R Kestenbaum
- Kidney Research Institute, Seattle, WA, USA
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA, USA
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Billa V, Zhong A, Bargman J, Vas S, Wong PY, Oreopoulos DG. High Prevalence of Hyperparathyroidism among Peritoneal Dialysis Patients: A Review of 176 Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000308] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectivesParathyroid dysfunction continues to produce significant morbidity in dialysis patients. Since the introduction of low calcium dialysate for peritoneal dialysis (PD), no large studies have been done to determine the prevalence of parathyroid dysfunction in these patients. This study was done to assess the prevalence of parathyroid disease in the PD population and to determine the risk factors associated with this dysfunction.DesignWe analyzed data on 176 patients who received PD at a single center between August 1998 and February 1999. Clinical data, laboratory variables related to parathyroid function, and data pertaining to dialysis treatment and weekly drug dosing were obtained for each patient on two different occasions, approximately 3 months apart. Variables predictive of the development of parathyroid dysfunction were calculated by univariate and multivariate logistic regression analysis.ResultsTwo-thirds of the patients surveyed had an abnormal intact parathyroid hormone (iPTH) level: 47% had an iPTH level more than three times normal, the mean was 54.6 ± 35.4 pmol/L; 23% had an iPTH value below the upper limit of normal, here the mean was 3.6 ± 1.8 pmol/L. Diabetic patients had lower iPTH levels (22.2 ± 28.4 pmol/L) than nondiabetics (33.9 ± 34.8 pmol/L) ( p = 0.02). On multivariate regression analysis, we found that age, duration of dialysis, Kt/V, serum bicarbonate, and serum ionized calcium levels did not significantly affect parathyroid function. Hyperphosphatemia was the only factor that was associated with the development of secondary hyperparathyroidism in this study population ( p = 0.029).ConclusionThere is a high prevalence of hyperparathyroidism in the current PD population. Phosphate control is suboptimal and hyperphosphatemia is an independent risk factor for the development of hyperparathyroidism.
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Affiliation(s)
- Viswanath Billa
- Division of Nephrology, Department of Medicine, University Health Network, Toronto Western Division, University of Toronto, Toronto, Ontario, Canada
| | - Aimin Zhong
- Division of Nephrology, Department of Medicine, University Health Network, Toronto Western Division, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Bargman
- Division of Nephrology, Department of Medicine, University Health Network, Toronto Western Division, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Vas
- Division of Nephrology, Department of Medicine, University Health Network, Toronto Western Division, University of Toronto, Toronto, Ontario, Canada
| | - Pui Y. Wong
- Division of Nephrology, Department of Medicine, University Health Network, Toronto Western Division, University of Toronto, Toronto, Ontario, Canada
| | - Dimitrios G. Oreopoulos
- Division of Nephrology, Department of Medicine, University Health Network, Toronto Western Division, University of Toronto, Toronto, Ontario, Canada
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Zhong A, Billa V, Rotstein LE, Wong PY, Bargman JM, Vas SI, Oreopoulos DG. Recurrence of Hyperparathyroidism after Total Parathyroidectomy and Autotransplantation in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the effectiveness of total parathyroidectomy (PTX) with autotransplantation in the treatment of secondary hyperparathyroidism (HPT), and to assess recurrence rate of HPT in this peritoneal dialysis (PD) population. Design A retrospective study in a single home PD unit. Patients Between 1994 and 1998, 19 of 574 patients on PD underwent PTX for treatment of secondary HPT. Main Outcome Measures Clinical and biochemical improvement, recurrence of HPT, improvement in anemia post-PTX. Results Nineteen (3.3%) patients required PTX between 1994 and 1998. These 5 men and 14 women ranged in age from 22 to 66 years; they had been on maintenance PD pre-PTX for 47.5 ± 38.1 months, and were followed for 26.1 ± 15.5 months post-PTX. Sixteen patients had temporary hypocalcemia that was managed by oral (n = 10) or intravenous (n = 6) calcium supplements and calcitriol, while 3 patients had severe “hungry bone” syndrome postoperatively. One patient had recurrent laryngeal nerve palsy post-PTX. Bone pain disappeared in all 12 patients. Pruritus improved in 12/13 patients; fatigue improved in 15/16 patients. Comparison showed significant differences between hemoglobin and hematocrit values 1 month pre-PTX and 12 months post-PTX ( p < 0.05). Parathyroid hormone (PTH) level in 15 (79%) patients returned to normal (≤€7.6 pmol/L) during the first month post-PTX. In 5/12 (42%) patients, PTH level was ≤ 7.6 pmol/L 2 years post-PTX, while in 2/12 (17%), PTH was > 22.8 pmol/L (three times normal) 2 years post-PTX, and 3/5 (60%) patients had a PTH > 22.8 pmol/L 3 years post-PTX. Conclusions Total PTX with autotransplantation is associated with a tendency for recurrence of HPT. Our findings suggest that total PTX with autotransplantation may be an ineffective procedure in controlling HPT over the long term.
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Affiliation(s)
- Aimin Zhong
- Division of Nephrology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Viswanath Billa
- Division of Nephrology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lorne E. Rotstein
- Division of Nephrology, Division of Surgery of the Head and Neck, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Pui Y. Wong
- Laboratory Medicine & Pathobiology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Joanne M. Bargman
- Division of Nephrology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Stephen I. Vas
- Division of Nephrology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Dimitrios G. Oreopoulos
- Division of Nephrology, The Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
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6
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Fried L, Hutchison A, Stegmayr B, Prichard S, Bargman JM. Recommendations for the Treatment of Lipid Disorders in Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089901900103] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Linda Fried
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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Gluba-Brzozka A, Franczyk B, Rysz J. Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients. Nutrients 2019; 11:E2820. [PMID: 31752189 PMCID: PMC6893650 DOI: 10.3390/nu11112820] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022] Open
Abstract
Chronic kidney disease (CKD) is a widespread disease with increasing prevalence in the modern society. Lipid disturbances are common in this group of patients. In most patients with CKD atherogenic dyslipidemia is observed. Dyslipidemia in patients with renal diseases increases the risk of cardiovascular diseases and it accelerates the progression of chronic kidney disease to its end stage. The amelioration of dyslipidemia and the lowering of oxidative stress, inflammatory processes, insulin sensitivity and remnant lipoproteins levels may lead to the reduction in cardiovascular burden. Nutritional interventions can strengthen the beneficial effect of treatment and they play an important role in the preservation of overall well-being of the patients with CKD since the aim of appropriate diet is to reduce the risk of cardiovascular events, prevent malnutrition, and hamper the progression of kidney disease. The management of dyslipidemia, regardless of the presence of chronic kidney disease, should be initiated by the introduction of therapeutic lifestyle changes. The introduction of diet change was shown to exert beneficial effect on the lipid level lowering that reaches beyond pharmacological therapy. Currently available evidence give the impression that data on dietary interventions in CKD patients is not sufficient to make any clinical practice guidelines and is of low quality.
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Affiliation(s)
- Anna Gluba-Brzozka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (B.F.); (J.R.)
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8
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Ruderman I, Holt SG, Kirkland GS, Maslen S, Hawley CM, Oliver V, Krishnasamy R, Gray NA, Talaulikar GS, Nelson CL, Rajaram Y, Gock H, Au E, Elder GJ, Mainra R, Toussaint ND. Outcomes of cinacalcet withdrawal in Australian dialysis patients. Intern Med J 2019; 49:48-54. [PMID: 29992701 DOI: 10.1111/imj.14036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism (SHPT) in chronic kidney disease is associated with cardiovascular and bone pathology. Measures to achieve parathyroid hormone (PTH) target values and control biochemical abnormalities associated with SHPT require complex therapies, and severe SHPT often requires parathyroidectomy or the calcimimetic cinacalcet. In Australia, cinacalcet was publicly funded for dialysis patients from 2009 to 2015 when funding was withdrawn following publication of the EVOLVE study, which resulted in most patients on cinacalcet ceasing therapy. We examined the clinical and biochemical outcomes associated with this change at Australian renal centres. AIM To assess changes to biochemical and clinical outcomes in dialysis patients following cessation of cinacalcet. METHODS We conducted a retrospective study of dialysis patients who ceased cinacalcet after August 2015 in 11 Australian units. Clinical outcomes and changes in biochemical parameters were assessed over a 24- and 12-month period, respectively, from cessation of cinacalcet. RESULTS A total of 228 patients was included (17.7% of all dialysis patients from the units). Patients were aged 63 ± 15 years with 182 patients on haemodialysis and 46 on peritoneal dialysis. Over 24 months following cessation of cinacalcet, we observed 26 parathyroidectomies, 3 episodes of calciphylaxis, 8 fractures and 50 deaths. Eight patients recommenced cinacalcet, meeting criteria under a special access scheme. Biochemical changes from baseline to 12 months after cessation included increased levels of serum PTH from 54 (interquartile range 27-90) pmol/L to 85 (interquartile range 41-139) pmol/L (P < 0.0001), serum calcium from 2.3 ± 0.2 mmol/L to 2.5 ± 0.1 mmol/L (P < 0.0001) and alkaline phosphatase from 123 (92-176) IU/L to 143 (102-197) IU/L (P < 0.0001). CONCLUSION Significant increases in serum PTH, calcium and alkaline phosphatase occurred over a 12-month period following withdrawal of cinacalcet. Longer-term follow up will determine if these biochemical and therapeutic changes are associated with altered rates of parathyroidectomies and cardiovascular mortality and morbidity.
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Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey S Kirkland
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Sophie Maslen
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Veronica Oliver
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast Hospital University Hospital, Sunshine Coast, Queensland, Australia
| | - Nicholas A Gray
- Department of Nephrology, Sunshine Coast Hospital University Hospital, Sunshine Coast, Queensland, Australia
| | - Girish S Talaulikar
- Department of Nephrology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Craig L Nelson
- Department of Nephrology, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Western Health, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia
| | - Yogeshwar Rajaram
- Department of Nephrology, St Vincent's Health, Melbourne, Victoria, Australia
| | - Hilton Gock
- Department of Nephrology, St Vincent's Health, Melbourne, Victoria, Australia
| | - Eric Au
- Department of Nephrology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Grahame J Elder
- Department of Nephrology, Westmead Hospital, Sydney, New South Wales, Australia.,Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Rahul Mainra
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
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Bandesh K, Prasad G, Giri AK, Kauser Y, Upadhyay M, Basu A, Tandon N, Bharadwaj D. Genome-wide association study of blood lipids in Indians confirms universality of established variants. J Hum Genet 2019; 64:573-587. [PMID: 30911093 DOI: 10.1038/s10038-019-0591-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 12/30/2022]
Abstract
Lipids foster energy production and their altered levels have been coupled with metabolic ailments. Indians feature high prevalence of metabolic diseases, yet uncharacterized for genes regulating lipid homeostasis. We performed first GWAS for quantitative lipids (total cholesterol, LDL, HDL, and triglycerides) exclusively in 5271 Indians. Further to corroborate our genetic findings, we investigated DNA methylation marks in peripheral blood in Indians at the identified loci (N = 233) and retrieved gene regulatory features from public domains. Recurrent GWAS loci-CELSR2, CETP, LPL, ZNF259, and BUD13 cropped up as lead signals in Indians, reflecting their universal applicability. Besides established variants, we found certain unreported variants at sub-genome-wide level-QKI, REEP3, TMCC2, FAM129C, FAM241B, and LOC100506207. These variants though failed to attain GWAS significance in Indians, but largely turned out to be active CpG sites in human subcutaneous adipose tissue and showed robust association to two or more lipid traits. Of which, QKI variants showed significant association to all four lipid traits and their designated region was observed to be a key gene regulatory segment denoting active transcription particularly in human subcutaneous adipose tissue. Both established and novel loci were observed to be significantly associated with altered DNA methylation in Indians for specific CpGs that resided in key regulatory elements. Further, gene-based association analysis pinpointed novel GWAS loci-LINC01340 and IQCJ-SCHIP1 for TC; IFT27, IFT88, and LINC02141 for HDL; and TEX26 for TG. Present study ascertains universality of selected known genes and also identifies certain novel loci for lipids in Indians by integrating data from various levels of gene regulation.
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Affiliation(s)
- Khushdeep Bandesh
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110020, India.,Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology Campus, New Delhi, 110020, India
| | - Gauri Prasad
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110020, India.,Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology Campus, New Delhi, 110020, India
| | - Anil K Giri
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110020, India.,Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology Campus, New Delhi, 110020, India
| | - Yasmeen Kauser
- Genomics and Molecular Medicine Unit, CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110020, India.,Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology Campus, New Delhi, 110020, India
| | - Medha Upadhyay
- Systems Genomics Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, 110067, India
| | | | - Analabha Basu
- National Institute of Biomedical Genomics, P.O.: Netaji Subhas Sanatorium, Kalyani, 741251, West Bengal, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Dwaipayan Bharadwaj
- Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology Campus, New Delhi, 110020, India. .,Systems Genomics Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, 110067, India.
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10
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Sukumar D, Becker KB, Cheung M, Diamond S, Duszak R, Aljahdali A, Volpe SL, Nasser JA. Can bone-regulating hormones and nutrients help characterize the metabolically healthy obese phenotype. Nutr Health 2018; 24:153-162. [PMID: 29950143 DOI: 10.1177/0260106018777336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND: Bone-regulating hormones and nutrients play an important role in influencing metabolic health. AIM: The aim of this study was to determine whether bone-regulating hormones and nutrients, such as parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and magnesium (Mg) could be used to characterize the metabolically healthy obese (MHO) phenotype. METHODS: This study included 27 overweight or obese participants (14 men/13 women) classified as MHO ( n = 14) or metabolically unhealthy obese (MUO) ( n = 13) based on the presence or absence of metabolic abnormalities, determined by percentage body fat, percentage trunk fat, and waist circumference. Biochemical (serum concentrations of hormones and cytokines such as PTH, 25OHD, ionized Mg (iMg), cytokines, lipids, glycemic indices), physiological (percentage body fat, percentage trunk fat, blood pressure (BP)), and dietary intake (Mg intake, calcium intake) measurements were obtained. RESULTS: Serum PTH concentrations were significantly lower ( p = 0.005) in the MHO group (39.68 ± 11.06 pg/mL) compared with the MUO group (63.78 ± 25.82 pg/mL). Serum iMg concentrations were higher ( p = 0.052) in the MHO group (0.565 ± 0.41 mmol/L) than in the MUO group (0.528 ± 0.050 mmol/L). Serum concentrations of osteocalcin were also higher (10.37 ± 3.70 ng/mL) in the MHO compared with the MUO (6.51 ± 4.14 ng/mL) group ( p = 0.017). The MHO group had significantly lower serum insulin concentrations ( p = 0.006) and diastolic BP ( p = 0.035). Concentrations of serum 25OHD, total triglycerides, C-reactive protein and systolic BP did not differ between groups. CONCLUSIONS: These findings suggest that bone-regulating hormones and nutrients, especially serum PTH, osteocalcin concentrations, and dietary Mg intakes, can help to characterize the MHO phenotype.
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Affiliation(s)
- Deeptha Sukumar
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Kendra B Becker
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - May Cheung
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Samantha Diamond
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Rittane Duszak
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Abeer Aljahdali
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Stella L Volpe
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Jennifer A Nasser
- 1 Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, USA
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11
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Ruderman I, Smith ER, Toussaint ND, Hewitson TD, Holt SG. Longitudinal changes in bone and mineral metabolism after cessation of cinacalcet in dialysis patients with secondary hyperparathyroidism. BMC Nephrol 2018; 19:113. [PMID: 29764395 PMCID: PMC5952622 DOI: 10.1186/s12882-018-0910-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The calcimimetic agent cinacalcet is effective for the management of secondary hyperparathyroidism (SHPT) in dialysis patients. Changes to reimbursement of cinacalcet in Australia provided an opportunity to assess effects of medication cessation on biochemical and clinical outcomes in dialysis patients, including changes to novel biomarkers such as calciprotein particles (CPP). CPP are nanoparticles of mineral and protein in the circulation associated with increased vascular calcification in patients with chronic kidney disease. METHODS Dialysis patients from a single center who ceased cinacalcet between August 2015 and March 2016 were included in a prospective observational study. Bloods were taken at the time of cessation of cinacalcet and at 1, 6 and 12 months. Clinical and biochemical outcomes were compared with an age- and gender-matched cohort of cinacalcet-naïve dialysis patients. RESULTS Sixty-two patients participated in the study. Mean age was 69.6 ± 13.2 years. Biochemical changes over 12 months following cessation of cinacalcet included an increase in serum parathyroid hormone (PTH) (42.2 [IQR 27.8-94.6] pmol/L to 114.8 [83.9-159.1] pmol/L [p < 0.001]), serum calcium (2.31 ± 0.21 mmol/L to 2.46 ± 0.14 mmol/L [p < 0.001]) and primary CPP (CPP-I) (p = 0.002). Changes in CPP were associated with an increase in PTH (p = 0.007), calcium (p = 0.002) and ferritin (p = 0.02) but a reduction in serum albumin (p = 0.001). Over the 12-month period, there were two fractures, five cardiovascular events, one episode of calciphylaxis, and one parathyroidectomy, with a mortality rate of 19% (n = 13). CONCLUSION Uniquely we report the effects of cinacalcet withdrawal in a real world setting with demonstrated increases in PTH, serum calcium and CPP subsets, novel CKD-MBD related factors, over a 12-month period.
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Affiliation(s)
- Irene Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia. .,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia.
| | - Edward R Smith
- Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Tim D Hewitson
- Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
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12
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Affiliation(s)
- D. Dave Roh
- Division of Nephrology, Department of Medicine, University of California, Irvine Nephrology Section, Department of Veterans Affairs Medical Center, Long Beach, California - USA
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13
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Vanholder R, Argilés A, Baurmeister U, Brunet P, Clark W, Cohen G, Dedeyn P, Deppisch R, Descamps-Latscha B, Henle T, Jörres A, Massy Z, Rodriguez M, Stegmayr B, Stenvinkel P, Wratten M. Uremic Toxicity: Present State of the Art. Int J Artif Organs 2018. [DOI: 10.1177/039139880102401004] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The uremic syndrome is a complex mixture of organ dysfunctions, which is attributed to the retention of a myriad of compounds that under normal condition are excreted by the healthy kidneys (uremic toxins). In the area of identification and characterization of uremic toxins and in the knowledge of their pathophysiologic importance, major steps forward have been made during recent years. The present article is a review of several of these steps, especially in the area of information about the compounds that could play a role in the development of cardiovascular complications. It is written by those members of the Uremic Toxins Group, which has been created by the European Society for Artificial Organs (ESAO). Each of the 16 authors has written a state of the art in his/her major area of interest.
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Affiliation(s)
- R. Vanholder
- The Nephrology Section, Department of Internal Medicine, University Hospital, Gent - Belgium
| | - A. Argilés
- Institute of Human Genetics, IGH-CNRS UPR 1142, Montpellier - France
| | | | - P. Brunet
- Nephrology, Internal Medicine, Ste Marguerite Hospital, Marseille - France
| | - W. Clark
- Baxter Healthcare Corporation, Lessines - Belgium
| | - G. Cohen
- Division of Nephrology, Department of Medicine, University of Vienna, Vienna - Austria
| | - P.P. Dedeyn
- Department of Neurology, Middelheim Hospital, Laboratory of Neurochemistry and Behaviour, University of Antwerp - Belgium
| | - R. Deppisch
- Gambro Corporate Research, Hechingen - Germany
| | | | - T. Henle
- Institute of Food Chemistry, Technical University, Dresden - Germany
| | - A. Jörres
- Nephrology and Medical Intensive Care, UK Charité, Campus Virchow-Klinikum, Medical Faculty of Humboldt-University, Berlin - Germany
| | - Z.A. Massy
- Division of Nephrology, CH-Beauvais, and INSERM Unit 507, Necker Hospital, Paris - France
| | - M. Rodriguez
- University Hospital Reina Sofia, Research Institute, Cordoba - Spain
| | - B. Stegmayr
- Norrlands University Hospital, Medical Clinic, Umea - Sweden
| | - P. Stenvinkel
- Nephrology Department, University Hospital, Huddinge - Sweden
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14
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Zhao FL, Zhang YZ, Tai GX, Wang Y, Tong QH, Fu L. Serum parathyroid hormone as a potential novel biomarker of coronary heart disease. Genet Test Mol Biomarkers 2014; 18:670-4. [PMID: 25192491 DOI: 10.1089/gtmb.2014.0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the relationships between serum parathyroid hormone (PTH) and coronary heart disease (CHD). METHODS From July 2011 to February 2013, a total of 79 CHD patients and 94 normal control patients with ages ranging from 25 to 79 years were included in this study. Serum PTH level and common risk factors of CHD (age, gender, cholesterol, glycosylated hemoglobin [HbA1c], blood pressure [BP], history of diabetes, smoking, and body mass index) were investigated. Pearson's correlation and multiple regression analyses were used to evaluate the relationships between serum PTH level and CHD risk factors. All statistical analyses were performed using the SPSS 18.0 software. RESULTS RESULTS from Pearson's correlation analysis indicated that age, systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), HbA1c, history of smoking, and serum PTH level were risk factors for CHD (all p<0.05). Serum PTH levels were positively correlated with DBP (r=0.256, p=0.010) and HbA1c (r=0.223, p=0.003), while not being related to other risk factors of CHD (all p>0.05). Multiple linear regression analysis showed that SBP, DBP, LDL-c, and HDL-c may be important determinants of CHD (all p<0.05). Further, serum PTH level is also an independent risk factor for CHD (p<0.001). CONCLUSION Our results provide evidence that serum PTH level may be involved in the pathogenesis of CHD. Thus, PTH could be used as an important biomarker in the diagnosis of CHD.
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Affiliation(s)
- Fa-Li Zhao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University , Harbin, People's Republic of China
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15
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Vaziri ND. Role of dyslipidemia in impairment of energy metabolism, oxidative stress, inflammation and cardiovascular disease in chronic kidney disease. Clin Exp Nephrol 2013; 18:265-8. [PMID: 23974528 DOI: 10.1007/s10157-013-0847-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/22/2013] [Indexed: 01/02/2023]
Abstract
Advanced chronic kidney disease (CKD) results in a constellation of dysregulation of lipid metabolism, oxidative stress, and inflammation which are causally interconnected and participate in a vicious cycle. The CKD-associated lipid disorders are marked by impaired clearance of very low density lipoprotein and chylomicrons, hypertriglyceridemia, formation of small dense low-density lipoprotein (LDL), oxidative modification of LDL, intermediate density lipoprotein and chylomicron remnants, and high-density lipoprotein deficiency and dysfunction. This review provides a brief overview of the role of CKD-induced lipid disorders in the pathogenesis of oxidative stress, inflammation, cardiovascular disease, impaired exercise capacity, cachexia and wasting syndrome.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Suite 400, City Tower, 101 City Drive, Orange, CA, 92868, USA,
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16
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Fisher A, Srikusalanukul W, Davis M, Smith P. Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links. Clin Interv Aging 2013; 8:239-56. [PMID: 23460043 PMCID: PMC3585505 DOI: 10.2147/cia.s38856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. AIMS AND METHODS To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. RESULTS CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. CONCLUSION SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.
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Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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17
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Vaziri ND, Norris KC. Reasons for the lack of salutary effects of cholesterol-lowering interventions in end-stage renal disease populations. Blood Purif 2013; 35:31-6. [PMID: 23343544 DOI: 10.1159/000345176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cardiovascular disease (CVD) is the main cause of premature death in patients with chronic kidney disease (CKD). The underlying mechanisms of CVD in patients with mild to moderate CKD are different from those with end-stage renal disease (ESRD). While serum cholesterol is frequently elevated and contributes to atherosclerosis in many CKD patients, particularly those with nephrotic proteinuria, it is usually normal, even subnormal, in most ESRD patients receiving hemodialysis. CVD in the ESRD population is primarily driven by oxidative stress, inflammation, accumulation of the oxidation-prone intermediate-density lipoproteins, chylomicron remnants and small dense low-density lipoprotein particles as well as high-density lipoprotein deficiency and dysfunction, hypertension, vascular calcification, and arrhythmias. Only a minority of hemodialysis patients have hypercholesterolemia which is most likely due to genetic or unrelated factors. In addition, due to peritoneal losses of proteins which simulate nephrotic syndrome, peritoneal dialysis patients often exhibit hypercholesterolemia. Clearly when present, hypercholesterolemia contributes to CVD in the CKD and ESRD population and justifies cholesterol-lowering therapy. However, the majority of ESRD patients and a subpopulation of CKD patients with minimal proteinuria have normal or subnormal serum cholesterol levels and do not benefit from and can be potentially harmed by statin therapy. In fact the lack of efficacy of statins in hemodialysis patients has been demonstrated in several randomized clinical trials. This review is intended to provide an overview of the mechanisms responsible for the failure of statins to reduce cardiovascular morbidity and mortality in most ESRD patients and to advocate the adoption of individualized care principles in the management of dyslipidemia in this population.
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Affiliation(s)
- Nosratola D Vaziri
- Departments of Medicine, Physiology and Biophysics, Division of Nephrology and Hypertension, University of California, Irvine, CA 92868, USA.
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18
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Keane WF, Tomassini JE, Neff DR. Lipid abnormalities in patients with chronic kidney disease: implications for the pathophysiology of atherosclerosis. J Atheroscler Thromb 2012; 20:123-33. [PMID: 23095239 DOI: 10.5551/jat.12849] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular disease is increased in patients with chronic kidney disease (CKD) and is the principle cause of morbidity and mortality in these patients. In patients with stage 5 CKD, structural changes in the myocardium have been implicated as the principle cardiovascular processes leading to this increase in morbidity and mortality, while atherosclerotic events including acute myocardial infarction and strokes are responsible for approximately 10-15% of cardiovascular deaths. Dyslipidemia is common in CKD patients and is usually not characterized by elevated cholesterol levels, except in patients with marked proteinuria. Increased triglyceride levels in conjunction with decreased high-density lipoprotein levels are the commonest qualitative abnormality. Characteristically, abnormalities in the metabolism of apolipoprotein (apo) B-containing lipoproteins have been described, including both gut derived (apoB-48) as well as those produced by hepatic synthesis (apoB-100). A decrease in enzymatic delipidation as well as reduced receptor removal of these lipoproteins both contribute to the increased levels of these apo-B-containing particles and their remnants (which are believed to be highly atherogenic). Abnormalities in the metabolism of apoA-containing lipoproteins are also present and these changes contribute to the lower levels of HDL seen. Qualitative abnormalities of these HDL particles may be associated with cellular oxidative injury and contribute to a pro-inflammatory, pro-thrombotic milieu that is frequently present in CKD patients.
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Affiliation(s)
- William F Keane
- University of Minnesota School of Medicine, Minneapolis, MN, USA.
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19
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Epstein M, Vaziri ND. Statins in the management of dyslipidemia associated with chronic kidney disease. Nat Rev Nephrol 2012; 8:214-23. [PMID: 22349484 DOI: 10.1038/nrneph.2012.33] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cause of death in the majority of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is accelerated cardiovascular disease and not renal failure per se, suggesting a role for statin therapy in this setting. During the past 6 years three large, randomized, placebo-controlled studies of three different statins have been conducted in the dialysis population-but two of these studies did not demonstrate any benefits of statin therapy, and the third study showed only marginally positive results. To understand why statins have failed to reduce cardiovascular events in patients with ESRD, the basic mechanisms underlying the pathogenesis of dyslipidemia in CKD must be critically examined. The observed negative results in the clinical trials of statin therapy might also reflect the biomarkers and targets that were chosen to be evaluated. The characteristics of dyslipidemia in patients with CKD not yet requiring dialysis treatment differ markedly from those of individuals with established ESRD and form the basis for therapeutic recommendations. The potential adverse effects associated with statin therapy are important to consider in the management of dyslipidemia in patients with CKD.
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Affiliation(s)
- Murray Epstein
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1201 North West 16th Street, Miami, FL 33125, USA.
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20
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Secondary hyperparathyroidism: benign bystander or culpable contributor to adverse health outcomes? South Med J 2012; 105:36-42. [PMID: 22189665 DOI: 10.1097/smj.0b013e31823c4155] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elevation in serum parathyroid hormone (PTH) often accompanies vitamin D deficiency and renal impairment. PTH elevation in renal failure is viewed as an unfavorable development. Evidence is increasing that PTH elevation may be associated with increased morbidity and mortality. In many instances these PTH effects appear to be independent of vitamin D status. PTH mediates its effects through the ubiquitous type 1 PTH/PTH-related peptide receptor, which is notably present in the cardiovascular system. Increased PTH may promote cardiovascular disease through diminished cardiac contractility, enhanced coronary risk, and cardiac valvular and vascular calcification. High PTH levels appear to be linked to the metabolic syndrome and are aligned with hyperlipidemia, decreased insulin sensitivity, and, perhaps, decreased insulin secretion. Increased PTH also is associated with neuroendocrine activation, increased sympathetic activity, and endothelial stress. The relation between PTH and vitamin D is complex and may show significant threshold variations, especially when calcium intake, age, and race are considered. Moreover, evidence is increasing that fragments of PTH may not only be hormonally active but also may have opposing effects to PTH. Despite these caveats, PTH values provide useful clinical diagnostic and prognostic information in monitoring many chronic ailments such as heart and renal failure and multiple sclerosis.
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21
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Bessette RW, Carter RL. Predicting hospital cost in CKD patients through blood chemistry values. BMC Nephrol 2011; 12:65. [PMID: 22133421 PMCID: PMC3377913 DOI: 10.1186/1471-2369-12-65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 12/01/2011] [Indexed: 11/10/2022] Open
Abstract
Background Controversy exists in predicting costly hospitalization in patients with chronic kidney disease and co-morbid conditions. We therefore tested associations between serum chemistry values and the occurrence of in-patient hospital costs over a thirteen month study period. Secondarily, we derived a linear combination of variables to estimate probability of such occurrences in any patient. Method We calculated parsimonious values for select variables associated with in-patient hospitalization and compared sensitivity and specificity of these models to ordinal staging of renal disease. Data from 1104 de-identified patients which included 18 blood chemistry observations along with complete claims data for all medical expenses. We employed multivariable logistic regression for serum chemistry values significantly associated with in-patient hospital costs exceeding $3,000 in any single month and contrasted those results to other models by ROC area curves. Results The linear combination of weighted Z scores for parathyroid hormone, phosphorus, and albumin correlated with in-patient hospital care at p < 0.005. ROC curves derived from weighted variables of age, eGFR, hemoglobin, albumin, creatinine, and alanine aminotransferase demonstrated significance over models based on non-weighted Z scores for those same variables or CKD stage alone. In contrast, the linear combination of weighted PTH, PO4 and albumin demonstrated better prediction, but not significance over non-weighted Z scores for PTH alone. Conclusion Further study is justified to explore indices that predict costly hospitalization. Such metrics could assist Accountable Care Organizations in evaluating risk adjusted compensation for providers.
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Affiliation(s)
- Russell W Bessette
- University of Louisville, Abell Administration Center, 323 East Chestnut St, Louisville, Kentucky 40202, USA.
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22
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Vaziri ND, Yuan J, Ni Z, Nicholas SB, Norris KC. Lipoprotein lipase deficiency in chronic kidney disease is accompanied by down-regulation of endothelial GPIHBP1 expression. Clin Exp Nephrol 2011; 16:238-43. [PMID: 22009636 DOI: 10.1007/s10157-011-0549-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 09/30/2011] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic renal failure (CRF) is associated with hypertriglyceridemia and impaired clearance of very low density lipoprotein (VLDL) and chylomicrons which are largely due to lipoprotein lipase (LPL) deficiency/dysfunction. After its release from myocytes and adipocytes, LPL binds to the endothelium in the adjacent capillaries where it catalyzes hydrolysis of triglycerides in VLDL and chylomicrons. The novel endothelium-derived molecule, glycosylphosphatidylinositol-anchored binding protein 1 (GPIHBP1), plays a critical role in LPL metabolism and function by anchoring LPL to the endothelium and binding chylomicrons. GPIHBP1-deficient mice and humans exhibit severe hypertriglyceridemia and diminished heparin-releasable LPL, pointing to the critical role of GPIHBP1 in regulation of LPL activity. Given its central role in regulation of LPL activity and triglyceride metabolism, we explored the effect of chronic kidney disease (CKD) on GPIHBP1 expression. METHODS Expression of GPIHBP1 and LPL were determined by reverse transcriptase-polymerase chain reaction, Western blot and immunohistochemical analyses in the adipose tissue, skeletal muscle and myocardium of rats 12 weeks after 5/6 nephrectomy (CRF) or sham-operation (control). RESULTS Compared to the controls, the CRF group exhibited severe hypertriglyceridemia, significant reduction of the skeletal muscle, myocardium and adipose tissue LPL mRNA and protein abundance. This was accompanied by parallel reductions of GPIHBP1 mRNA abundance and immunostaining in the tested tissues. CONCLUSIONS LPL deficiency in CKD is associated with and compounded by GPIHBP1 deficiency. Together these abnormalities contribute to impaired clearance of triglyceride-rich lipoproteins, diminished availability of lipid fuel for energy storage in adipocytes and energy production in myocytes and consequent hypertriglyceridemia, cachexia, muscle weakness and atherosclerosis.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California, Irvine, Irvine, CA, USA.
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23
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Tsimihodimos V, Mitrogianni Z, Elisaf M. Dyslipidemia associated with chronic kidney disease. Open Cardiovasc Med J 2011; 5:41-8. [PMID: 21643500 PMCID: PMC3106357 DOI: 10.2174/1874192401105010041] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease is a major cause of morbidity and mortality in patients with impaired renal function. Dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease (CVD) in the general population and it is well known that patients with chronic kidney disease (CKD) exhibit significant alterations in lipoprotein metabolism. In this review, the pathogenesis and treatment of CKD-induced dyslipidemia are discussed. Studies on lipid abnormalities in predialysis, hemodialysis and peritoneal dialysis patients are analyzed. In addition, the results of the studies that tested the effects of the hypolipidemic drugs on cardiovascular morbidity and mortality in patients with CKD are reported.
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Affiliation(s)
- Vasilis Tsimihodimos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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24
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Poor coronary collateral vessel development in patients with mild to moderate renal insufficiency. Clin Res Cardiol 2010; 100:227-33. [PMID: 20865265 DOI: 10.1007/s00392-010-0233-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The development of coronary collaterals is crucial to survival through acute ischemia. Mild to moderate loss of renal function has been suggested to play a role in this event, but evidential data are scarce. The aim of this study was to investigate the relationship between mild to moderate renal insufficiency and coronary collateral development in patients with chronic total coronary artery occlusion. METHODS AND RESULTS A total of 83 patients with mild to moderate loss of renal function (30 mL/min/1.73 m(2) ≤ eGFR < 90 mL/min/1.73 m(2)) with chronic total coronary artery occlusion were included in our study. The collateral circulation was graded according to Rentrop classification and the function of collateral circulation was graded according to Werner collateral connection (CC) grades. Compared to patients with good collateral circulation (Rentrop = 2,3), eGFR was found to be lower in those patients with poor coronary collateral circulation (Rentrop = 0,1) (63.30 ± 10.51 vs. 54.13 ± 10.56, P = 0.02). eGFR was also found to be lower in poorly functioning coronary collateral circulation (CC = 0,1) than in efficiently functioning coronary collateral circulation (CC = 2) (55.22 ± 9.98 vs. 66.28 ± 9.16, P = 0.03). Multiple logistic regression analysis showed that low eGFR was independently associated with poor coronary collateral circulation (Rentrop = 0,1, 95% CI, 0.09-1.09, P = 0.044) and poor function of coronary collateral circulation (CC = 0,1, 95% CI, 0.02-0.17, P = 0.02). CONCLUSIONS Lower eGFR is associated with poorer coronary collateral vessel development in patients experiencing mild to moderate renal insufficiency. Moreover, eGFR represents an independent factor affecting coronary collateral vessel development.
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Abstract
End-stage renal disease (ESRD) is associated with accelerated atherosclerosis and premature death from cardiovascular disease. These events are driven by oxidative stress inflammation and lipid disorders. ESRD-induced lipid abnormalities primarily stem from dysregulation of high-density lipoprotein (HDL), triglyceride-rich lipoprotein metabolism, and oxidative modification of lipoproteins. In this context, production and plasma concentration of Apo-I and Apo-II are reduced, HDL maturation is impaired, HDL composition is altered, HDL antioxidant and anti-inflammatory functions are depressed, clearance of triglyceride-rich lipoproteins and their atherogenic remnants is impaired, their composition is altered, and their plasma concentration is elevated in ESRD. The associated defect in HDL maturation is largely caused by acquired lecithin-cholesterol acyltransferase deficiency while its triglyceride enrichment is due to hepatic lipase deficiency. Hypertriglyceridemia, abnormal composition, and impaired clearance of triglyceride-rich lipoproteins and their remnants are mediated by down-regulation of lipoprotein lipase, hepatic lipase, very low-density lipoprotein (VLDL) receptor, and LDL receptor-related protein, relative reduction in ApoC-II/ApoC-III ratio, up-regulation of acyl-CoA cholesterol acyltransferase, and elevated plasma level of cholesterol ester-poor prebeta HDL. Impaired clearance and accumulation of oxidation-prone VLDL and chylomicron remnants and abnormal LDL composition in the face of oxidative stress and inflammation favors their uptake by macrophages and resident cells in the artery wall. The effect of heightened influx of lipids is compounded by impaired HDL-mediated reverse cholesterol transport leading to foam cell formation which is the central event in atherosclerosis plaque formation and subsequent plaque rupture, thrombosis, and tissue damage.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology and Hypertension, Departments of Medicine, Physiology and Biophysics, University of California, Irvine, California, USA.
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26
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Stegmayr B, Olivecrona T, Olivecrona G. Lipoprotein lipase disturbances induced by uremia and hemodialysis. Semin Dial 2010; 22:442-4. [PMID: 19708998 DOI: 10.1111/j.1525-139x.2009.00597.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Factors such as malnutrition, physical inactivity, uremic toxins, and inflammation are known to influence the activity of lipoprotein lipase (LPL), an important enzyme in metabolism of blood lipids. In patients with chronic kidney disease these factors are common and may result in a decreased LPL activity. This is particularly so in patients on hemodialysis. Further, during each dialysis treatment, the use of heparin (or low molecular weight heparin) induces a release of LPL from its normal binding sites at the plasma membrane of endothelial cells. This results in an increased degradation of the enzyme and a relative lack of LPL activity for up to 10 hours from the start of the dialysis. Thus, the use of conventional anticoagulation for hemodialysis, in addition to the consequences of the uremic state, may cause a severe functional deficiency of LPL. This in turn may have deleterious effects on energy metabolism and may contribute to the increased risk for cardiovascular disease in this vulnerable group of patients.
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Affiliation(s)
- Bernd Stegmayr
- Department of Internal Medicine, Division of Nephrology, University Hospital, Umeå, Sweeden.
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Zanos S, Mitsopoulos E, Sakellariou G. Parathyroid Hormone Levels, Calcium-Channel Blockers, and the Dyslipidemia of Nondiabetic Hemodialysis Patients. Ren Fail 2009. [DOI: 10.1081/jdi-48229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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28
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Evenepoel P. Calcimimetics in chronic kidney disease: evidence, opportunities and challenges. Kidney Int 2008; 74:265-75. [DOI: 10.1038/ki.2008.166] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
The field of reptilian clinical endocrinology is still in its infancy. The thyroid and parathyroid glands are intimately involved with many basic metabolic functions. These glands have been the subject of extensive research studies in reptilian species; however, the effects of abnormal gland function have been poorly documented in clinical cases. These glands play a major role in maintaining physiologic homeostasis in all vertebrates. With the advent of more sensitive assays, it should be possible to measure the small amounts of hormones found in reptilian species. The purpose of this article is to review the literature regarding clinical endocrinology of the thyroid and parathyroid glands in reptiles.
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Affiliation(s)
- Sam Rivera
- Department of Animal Health, Zoo Atlanta, 800 Cherokee Avenue SE, Atlanta, GA 30315-1440, USA.
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März W, Seelhorst U, Wellnitz B, Tiran B, Obermayer-Pietsch B, Renner W, Boehm BO, Ritz E, Hoffmann MM. Alanine to serine polymorphism at position 986 of the calcium-sensing receptor associated with coronary heart disease, myocardial infarction, all-cause, and cardiovascular mortality. J Clin Endocrinol Metab 2007; 92:2363-9. [PMID: 17374704 DOI: 10.1210/jc.2006-0071] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Disorders of calcium homeostasis have been implicated in atherosclerosis. The calcium-sensing receptor (CASR) is crucial to the regulation of calcium metabolism. An alanine (A) to serine (S) polymorphism at codon 986 (A986S) of the CASR gene has been associated with higher calcium and osteoporosis; the association with coronary artery disease (CAD) has not been studied. METHODS AND RESULTS We investigated this polymorphism in individuals with CAD (n = 2561), including survivors of myocardial infarction (MI) (n = 1358) compared to 698 controls without angiographic CAD. Compared to AA homozygotes, the prevalence of CAD [multivariate odds ratio 1.25; 95% confidence interval (CI) 1.02-1.54] and previous MI (multivariate odds ratio 1.33; 95% CI 1.06-1.68) was increased in carriers of at least one S-allele. With each S-allele, the prevalence of CAD and MI increased 1.22-fold (95% CI 1.02-1.47) and 1.30-fold (95% CI 1.06-1.60), respectively. Fully adjusted hazard ratios for total and cardiovascular mortality per one S-allele were 1.24 (95% CI 1.05-1.46) and 1.38 (95% CI 1.13-1.67), respectively. In carriers of at least one S-allele, the adjusted hazard ratios for all-cause and cardiovascular death were 1.25 (95% CI 1.04-1.51) and 1.48 (95% CI 1.18-1.86), respectively. These associations were independent of cardiovascular risk factors, calcium and phosphate. The S-allele was associated with higher calcium (P < 0.001) and PTH (P < 0.02), and lower phosphate (P < 0.003) in CAD patients and controls. CONCLUSION Serine at position 986 of CASR may be an independent genetic predictor of angiographic CAD, previous MI, and cardiovascular mortality.
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Affiliation(s)
- Winfried März
- Synlab Center of Laboratory Diagnostics Heidelberg, Heidelberg, Germany.
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Trombetti A, Stoermann C, Robert JH, Herrmann FR, Pennisi P, Martin PY, Rizzoli R. Survival after Parathyroidectomy in Patients with End-stage Renal Disease and Severe Hyperparathyroidism. World J Surg 2007; 31:1014-21. [PMID: 17420960 DOI: 10.1007/s00268-006-0693-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) and secondary hyperparathyroidism (SHPT) are at high risk of mortality. Whether an increased risk of death persists after a parathyroidectomy (PTX) is not clearly established. SUBJECTS AND METHODS The survival of 40 patients with ESRD and SHPT who underwent PTX was compared with that of 664 ESRD patients. RESULTS From first dialysis, a lower mortality rate was found in the group of patients who underwent PTX than in the nonoperated ESRD group (hazard ratio: 0.23; 95% CI: 0.14-0.37). The patients who underwent PTX were younger, had a longer time on dialysis, and had a higher prevalence of kidney transplantation. The mean number of comorbidities was lower (Charlson score 4.2 +/- 2.1 versus 6.4 +/- 2.9, p < 0.001). Then, we randomly selected two matched controls for each PTX case (80 controls, 40 PTX) who had at least an equivalent mean duration of dialysis between the first dialysis and PTX of the PTX group. In a univariate model, there was a trend for PTX being associated with prolonged survival. The mortality was higher both among those at an advanced age and those with a high Charlson score. Adjustments for these covariates made the effect of PTX no more significant. CONCLUSIONS The risk of death of patients with severe SHPT leading to PTX differed from that of nonoperated subjects. The apparent differences in survival may be related to the number and severity of associated comorbidities. ESRD patients who undergo PTX may represent a subset of healthier subjects.
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Affiliation(s)
- Andrea Trombetti
- Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland.
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Shoji T, Nishizawa Y. Plasma Lipoprotein Abnormalities in Hemodialysis Patients—Clinical Implications and Therapeutic Guidelines. Ther Apher Dial 2006; 10:305-15. [PMID: 16911182 DOI: 10.1111/j.1744-9987.2006.00382.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with advanced stages of chronic kidney disease (CKD) have an increased risk of death from cardiovascular disease (CVD). Dyslipidemias are associated with atherosclerotic vascular changes and the risk of occurrence of acute myocardial infarction in hemodialysis patients. However, management of dyslipidemia in hemodialysis patients does not appear to be actively carried out in routine practice. Presumably, there are three reasons for this reluctance to lipid-lowering in hemodialysis patients. First, there are epidemiological data showing the inverse relationship between cholesterol and mortality rate; a high cholesterol predicts a better survival. Second, lipids are not usually measured using standard fasting serum, but a non-fasting specimen. Third, although hypertriglyceridemia is the most common abnormality, fibrates are contraindicated in patients with renal failure because of a high risk of rhabdomyolysis. These issues are discussed in the current review article. Based on published work, lipid lowering would not increase the death rate if carried out without worsening malnutrition. The National Kidney Foundation K/DOQI Clinical Practice Guidelines recommend a reduction in fasting LDL-C below 100 mg/dL for the prevention of CVD in dialysis patients. Practically, however, the use of non-HDL-C measured by casual blood samples might be sufficient for the risk assessment in many hemodialysis patients. Statins are a good choice for lipid-lowering in dialysis patients. Furthermore, lipoprotein profile might be improved by an inventive use of dialyzer membranes, dialysate solutions, and other dialysis-related medications. For severe hypercholesterolemia, LDL-apheresis is another choice for consideration. Further studies are needed to clearly prove the benefit of lipid reduction in hemodialysis patients and those with CKD at earlier stages.
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Affiliation(s)
- Tetsuo Shoji
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
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Abstract
Chronic renal failure is associated with profound dysregulation of lipid metabolism and marked abnormalities of plasma lipid profile. This review is intended to provide an overview of the molecular basis of lipid disorders in chronic renal failure and explore their potential impact on cardiovascular disease and energy metabolism.
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Affiliation(s)
- Nosratola D Vaziri
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, California 92868, USA.
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Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential consequences. Am J Physiol Renal Physiol 2006; 290:F262-72. [PMID: 16403839 DOI: 10.1152/ajprenal.00099.2005] [Citation(s) in RCA: 307] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic renal failure (CRF) results in profound lipid disorders, which stem largely from dysregulation of high-density lipoprotein (HDL) and triglyceride-rich lipoprotein metabolism. Specifically, maturation of HDL is impaired and its composition is altered in CRF. In addition, clearance of triglyceride-rich lipoproteins and their atherogenic remnants is impaired, their composition is altered, and their plasma concentrations are elevated in CRF. Impaired maturation of HDL in CRF is primarily due to downregulation of lecithin-cholesterol acyltransferase (LCAT) and, to a lesser extent, increased plasma cholesteryl ester transfer protein (CETP). Triglyceride enrichment of HDL in CRF is primarily due to hepatic lipase deficiency and elevated CETP activity. The CRF-induced hypertriglyceridemia, abnormal composition, and impaired clearance of triglyceride-rich lipoproteins and their remnants are primarily due to downregulation of lipoprotein lipase, hepatic lipase, and the very-low-density lipoprotein receptor, as well as, upregulation of hepatic acyl-CoA cholesterol acyltransferase (ACAT). In addition, impaired HDL metabolism contributes to the disturbances of triglyceride-rich lipoprotein metabolism. These abnormalities are compounded by downregulation of apolipoproteins apoA-I, apoA-II, and apoC-II in CRF. Together, these abnormalities may contribute to the risk of arteriosclerotic cardiovascular disease and may adversely affect progression of renal disease and energy metabolism in CRF.
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Affiliation(s)
- N D Vaziri
- Division of Nephrology and Hypertension, UCI Medical Center, Orange, CA 92868, USA.
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Abstract
BACKGROUND Chronic renal failure (CRF) is associated with premature atherosclerosis, impaired high-density lipoprotein (HDL)-mediated reverse cholesterol transport, depressed clearance, and elevated plasma concentrations of very low-density lipoprotein (VLDL), chylomicrons, and their atherogenic remnants. LDL receptor-related protein (LRP) is a member of the LDL receptor gene family that is heavily expressed in the liver, and mediates removal of at least 30 different ligands, including VLDL remnants (IDL) and chylomicron remnants. This study was conducted to test the hypothesis that the well-known defect in clearance of IDL and chylomicron remnants in CRF may be indicative of diminished hepatic LRP abundance. METHODS Hepatic tissue LRP mRNA abundance [reverse transcription-polymerase chain reaction (RT-PCR)] and protein abundance (Western blot analysis) were determined in rats 8 weeks after 5/6 nephrectomy (CRF group) or sham operation (control group). RESULTS The CRF group exhibited hypertension, diminished creatinine clearance, increased plasma triglyceride concentration, and elevated total cholesterol-to-HDL cholesterol concentration ratio compared to the corresponding values found in the control group. This was associated with a significant down-regulation of hepatic LRP mRNA expression and immunodetectable LRP protein. CONCLUSION CRF results in down-regulation of hepatic LRP. This abnormality can, at least in part, account for the previously documented elevation of plasma concentration and depressed clearance of chylomicron remnants and IDL in CRF.
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Affiliation(s)
- Choong Kim
- Division of Nephrology and Hypertension, and Department of Physiology and Biophysics, University of California, Irvine, California, USA
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Evenepoel P, Claes K, Kuypers D, Maes B, Vanrenterghem Y. Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study. Nephrol Dial Transplant 2005; 20:1714-20. [PMID: 15919696 DOI: 10.1093/ndt/gfh892] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Successful kidney transplantation is believed to reverse secondary hyperparathyroidism, but persistent disease has emerged in a significant number of allograft recipients. Parathyroid hormone (PTH) is not only involved in the aetiology of calcium/phosphate abnormalities and osteitis fibrosa, but it is also a permissive factor in the occurrence of hypertension, cardiovascular damage and dyslipidaemia. In experimental renal failure, abrogation of hyperparathyroidism by administration of a calcimimetic or parathyroidectomy (PTX) attenuates progression of renal failure. To evaluate the impact of PTX on blood pressure (BP), renal graft function and serum lipids, we performed a retrospective case-controlled study in renal graft recipients. METHODS Charts of 1647 kidney allograft recipients, transplanted between 1989 and 2004, were reviewed. Thirty-two patients with a functioning graft and a history of a successful PTX performed at least 9 months after transplantation were identified. Biochemical and clinical data available 6 months pre- and post-PTX were registered. Changes in BP, renal function and serum lipids were assessed. The data were compared with those obtained in a similar time frame in a control group closely matched for date of transplantation. RESULTS Systolic BP (149.9 vs 141.7 mmHg), diastolic BP (85.6 vs 81.9 mmHg), pulse pressure (64.3 vs 58.8 mmHg), total cholesterol concentration (221.4 vs 211.1 mg/dl) and low-density lipoprotein cholesterol concentration (123.9 vs 106.7 mg/dl) improved significantly after successful PTX. Serum creatinine, conversely, significantly increased after PTX (1.75 vs 2.13 mg/dl, P<0.0001). No significant changes were observed in the control group in the same time period. CONCLUSION In patients with a functioning renal graft, BP and dyslipidaemia improve, whereas serum creatinine worsens following successful PTX. Our data are in agreement with a stimulatory effect of PTH on plasma renin activity and an inhibitory effect on lipase activity, as previously demonstrated by others. To what extent the increased serum creatinine following PTX reflects a true deterioration of the glomerular filtration rate and/or is the consequence of vitamin D-induced reduction of the renal tubular secretion of creatinine needs to be elucidated by further research.
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Affiliation(s)
- Pieter Evenepoel
- Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Rosas S, Szapary P, Rader DJ. Management of selected lipid abnormalities: hypertriglyceridemia, isolated low HDL-cholesterol, lipoprotein(a), and lipid abnormalities in renal diseases and following solid organ transplantation. Cardiol Clin 2003; 21:377-92. [PMID: 14621452 DOI: 10.1016/s0733-8651(03)00075-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although the focus in treating lipid disorders is on reducing LDL-C levels, additional lipid-related independent risk factors, such as TG, HDL-C, and Lp(a) levels, should be used clinically to assess cardiovascular risk. Decisions to initiate drug therapy for LDL-C reduction may be influenced by levels of these other lipoprotein fractions. Data supporting intervention to modify these factors are less abundant than for LDL-C reduction, but in certain circumstances. drug therapy targeted at TGs or HDL-C may be appropriate. Patients who have nephrotic syndrome and end-stage renal disease are at particularly high risk for the development of CVD and should be treated aggressively for their lipid disorders. Finally, solid organ transplant recipients are almost always hyperlipidemic and appropriate therapy could reduce cardiovascular events.
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Affiliation(s)
- Sylvia Rosas
- University of Pennsylvania Medical Center, 654 BRBII/III Labs, 421 Curie Boulevard, Philadelphia, PA 19104-6160, USA
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Ogata H, Ritz E, Odoni G, Amann K, Orth SR. Beneficial effects of calcimimetics on progression of renal failure and cardiovascular risk factors. J Am Soc Nephrol 2003; 14:959-67. [PMID: 12660330 DOI: 10.1097/01.asn.0000056188.23717.e5] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In renal failure, parathyroid hormone (PTH) is not only involved in the genesis of disturbed calcium/phosphate metabolism and ostitis fibrosa; it is also a permissive factor in the genesis of hypertension, cardiovascular damage, and dyslipidemia. The allosteric activator of the calcium sensing receptor NPSR-568 (R-568) has been shown to reduce the serum intact PTH (iPTH) concentration in uremic rats. It was the purpose of this study in subtotally nephrectomized (SNX) rats to compare pharmacologic abrogation of secondary hyperparathyroidism by R-568 with parathyroidectomy (PTX). The effects on progression of renal failure, BP, and lipid and structural parameters of kidney and heart were studied. Four groups of male SD-rats were studied: (1) sham-operated + vehicle-treated rats (controls); (2) SNX + vehicle-treated rats (SNX); (3) parathyroidectomized SNX + vehicle-treated rats (SNX+PTX); and (4) SNX + calcimimetic R-568-treated rats (SNX+R-568). R-568 (50 micro mol/kg per d) was administered by gavage. Eight weeks after SNX, serum creatinine concentration, urinary albumin excretion, BP, and serum LDL-cholesterol concentration were significantly lower in both R-568-treated and parathyroidectomized SNX compared with vehicle-treated SNX. In addition, structural abnormalities of the kidney (glomerulosclerosis, tubulointerstitial changes) and the heart (interstitial fibrosis, capillary length density, arteriolar wall thickness) were significantly less pronounced than in vehicle-treated SNX. It is concluded that in experimental renal failure abrogation of hyperparathyroidism by administration of a calcimimetic or PTX similarly attenuates progression of renal failure. Furthermore, it interferes with the development of cardiovascular risk factors and cardiac remodeling.
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Affiliation(s)
- Hiroaki Ogata
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
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42
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Sato T, Liang K, Vaziri ND. Down-regulation of lipoprotein lipase and VLDL receptor in rats with focal glomerulosclerosis. Kidney Int 2002; 61:157-62. [PMID: 11786096 DOI: 10.1046/j.1523-1755.2002.00104.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients and animals with nephrotic syndrome and those with chronic renal failure (CRF) often exhibit hypertriglyceridemia and impaired very low-density lipoprotein (VLDL) clearance. Imai rats that were originally derived from Sprague-Dawley rats develop spontaneous proteinuria, hyperlipidemia, progressive renal insufficiency and histologic changes of focal glomerulosclerosis (FGS), closely resembling human FGS. This study was undertaken to test the hypothesis that elevation of plasma triglyceride and VLDL concentrations in the Imai rats is associated with deficiency of lipoprotein lipase (LPL) and VLDL receptor which are the main pathways of triglyceride-rich lipoprotein clearance. METHODS Male Imai and Sprague-Dawley control rats were fed regular rat chow and studied at 10 and 34 weeks of age. Tissue LPL and VLDL-r protein abundance (Western analysis) and post-heparin lipolytic activity were determined. RESULTS At 10 weeks of age, Imai rats showed mild proteinuria, moderate hyperlipidemia, normal creatinine clearance and blood pressure. By 34 weeks of age, the study animal exhibited severe proteinuria, marked hyperlipidemia, significant renal insufficiency and hypertension. This was associated with a severe progressive reduction in skeletal muscle and adipose tissue LPL and VLDL-r protein abundance and depressed plasma post heparin, lipolytic activity. CONCLUSION Progressive hyperlipidemia in the Imai rats with spontaneous FGS is accompanied by severe combined LPL and VLDL-r deficiencies that can, in part, account for the associated hypertriglyceridemia and elevated plasma VLDL concentrations.
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Affiliation(s)
- Tadashi Sato
- Department of Pediatrics, Saga Medical School Saga-City, Saga, Japan
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Ozdemir FN, Güz G, Sezer S, Arat Z, Turan M, Haberal M. Atherosclerosis risk is higher in continuous ambulatory peritoneal dialysis patients than in hemodialysis patients. Artif Organs 2001; 25:448-52. [PMID: 11453874 DOI: 10.1046/j.1525-1594.2001.025006448.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While it has been reported that myocardial infarction and cerebrovascular disease are more common in continuous ambulatory peritoneal dialysis (CAPD) patients than in hemodialysis patients, some studies have not supported these results. The aim of this study was to compare CAPD and hemodialysis patients with regard to atherosclerotic changes and to assess which factors might be responsible for atherosclerosis in dialysis patients. Group 1 consisted of 65 CAPD patients, and Group 2 consisted of 109 hemodialysis patients who were age-, gender-, and duration-of-dialysis-matched with CAPD patients. We used ultrasonographic measurement of carotid artery intima media thickness to identify atherosclerosis. Known risk factors for atherosclerosis including hypertension, smoking, serum levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, lipoprotein (a) [Lp(a)], albumin, intact parathormone, fibrinogen, and C-reactive protein were determined in all patients. More atherosclerotic changes were seen in CAPD than in hemodialysis patients. Of all the atherosclerosis risk factors, only serum total cholesterol, LDL-C, and Lp(a) levels were significantly higher in patients on CAPD.
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Affiliation(s)
- F N Ozdemir
- Department of Nephrology, Baskent University Faculty of Medicine, Fevzi Cakmak Bulvari 10, Sokak No: 45, Bahçelievler, Ankara, 06490, Turkey.
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Rader DJ, Rosas S. MANAGEMENT OF SELECTED LIPID ABNORMALITIES. Cardiol Clin 2001. [DOI: 10.1016/s0733-8651(05)70215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gadallah MF, El-Shahawy M, Andrews G, Torres-Rivera C, Hanna D, Blatt M, Ibrahim M, Morkos A, Abbassian M, Cooper M. Lipid Metabolism and Cardiovascular Morbidity and Mortality in Hemodialysis Patients: Role of Factors Modulating Cytosolic Calcium. Hemodial Int 2001; 5:59-65. [PMID: 28452450 DOI: 10.1111/hdi.2001.5.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Animal studies indicate that insulin resistance and glucose intolerance leading to dyslipidemia in uremic rats are associated with increased cytosolic calcium ([Ca++ i]). The resistance and intolerance are reversed with verapamil, but recur after its discontinuation. This finding suggests that hyperparathyroid-induced [Ca ++ i] increase is responsible for the metabolic derangement. We retrospectively examined, over a 12-year period, the effects of factors that lower [Ca ++ i] on total serum cholesterol and triglycerides in 332 hemodialysis (HD) patients. Because the study was retrospective, detailed lipid profiles were not available. We therefore relied on morbidity and mortality outcomes related to atherosclerotic vascular disease. Patients with diabetes mellitus were excluded, because their dyslipidemia and vascular disease are mediated via a different mechanism. Four groups emerged: group I [high parathormone (PTH) in the absence of calcium channel blockers (CCBs), n = 107], representing the highest [Ca++ i]; group II (high PTH in the presence of CCBs, n = 76) and group III (lower PTH in the absence of CCBs, n = 66), representing intermediate [Ca ++ i]; and group IV (lower PTH in the presence of CCBs, n = 83) representing the lowest [Ca ++ i]. The theoretically lower [Ca ++ i] was achieved via CCB therapy or lower PTH, or both. The mean serum cholesterol in group I was 322 ± 24 mg/dL and the level of triglycerides was 398 ± 34 mg/dL. Group II had mean serum cholesterol of 196 ± 16 mg/dL and triglycerides of 157 ± 17 mg/dL. Group III had a mean serum cholesterol of 202 ± 19 mg/dL and triglycerides of 160 ± 15 mg/dL. Group IV had a mean serum cholesterol of 183 ± 9 mg/dL and triglycerides of 94 ± 6 mg/dL. The differences in cholesterol and triglyceride levels among four groups were significant (p < 0.001) by one-way analysis of variance (ANOVA). The incidence of cardiovascular morbidity and mortality events was 61% in group I, 24% in group II, 28% in group III, and 18% in group IV (χ 2 = 47.7, p < 0.001). We conclude that, in non diabetic HD patients, hyperparathyroidism, especially in the absence of CCBs, is associated with severe dyslipidemia and increased risk of cardiovascular morbidity and mortality. Dyslipidemia may be related to a hyperparathyroid-induced increase in cytosolic calcium [Ca++ i]. Lowering [Ca++ i] by decreasing PTH or by blocking calcium entry into cells (via CCBs), or both, is associated with less dyslipidemia and improved long-term cardiovascular morbidity and mortality. Prospective randomized studies, with actual measurement of [Ca ++ i], are needed to verify the results of this study.
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Affiliation(s)
- Merit F Gadallah
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Mohamed El-Shahawy
- Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - George Andrews
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Carlos Torres-Rivera
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Dina Hanna
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Marc Blatt
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Magued Ibrahim
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Atef Morkos
- Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Mohammad Abbassian
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
| | - Mark Cooper
- Division of Nephrology and Hypertension, Department of Medicine, University of Florida, Jacksonville, Florida, U.S.A
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Rader DJ, Rosas S. Management of selected lipid abnormalities. Hypertriglyceridemia, low HDL cholesterol, lipoprotein(a), in thyroid and renal diseases, and post-transplantation. Med Clin North Am 2000; 84:43-61. [PMID: 10685127 DOI: 10.1016/s0025-7125(05)70206-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although the focus in treating lipid disorders is on reducing LDL cholesterol levels, triglycerides, HDL cholesterol, and Lp(a) are all independent risk factors that can be used clinically to assess cardiovascular risk. Decisions to initiate drug therapy for LDL cholesterol reduction may be influenced by levels of these other lipoprotein fractions. Data supporting intervention to modify these factors is less abundant than for LDL cholesterol reduction, but in certain circumstances drug therapy targeted at triglycerides or HDL cholesterol may be appropriate. Patients with nephrotic syndrome and end-stage renal disease are at particularly high risk for the development of cardiovascular disease and should be treated aggressively for lipid disorders. Finally, solid organ transplant recipients are almost always hyperlipidemic, and appropriate therapy could reduce cardiovascular events.
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Affiliation(s)
- D J Rader
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA
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47
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Querfeld U, Hoffmann MM, Klaus G, Eifinger F, Ackerschott M, Michalk D, Kern PA. Antagonistic effects of vitamin D and parathyroid hormone on lipoprotein lipase in cultured adipocytes. J Am Soc Nephrol 1999; 10:2158-64. [PMID: 10505692 DOI: 10.1681/asn.v10102158] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The effects of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) (calcitriol) and parathyroid hormone (PTH) on synthesis and secretion of lipoprotein lipase (LPL) were studied in 3T3-L1 adipocytes. Expression of the vitamin D receptor was demonstrated by saturation kinetics with radiolabeled calcitriol. Incubation with calcitriol (10(-8) M) for up to 4 d resulted in a time-dependent significant increase in heparin-releasable LPL activity (LPLa) accompanied by a significant increase in LPL mRNA. In contrast, incubation with intact (1-84) PTH (10(-6) to 10(-9) M) produced a time- and dose-dependent significant decrease in LPLa, but no change in LPL mRNA. The effect of PTH (24-h incubation, 10(-8) M) could be prevented by the calcium channel blocker verapamil. Coincubation with both calcitriol and PTH at equimolar concentration (10(-8) M) resulted in an increase in LPLa and LPL mRNA. These data indicate an antagonistic role for calcitriol and PTH in the regulation of LPL, possibly mediated by intracellular calcium, which may contribute to the alterations in lipoprotein metabolism occurring in uremia.
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Affiliation(s)
- U Querfeld
- University Children's Hospital, Cologne, Germany.
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48
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Abstract
BACKGROUND Parathyroid hormone and vitamin D have been shown to influence cardiac and vascular growth and function experimentally in human subjects with normal renal function. Because of the increased prevalence of hyperparathyroidism and altered vitamin D status in chronic renal failure, these alterations have been considered to contribute to the increased prevalence of cardiovascular disease and hypertension seen in this patient population. Methods and Results. In this article, we review experimental and clinical literature on the cardiovascular effects of parathyroid hormone and vitamin D and relate them to the development of cardiac and vascular dysfunction in uremia, such as: cardiomyopathy, myocardial hypertrophy, and fibrosis, as well as to myocardial ischemia; uremic glucose intolerance, dyslipidemia, and atherosclerosis; hypertension; and vascular and cardiac calcifications. CONCLUSIONS The hyperparathyroid state and altered vitamin D status found in uremia contribute to the cardiovascular pathology seen clinically in uremia and also to the excess mortality from cardiovascular causes found in this patient group. The therapeutic implications of these observations are also discussed.
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Affiliation(s)
- S G Rostand
- The Nephrology Research and Training Center, The University of Alabama at Birmingham, 35294, USA.
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49
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Kimak E, Solski J, Janicka L, Wojtysiak B, Zagojska M. Effect of dialysis membranes on lipoprotein profile of serum in haemodialysed patients. Int Urol Nephrol 1999; 30:789-98. [PMID: 10195875 DOI: 10.1007/bf02564868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The subjects of the studies were 31 haemodialysed (HD) patients with chronic renal insufficiency (CRI). In this group of patients the lipoprotein profile was determined and 8 patients were selected for further studies. During the study the patients were treated with cuprophane membranes for 6 months. For the next 6 months the same patients were treated using polysulfone dialysers, and for further 6 months HD with polysulfone dialysers was continued. Patients' sera were tested after every 6 months of treatment. The delta values were calculated as 6-month HD with polysulfone minus 6-month HD with cuprophane (deltaI) and 12-month HD with polysulfone minus 6-month HD with polysulfone (deltaII). We concluded that after long-term HD with low flux polysulfone treatment the lipoprotein profiles improved, but the mechanism of the process is not clear.
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Affiliation(s)
- E Kimak
- Department of Clinical Analytics, Medical School, St. Wyszyński Specialistic Hospital, Lublin, Poland
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50
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Lundgren E. Primary hyperparathyroidism of postmenopausal women. Prospective population-based case-control analysis on prevalence, clinical findings and treatment. Minireview based on a doctoral thesis. Ups J Med Sci 1999; 104:87-130. [PMID: 10422215 DOI: 10.3109/03009739909178956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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