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Ibrahim M, Suleiman ME, Gandomkar Z, Tavakoli Taba A, Arnott C, Jorm L, Barraclough JY, Barbieri S, Brennan PC. Associations of Breast Arterial Calcifications with Cardiovascular Disease. J Womens Health (Larchmt) 2023; 32:529-545. [PMID: 36930147 DOI: 10.1089/jwh.2022.0394] [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: 03/18/2023] Open
Abstract
Cardiovascular diseases (CVD), including coronary artery disease (CAD), continue to be the leading cause of global mortality among women. While traditional CVD/CAD prevention tools play a significant role in reducing morbidity and mortality among both men and women, current tools for preventing CVD/CAD rely on traditional risk factor-based algorithms that often underestimate CVD/CAD risk in women compared with men. In recent years, some studies have suggested that breast arterial calcifications (BAC), which are benign calcifications seen in mammograms, may be linked to CVD/CAD. Considering that millions of women older than 40 years undergo annual screening mammography for breast cancer as a regular activity, innovative risk prediction factors for CVD/CAD involving mammographic data could offer a gender-specific and convenient solution. Such factors that may be independent of, or complementary to, current risk models without extra cost or radiation exposure are worthy of detailed investigation. This review aims to discuss relevant studies examining the association between BAC and CVD/CAD and highlights some of the issues related to previous studies' design such as sample size, population types, method of assessing BAC and CVD/CAD, definition of cardiovascular events, and other confounding factors. The work may also offer insights for future CVD risk prediction research directions using routine mammograms and radiomic features other than BAC such as breast density and macrocalcifications.
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Affiliation(s)
- Mu'ath Ibrahim
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ziba Gandomkar
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Amir Tavakoli Taba
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Clare Arnott
- Cardiovascular Program, The George Institute for Global Health, Newtown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Louisa Jorm
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Jennifer Y Barraclough
- Cardiovascular Program, The George Institute for Global Health, Newtown, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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Vascular calcification in different arterial beds in ex vivo ring culture and in vivo rat model. Sci Rep 2022; 12:11861. [PMID: 35831341 PMCID: PMC9279329 DOI: 10.1038/s41598-022-15739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022] Open
Abstract
Vascular calcification is a risk factor for cardiovascular and kidney diseases. Medial calcification may differently affect the arterial tree depending on vessel location and smooth muscle injury. The aim was to map the anatomical distribution of vascular calcifications on different arteries and artery locations, in cultured artery rings (ex vivo) and in a rat model of elastocalcinosis (in vivo). Vascular calcification was assessed histologically (von Kossa staining of the media) and by calcium content measurement. Arteries of different sizes were harvested from untreated rats for ring culture and from the vitamin D3-nicotine (VDN) rat model for direct observation. When cultured in pro-calcifying conditions, thoracic aorta exhibited similar calcification from the arch to the diaphragm. Calcification increased in abdominal aorta along with the reduction in cross sectional area. Carotid and renal arteries exhibited similar ex vivo calcification. In VDN rats, calcification was greater in carotid artery than in aorta, and was accompanied by fibrosis and apoptosis. Ex vivo, calcification was increased by the induction of lesions on arteries. Along the vascular tree, calcification of the arterial wall increases with the narrowing of vessels in ex vivo ring culture and in vivo. The observed differences represent local susceptibility of the vessels to the calcifying processes.
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Van Berkel B, Van Ongeval C, Van Craenenbroeck AH, Pottel H, De Vusser K, Evenepoel P. Prevalence, progression and implications of breast artery calcification in patients with chronic kidney disease. Clin Kidney J 2022; 15:295-302. [PMID: 35145644 PMCID: PMC8825218 DOI: 10.1093/ckj/sfab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 12/19/2022] Open
Abstract
Breast arterial calcification (BAC) is increasingly recognized as a specific marker of medial calcification. The present retrospective observational cohort study aimed to define the prevalence, progression rate, risk factors and clinical implications of BAC in chronic kidney disease (CKD) patients across stages of disease. The presence and extent of BAC were determined on mammograms in 310 females (58.7 ± 10.8 years, Caucasian) with CKD across various stages of disease [CKD G2-5D n = 132; transplant (Tx) recipients n = 178]. In a subset of 88 patients, repeat mammography was performed, allowing us to calculate the annualized BAC rate. Overall, BAC was observed in 34.7% of the patients. BAC prevalence (P = 0.02) and BAC score (P = 0.05) increased along the progression of CKD. In the overall cohort, patients with BAC were characterized by older age, more cardiovascular disease, more inflammation, higher pulse pressure and borderline higher prevalence of diabetes and were more often treated with a vitamin K antagonist (VKA). The BAC progression rate was significantly lower in Tx patients as compared with CKD G5D. Progressors were characterized by more inflammation, worse kidney function, higher BAC score and higher serum phosphate level (Tx only) at baseline and were more often treated with a VKA. Major adverse cardiovascular event-free survival was significantly worse in Tx patients with BAC. In conclusion, BAC is common among CKD patients, progresses at a slower pace in Tx patients as compared with CKD 5D and associates with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and VKA usage seem to be important determinants of progression.
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Affiliation(s)
- Brecht Van Berkel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Chantal Van Ongeval
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Kulak, Kortrijk, Belgium
| | - Katrien De Vusser
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Pieter Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
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Calciphylaxis-Associated Cutaneous Vascular Calcification in Noncalciphylaxis Patients. Am J Dermatopathol 2021; 42:557-563. [PMID: 32701689 DOI: 10.1097/dad.0000000000001519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Calciphylaxis is a highly morbid disease that is strongly associated with chronic kidney disease (CKD); however, the histologic criteria for diagnosis have not been well established nor have their specificity for calciphylaxis been determined. This retrospective study aimed to examine the prevalence of histologic features commonly associated with calciphylaxis in noncalciphylaxis patients. We also sought to evaluate whether these features may be more prevalent in patients with CKD. To assess this, healthy marginal skin tissue from above-the-knee amputation specimens was compared between patients with CKD (n = 23) and without CKD (n = 47). Intravascular calcification of capillaries or small-to-medium arterioles was detected on von Kossa stain in 40.0% of the entire cohort. Capillary calcification and intravascular thrombosis were more prevalent in patients with CKD. Finely stippled capillary calcification was present in 26.1% of patients with CKD versus 8.5% of patients without CKD (P = 0.0484), and intravascular thrombosis was present in 8.7% of patients with CKD and 0.0% of patients without CKD (P = 0.0403). None of the patients in this study had clinical evidence of calciphylaxis at presentation and in at least a 1-year follow-up period. This study confirms that the histologic features previously associated with calciphylaxis are nonspecific and are more prevalent in patients with CKD.
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Chen W, Fitzpatrick J, Monroy-Trujillo JM, Sozio SM, Jaar BG, Estrella MM, Serrano J, Anokhina V, Miller BL, Melamed ML, Bushinsky DA, Parekh RS. Associations of Serum Calciprotein Particle Size and Transformation Time With Arterial Calcification, Arterial Stiffness, and Mortality in Incident Hemodialysis Patients. Am J Kidney Dis 2020; 77:346-354. [PMID: 32800846 DOI: 10.1053/j.ajkd.2020.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/20/2020] [Indexed: 01/09/2023]
Abstract
RATIONALE & OBJECTIVE Characteristics of the transformation of primary to secondary calciprotein particles (CPPs) in serum, including the size of secondary CPP (CPP2) aggregates and the time of transformation (T50), may be markers for arterial calcification in patients undergoing hemodialysis (HD). We examined the associations of CPP2 aggregate size and T50 with arterial calcification in incident HD patients. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Incident HD patients (n=402with available CPP2 measures and n=388with available T50 measures) from the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) Study PREDICTORS: Serum CPP2 size and T50 at baseline. OUTCOMES Primary outcomes were baseline coronary artery and thoracic aorta calcifications. Exploratory outcomes included baseline arterial stiffness, measured by pulse wave velocity (PWV) and ankle brachial index, and longitudinally, repeat measures of PWV and all-cause mortality. ANALYTICAL APPROACH Tobit regression, multiple linear regression, Poisson regression, linear mixed-effects regression, and Cox proportional hazards regression. RESULTS Mean age was 55±13 years, 41% were women, 71% were Black, and 57% had diabetes mellitus. Baseline CPP2 size and T50 were correlated with baseline fetuin A level (r=-0.59 for CPP2 and 0.44 for T50; P<0.001 for both), but neither was associated with baseline measures of arterial calcification or arterial stiffness. Baseline CPP2 size and T50 were not associated with repeat measures of PWV. During a median follow-up of 3.5 (IQR, 1.7-6.2) years, larger CPP2 was associated with higher risk for mortality (HR, 1.17 [95% CI, 1.05-1.31] per 100nm larger CPP2 size) after adjusting for demographics and comorbid conditions, but there was no association between baseline T50 and risk for mortality. LIMITATIONS Possible imprecision in assays, small sample size, limited generalizability to incident HD populations with different racial composition, and residual confounding. CONCLUSIONS In incident HD patients, neither CPP2 size nor T50 was associated with prevalent arterial calcification and stiffness. Larger CPP2 was associated with risk for mortality, but this finding needs to be confirmed in future studies.
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Affiliation(s)
- Wei Chen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Jessica Fitzpatrick
- Department of Medicine and Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD; Nephrology Center of Maryland, Baltimore, MD
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, CA; San Francisco VA Health Care System, San Francisco, CA
| | - Jishyra Serrano
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Viktoriya Anokhina
- Departments of Biochemistry and Biophysics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Benjamin L Miller
- Departments of Biochemistry and Biophysics, University of Rochester School of Medicine and Dentistry, Rochester, NY; Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY; Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - David A Bushinsky
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Rulan S Parekh
- Department of Medicine and Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
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Evenepoel P, Dejongh S, Verbeke K, Meijers B. The Role of Gut Dysbiosis in the Bone-Vascular Axis in Chronic Kidney Disease. Toxins (Basel) 2020; 12:toxins12050285. [PMID: 32365480 PMCID: PMC7290823 DOI: 10.3390/toxins12050285] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of bone mineral density loss and vascular calcification. Bone demineralization and vascular mineralization often concur in CKD, similar to what observed in the general population. This contradictory association is commonly referred to as the 'calcification paradox' or the bone-vascular axis. Mounting evidence indicates that CKD-associated gut dysbiosis may be involved in the pathogenesis of the bone-vascular axis. A disrupted intestinal barrier function, a metabolic shift from a predominant saccharolytic to a proteolytic fermentation pattern, and a decreased generation of vitamin K may, alone or in concert, drive a vascular and skeletal pathobiology in CKD patients. A better understanding of the role of gut dysbiosis in the bone-vascular axis may open avenues for novel therapeutics, including nutriceuticals.
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Affiliation(s)
- Pieter Evenepoel
- Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven—University of Leuven, B-3000 Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, B-3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-16-344591; Fax: +32-16-344599
| | - Sander Dejongh
- Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven—University of Leuven, B-3000 Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven—University of Leuven, B-3000 Leuven, Belgium
| | - Bjorn Meijers
- Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven—University of Leuven, B-3000 Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, B-3000 Leuven, Belgium
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Niu Q, Zhao H, Wu B, Tsai S, Wu J, Zhang M, Lu L, Qiao J, Men C, Zuo L, Wang M. Abdominal aortic calcification is superior to other arteries calcification in predicting the mortality in peritoneal dialysis patients - a 8 years cohort study. BMC Nephrol 2019; 20:439. [PMID: 31791277 PMCID: PMC6888938 DOI: 10.1186/s12882-019-1593-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In recent years, there has been a growing concern that abdominal aortic calcification (AAC) has a predictive effect on the prognosis of patients with end-stage renal disease (ESRD). However, whether other vascular calcification (VC) can predict the occurrence of adverse events in patients, and whether it is necessary to assess the calcification of other blood vessels remains controversial. This study aimed to assess VC in different sites using X-ray films, and to investigate the predictive effects of VC at different sites on all-cause mortality and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients. METHODS The data of Radiographs (lateral abdominal plain film, frontal pelvic radiograph and both hands radiograph) were collected to evaluate the calcification of abdominal aorta, iliac artery, femoral artery, radial artery, and finger arteries. Patients' demographic data, clinical characteristics, laboratory data were recorded. The total follow-up period was 8 years, and the time and cause of death were recorded. Survival curves were estimated using Kaplan-Meier analysis. COX regression analysis was used to examine independent predictors of all-cause mortality and CV mortality. RESULTS One hundred fifty PD patients were included, a total of 79 patients (52.7%) died at the end of follow-up. After adjusting variables in the multivariate COX regression analysis, AAC was an independent predictor of all-cause mortality in PD patients (HR = 2.089, 95% CI: 1.089-4.042, P = 0.029), and was also an independent predictor of CV mortality (HR = 4.660, 95% CI: 1.852-11.725, P = 0.001). We also found that femoral artery calcification had a predictive effect on all-cause and CV mortality. But the calcification in iliac artery, radial artery, and finger arteries were not independent predictors of patients' all-cause and CV mortality in PD patients. CONCLUSION AAC was more common in PD patients and was an independent predictor of all-cause mortality and CV mortality. The femoral artery calcification also can predict the mortality, but the calcification of iliac artery, radial artery, and finger arteries cannot predict the mortality of PD patients.
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Affiliation(s)
- Qingyu Niu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Huiping Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China.
| | - Bei Wu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Shihming Tsai
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jian Wu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Meng Zhang
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Lixia Lu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Jie Qiao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Chuncui Men
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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Schuchardt M, Siegel NV, Babic M, Reshetnik A, Lützenberg R, Zidek W, van der Giet M, Tölle M. A Novel Long-Term ex vivo Model for Studying Vascular Calcification Pathogenesis: The Rat Isolated-Perfused Aorta. J Vasc Res 2019; 57:46-52. [PMID: 31722349 DOI: 10.1159/000503785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 09/30/2019] [Indexed: 11/19/2022] Open
Abstract
The investigation of vascular calcification and its underlying cellular and molecular pathways is of great interest in current research efforts. Therefore, suitable assays are needed to allow examination of the complex calcification process under controlled conditions. The current study describes a new ex vivo model of isolated-perfused rat aortic tissue with subsequent quantification and vessel staining to analyze the calcium content of the aortic wall. A rat aorta was perfused ex vivo with control and calcification media for 14 days, respectively. The calcification medium was luminally perfused and induced a significant increase in calcium deposition within the media of the vessel wall detected alongside the elastic laminae. Perfusion with control medium induced no calcification. In addition, the mRNA expression of the osteogenic marker bone morphogenetic protein 2 (BMP-2) increased in aortic tissue after perfusion, while SM22α as smooth muscle marker decreased. This newly developed ex vivo model of isolated-perfused rat aorta is suitable for vascular calcification studies testing inducers and inhibitors of vessel calcification and studying signaling pathways within calcification progression.
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Affiliation(s)
- Mirjam Schuchardt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany
| | - Nathalie Vanessa Siegel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany
| | - Milen Babic
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany
| | - Alexander Reshetnik
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany
| | - Ronald Lützenberg
- Klinik für Plastische, Ästhetische und Handchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Walter Zidek
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany
| | - Markus van der Giet
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany,
| | - Markus Tölle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Department of Nephrology, Berlin Institute of Health, Berlin, Germany
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Evenepoel P, Opdebeeck B, David K, D'Haese PC. Bone-Vascular Axis in Chronic Kidney Disease. Adv Chronic Kidney Dis 2019; 26:472-483. [PMID: 31831125 DOI: 10.1053/j.ackd.2019.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of osteoporosis and vascular calcification. Bone demineralization and vascular mineralization go often hand in hand in CKD, similar to as in the general population. This contradictory association is independent of aging and is commonly referred to as the "calcification paradox" or the bone-vascular axis. Various common risk factors and mechanisms have been identified. Alternatively, calcifying vessels may release circulating factors that affect bone metabolism, while bone disease may infer conditions that favor vascular calcification. The present review focuses on emerging concepts and major mechanisms involved in the bone-vascular axis in the setting of CKD. A better understanding of these concepts and mechanisms may identify therapeutics able to target and exert beneficial effects on bone and vasculature simultaneously.
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Diabetes Mellitus Modifies the Associations of Serum Magnesium Concentration With Arterial Calcification and Stiffness in Incident Hemodialysis Patients. Kidney Int Rep 2019; 4:806-813. [PMID: 31194171 PMCID: PMC6551514 DOI: 10.1016/j.ekir.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Magnesium (Mg) may protect against arterial calcification. We tested the hypotheses that a higher serum Mg concentration is associated with less arterial calcification and stiffness in patients on hemodialysis (HD) and that these associations are modified by diabetes mellitus. Methods We performed cross-sectional analyses of 367 incident HD patients from the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) cohort. Measures of arterial calcification and stiffness included coronary arterial calcification (CAC) and thoracic aortic calcification (TAC) scores, ankle brachial index (ABI; high ABI: >1.4 or incompressible vessels), pulse wave velocity (PWV), and pulse pressure. Results Mean Mg was 1.8 ± 0.2 mEq/l and 58% had diabetes. Among nondiabetic individuals, per 0.1 mEq/l higher Mg, non-zero CAC score was lower (% difference: −15.4%; 95% confidence interval [CI]: −28% to −0.55%; P = 0.03), the odds of having TAC score >0 and the odds of having high ABI were lower (odds ratio [OR]: 0.66; 95% CI 0.47–0.93; P = 0.02, and 0.23; 95% CI: 0.06–0.83, P = 0.03, respectively) while adjusting for demographics, comorbidities, markers of mineral metabolism, and dialysis clearance. Among diabetic individuals, per 0.1 mEq/l higher Mg, the odds of having TAC score >0 was higher (OR: 1.57; 95% CI: 1.09–2.26; P = 0.02). Mg was not associated with CAC or high ABI among diabetic individuals. Mg was not associated with PWV or pulse pressure regardless of diabetes status. Conclusion Diabetes modified the associations of serum Mg with arterial calcification and stiffness in incident HD patients. Higher Mg was associated with less arterial calcification and less peripheral arterial stiffness among nondiabetic individuals, but Mg was only associated with TAC among diabetic individuals with higher Mg being associated with higher likelihood of having TAC score >0.
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Mizuiri S, Nishizawa Y, Yamashita K, Mizuno K, Ishine M, Doi S, Masaki T, Shigemoto K. Coronary artery calcification score and common iliac artery calcification score in non-dialysis CKD patients. Nephrology (Carlton) 2018; 23:837-845. [PMID: 28703899 PMCID: PMC6120488 DOI: 10.1111/nep.13113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 12/27/2022]
Abstract
AIM Many studies have validated Agatston's coronary artery calcification score (CACS) for assessing vascular calcification (VC) in chronic kidney disease (CKD) patients. This study aimed to evaluate the CACS and common iliac artery calcification score (IACS) and to examine the variables related to each score. METHODS The subjects were 145 non-dialysis CKD patients. The CACS and IACS were determined using the same thoracicoabdominal multi-detector computed tomography. Multiple regression analyses were performed to assess the factors associated with the CACS or IACS. The associations between progression to renal replacement therapy (RRT) and the CACS or IACS were studied using Cox hazards models. RESULTS The subjects' median age, estimated glomerular filtration rate (eGFR), and follow-up period were 72 (62-78) years, 32 (18-50) mL/min/1.73m2 , and 864 (550-1425) days, respectively. Age, diabetes, the serum phosphate level, and the eGFR were found to be significant factors of the CACS [β (95% CI): 0.38 (0.02-0.04), P < 0.0001, 0.28 (0.19-0.50), P < 0.0001, 0.16 (0.03-0.45), P < 0.05 and -0.15 (-0.02-0.00), P < 0.05, respectively]. Age and diabetes were shown to be significant factors of the IACS [β (95% CI): 0.53 (0.04-0.06), P < 0.0001, and 0.18 (0.07-0.40), P < 0.01, respectively]. Progression to RRT occurred in 31 patients and was significantly associated with the CACS (hazard ratio: 1.01, P < 0.01), urinary protein level and eGFR, but not the IACS. CONCLUSION Chronic kidney disease related risk factors for VC, such as the eGFR and hyperphosphataemia, are significantly associated with a high CACS, but not a high IACS, and the CACS is a significant predictor of progression to RRT.
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Affiliation(s)
- Sonoo Mizuiri
- Department of NephrologyIchiyokai Harada HospitalHiroshimaJapan
| | | | | | - Kenji Mizuno
- Department of RadiologyIchiyokai Harada HospitalHiroshimaJapan
| | - Masahiro Ishine
- Department of RadiologyIchiyokai Harada HospitalHiroshimaJapan
| | - Shigehiro Doi
- Department of NephrologyHiroshima University HospitalHiroshimaJapan
| | - Takao Masaki
- Department of NephrologyHiroshima University HospitalHiroshimaJapan
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Erbil D, Onal EM, Demirel C, Sag AA, Dagel T, Afsar B, Covic A, Kanbay M. Can Incidental Vascular Calcifications at Mammography be Used as a Screening Biomarker for Heart and Kidney Disease? Angiology 2018; 70:210-219. [PMID: 29886750 DOI: 10.1177/0003319718779322] [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: 11/15/2022]
Abstract
Mammography is a screening test with extensive international application and financial infrastructure promoting accessibility and affordability. Designed specifically to detect microcalcifications, mammography is powered to detect calcifications in vessel walls. Breast arterial calcifications (BAC) are one of the most common incidental findings documented by mammography. This review considers the literature regarding BAC in relation to cardiovascular disease (CVD) and its risk factors. The aim is to assess the possibility of using BAC as an early surrogate imaging biomarker of CVD.
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Affiliation(s)
- Damla Erbil
- Koc University School of Medicine, Istanbul, Turkey
| | - Emine M Onal
- Koc University School of Medicine, Istanbul, Turkey
| | | | - Alan A Sag
- Division of Interventional Radiology, Department of Radiology, Eastern Virginia School of Medicine, Norfolk, VA, USA.,Medical Center Radiologists, Virginia Beach, VA, USA
| | - Tuncay Dagel
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Adrian Covic
- Department of Nephrology, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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Petković N, Ristić S, Marinković J, Marić R, Kovačević M, Djukanović L. Differences in Risk Factors and Prevalence of Vascular Calcification between Pre-Dialysis and Hemodialysis Balkan Nephropathy Patients. ACTA ACUST UNITED AC 2018; 54:medicina54010004. [PMID: 30344235 PMCID: PMC6037237 DOI: 10.3390/medicina54010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/03/2022]
Abstract
Aims: The aim of this study was to compare the risk factors and prevalence of vascular calcification (VC) in pre-dialysis and hemodialysis (HD) patients with Balkan endemic nephropathy (BEN) or other kidney diseases (non-BEN). Materials and Methods: The study involved 115 patients, 32 pre-dialysis and 83 HD patients, separated into groups of BEN and non-BEN patients. In addition to interviews, objective examinations and laboratory analyses, VC was assessed using Adragao score. Results: Patients with BEN were significantly older in both groups, while pre-dialysis BEN patients had significantly lower systolic blood pressure, serum cholesterol and phosphorus levels, but higher urinary excretion of phosphorus than non-BEN patients. These differences were lost in HD groups. In pre-dialysis patients, prevalence of VC was lower in BEN than in non-BEN group and mean VC score differed significantly between them (2.8 (1.7) vs. 4.6 (1.8); p = 0.009). No significant difference in VC score was found between BEN and non-BEN patients on HD. Multivariate analysis showed that in pre-dialysis patients VC score >4 was associated with lower iPTH and higher serum cholesterol level, but in the HD group with higher serum triglyceride level and longer HD vintage. Conclusions: Lower prevalence of risk factors for VC in the BEN than non-BEN patients was found in pre-dialysis but not in HD group and this was reflected in the prevalence and severity of VC in the groups. Prevalence of VC and mean VC score were significantly lower in pre-dialysis BEN than in non-BEN patients but not for those on HD.
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Affiliation(s)
- Nenad Petković
- Fresenius Medical Care Dialysis Center, 76230 Šamac, The Republic of Srpska, Bosnia and Herzegovina.
| | - Siniša Ristić
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, The Republic of Srpska, Bosnia and Herzegovina.
| | | | - Radmil Marić
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, The Republic of Srpska, Bosnia and Herzegovina.
| | - Marijana Kovačević
- Faculty of Medicine, University of East Sarajevo, 73300 Foča, The Republic of Srpska, Bosnia and Herzegovina.
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14
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Li XY, Li QM, Fang Q, Zha XQ, Pan LH, Luo JP. Laminaria japonica Polysaccharide Inhibits Vascular Calcification via Preventing Osteoblastic Differentiation of Vascular Smooth Muscle Cells. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2018; 66:1821-1827. [PMID: 29415538 DOI: 10.1021/acs.jafc.7b06115] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aimed to investigate the effect and underlying mechanism of a purified Laminaria japonica polysaccharide (LJP61A) on preventing vascular calcification (VC). In the adenine-induced chronic renal failure (CRF) mice VC model and the β-glycerophosphate (β-GP)-induced vascular smooth muscle cells (VSMC) calcification model, LJP61A was found to significantly inhibit VC phenotypes as determined by biochemical analysis and von Kossa, alizarin red, and immunohistochemical staining. Meanwhile, LJP61A remarkably up-regulated the mRNA levels of VSMC related markers and down-regulated the mRNA levels of sodium-dependent phosphate cotransporter Pit-1. In addition, LJP61A could significantly decrease the protein levels of core-binding factor-1, osteocalcin, bone morphogenetic protein 2, and receptor activator for nuclear factor-κB ligand, and it can increase the protein levels of osteoprotegerin and matrix gla protein. These results indicated that LJP61A ameliorated VC both in vivo and in vitro via preventing osteoblastic differentiation of VSMC, suggesting LJP61A might be a potential therapeutic agent for VC in CRF patients.
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MESH Headings
- Animals
- Bone Morphogenetic Protein 2/genetics
- Bone Morphogenetic Protein 2/metabolism
- Cell Differentiation/drug effects
- Cells, Cultured
- Humans
- Laminaria/chemistry
- Male
- Mice
- Mice, Inbred C57BL
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Osteoblasts/cytology
- Osteoblasts/drug effects
- Osteoblasts/metabolism
- Osteocalcin/genetics
- Osteocalcin/metabolism
- Plant Extracts/administration & dosage
- Polysaccharides/administration & dosage
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/genetics
- Renal Insufficiency, Chronic/metabolism
- Renal Insufficiency, Chronic/physiopathology
- Vascular Calcification/drug therapy
- Vascular Calcification/genetics
- Vascular Calcification/metabolism
- Vascular Calcification/physiopathology
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Affiliation(s)
- Xue-Ying Li
- School of Biological and Medical Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
- School of Food Science and Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
| | - Qiang-Ming Li
- School of Food Science and Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
| | - Qing Fang
- School of Food Science and Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
| | - Xue-Qiang Zha
- School of Biological and Medical Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
- School of Food Science and Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
| | - Li-Hua Pan
- School of Food Science and Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
| | - Jian-Ping Luo
- School of Food Science and Engineering, Hefei University of Technology , Hefei 230009, People's Republic of China
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15
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Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study. Int Urol Nephrol 2018; 50:939-946. [PMID: 29441480 DOI: 10.1007/s11255-018-1821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/04/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment. METHODS We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6-160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q). RESULTS Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 ± 47 months (Q1), 87 ± 51 month (Q2), 66 ± 48 (Q3) and 54 ± 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles. CONCLUSION Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies.
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Viskovic K, Aslam M. Upper Extremity Medial Arterial Calcification and Peripheral Artery Disease in Asymptomatic Patients With Chronic Kidney Disease in Predialysis Stage. Angiology 2017; 69:406-415. [PMID: 28823179 DOI: 10.1177/0003319717725966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two types of peripheral artery disease (PAD) in asymptomatic patients with chronic kidney disease (CKD) can be detected by the use of duplex Doppler: medial arterial calcification (MAC) and occlusive PAD. The aim of this pilot study is to evaluate different types of subclinical PAD in upper extremities of patients with CKD. The prevalence of upper extremity MAC and occlusive PAD was investigated in 41 asymptomatic patients with CKD and 18 controls with normal kidney function, using duplex Doppler ultrasound, according to the vascular laboratory protocol. A mild-to-severe MAC was significantly more prevalent in patients with CKD compared to the control group ( P = .015), mostly in radial arteries (RAs; P = .002 and P = .016, respectively). The prevalence of occlusive PAD was not significantly different between the 2 groups ( P = .381). Patients in the CKD group were younger, nonsmokers, and more often had hypertension ( P = .038, P = .038, and P = .034, respectively). A duplex ultrasound screening for upper extremity subclinical PAD in patients with CKD in a predialysis stage may identify patients with mild-to-severe MAC which is important in surgery of hemodialysis access.
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Affiliation(s)
- Klaudija Viskovic
- 1 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Mohammed Aslam
- 2 Department of Surgery, Imperial College, London, United Kingdom
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17
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Ronzani FAT, Kirchmaier FM, Monteze NM, Magacho EJDC, Bastos MG, Fernandes NMDS. Routine mammography: an opportunity for the diagnosis of chronic degenerative diseases? A cross-sectional study. Radiol Bras 2017; 50:82-89. [PMID: 28428650 PMCID: PMC5396997 DOI: 10.1590/0100-3984.2015.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of this study was to evaluate breast arterial calcification (BAC)
detected on routine mammography, analyzing its association with chronic
degenerative disease. Materials and Methods This was a cross-sectional study involving women treated at a specialized
outpatient clinic for high-risk hypertension, diabetes, or chronic kidney
disease, as well as volunteers who participated in a study to validate a
method of screening for occult renal disease. A total of 312 patients
between 40 and 69 years of age, with no history of breast cancer, all of
whom had undergone routine mammography in the last two years, were included.
The mammograms were analyzed by researchers who were unaware of the risk
factors for BAC in each case. Results The mean age was 55.9 ± 7.4 years, and 64.3% of the patients were
white. The mean glomerular filtration rate was 41.87 ± 6.23
mL/min/1.73 m2. Seventy-one patients (22.8%) had BAC. We found
that BAC was associated with advanced age, hypertension, diabetes, chronic
kidney disease, and low glomerular filtration rate. In the multivariate
analysis, advanced age and diabetes continued to be associated with BAC. The
odds ratio for BAC was higher for all chronic diseases. Conclusion The association of BAC with advanced age, hypertension, diabetes, chronic
kidney disease, and low glomerular filtration rate should call the attention
of radiologists. Therefore, the presence of BAC should be reported, and
patients with BAC should be screened for those diseases.
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Affiliation(s)
- Flávio Augusto Teixeira Ronzani
- MSc, Assistant Professor in the Department of Clinical Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | - Filomena Maria Kirchmaier
- Nurse, Department of Clinical Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | - Nathália Mussi Monteze
- MD, Department of Clinical Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | - Marcus Gomes Bastos
- MD, PhD, Coordinator of the Interdisciplinary Center for Studies, Research, and Treatment in Nephrology, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
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18
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Ramirez-Sandoval JC, Casanova I, Villar A, Gomez FE, Cruz C, Correa-Rotter R. Biomarkers Associated with Vascular Calcification in Peritoneal Dialysis. Perit Dial Int 2015; 36:262-8. [PMID: 26293840 DOI: 10.3747/pdi.2014.00250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 12/06/2014] [Indexed: 01/07/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND Vascular calcification is strongly associated with cardiovascular disease and mortality. However, some factors related to vascular calcification in patients with end-stage renal disease receiving peritoneal dialysis (PD) remain unknown. This study aimed to evaluate the associations of osteoprotegerin (OPG), osteopontin (OPN), osteocalcin (OCN), fibroblast growth factor 23 (FGF-23), magnesium, and phosphate clearance with vascular calcification in PD subjects, assessed by plain radiographs. ♦ METHODS Simple vascular calcification scores (SVCS) obtained from plain X-rays of the pelvis and hands, and the Kauppila Index (KI) from lateral lumbar X-rays were assessed in 76 adults receiving PD for ≥ 6 months (43 women, median age 39 years, median time on PD 1.4 years). Levels of OPG, OPN, OCN, and FGF-23 were determined by luminometry. ♦ RESULTS Serum OPG levels were higher in subjects with vascular calcification (n = 22 with SVCS > 3; n = 19 with KI > 7) compared with those with less calcification (p < 0.001). Spearman's correlation coefficients between OPG and SVCS and KI were r = 0.49 and r = 0.51, respectively (both p < 0.001). Subjects with vascular calcification had significantly lower renal phosphate clearance. Multiple regression analysis showed that vascular calcification assessed by SVCS was associated with age (r = 0.2, p = 0.042), diabetes mellitus (r = 2.4, p < 0.001), body mass index (BMI) (r = 0.09, p = 0.037), and OPG (r = 0.22, p = 0.001). Vascular calcification assessed by KI was associated with age (r = 0.16, p < 0.001), time on PD (r = 0.54, p = 0.001) and OPG (r = 0.08, p = 0.04). Osteocalcin, OPN, FGF-23, and magnesium were not associated with vascular calcification. ♦ CONCLUSIONS Higher levels of OPG were consistently associated with vascular calcification in subjects on PD.
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Affiliation(s)
- Juan C Ramirez-Sandoval
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Ivan Casanova
- Department of Radiology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Alejandro Villar
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - F Enrique Gomez
- Department of Physiology of Nutrition, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Cristino Cruz
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
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Schlieper G, Schurgers L, Brandenburg V, Reutelingsperger C, Floege J. Vascular calcification in chronic kidney disease: an update. Nephrol Dial Transplant 2015; 31:31-9. [PMID: 25916871 DOI: 10.1093/ndt/gfv111] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/17/2015] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular calcification is both a risk factor and contributor to morbidity and mortality. Patients with chronic kidney disease (and/or diabetes) exhibit accelerated calcification of the intima, media, heart valves and likely the myocardium as well as the rare condition of calcific uraemic arteriolopathy (calciphylaxis). Pathomechanistically, an imbalance of promoters (e.g. calcium and phosphate) and inhibitors (e.g. fetuin-A and matrix Gla protein) is central in the development of calcification. Next to biochemical and proteinacous alterations, cellular processes are also involved in the pathogenesis. Vascular smooth muscle cells undergo osteochondrogenesis, excrete vesicles and show signs of senescence. Therapeutically, measures to prevent the initiation of calcification by correcting the imbalance of promoters and inhibitors appear to be essential. In contrast to prevention, therapeutic regression of cardiovascular calcification in humans has been rarely reported. Measures to enhance secondary prevention in patients with established cardiovascular calcifications are currently being tested in clinical trials.
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Affiliation(s)
- Georg Schlieper
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Leon Schurgers
- Department of Biochemistry, Faculty of Medicine, Health and Life Science, Maastricht, The Netherlands
| | | | - Chris Reutelingsperger
- Department of Biochemistry, Faculty of Medicine, Health and Life Science, Maastricht, The Netherlands
| | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
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Chen W, Melamed ML. Vascular calcification in predialysis CKD: common and deadly. Clin J Am Soc Nephrol 2015; 10:551-3. [PMID: 25770177 DOI: 10.2215/cjn.01940215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Wei Chen
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; and
| | - Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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Schlieper G, Hess K, Floege J, Marx N. The vulnerable patient with chronic kidney disease. Nephrol Dial Transplant 2015; 31:382-90. [DOI: 10.1093/ndt/gfv041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/25/2015] [Indexed: 11/14/2022] Open
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Moldovan D, Kacso IM, Rusu C, Potra A, Bondor CI, Moldovan I, Patiu IM, Vladutiu D, Caprioara MG. Role of osteoprotegerin in vascular disorders of the end-stage renal disease patients. Biomarkers 2015; 20:116-22. [PMID: 25585925 DOI: 10.3109/1354750x.2014.1000376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To assess the osteoprotegerin (OPG) relationship with cardiovascular complications in hemodialysis (HD) patients. METHODS The study included 87 HD patients. Clinical characteristics, ankle-arm index (AAI), OPG and mineral markers levels were recorded. Arterial intimal calcification (AIC) and arterial medial calcification (AMC) were registered. RESULTS OPG levels were increased in HD patients. Patients with AIC (p = 0.006)/ AMC (p = 0.01) had higher OPG levels. OPG did not have any relation with cardiovascular diseases. OPG correlated positively with age, increased HD vintage and inversely with albumin and AAI. OPG has not been a risk factor for VC or cardiovascular disease. CONCLUSION OPG rising could be a reaction in defense to vascular aggression, because OPG was associated with VC, but not with vascular disease.
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Zitt E, Knoll F, Lhotta K. Variable mechanisms of vascular calcification in different segments of the arterial tree in patients with chronic kidney disease. Kidney Int 2014; 86:858. [PMID: 25265960 DOI: 10.1038/ki.2014.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emanuel Zitt
- 1] Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria [2] Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Florian Knoll
- Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Karl Lhotta
- 1] Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria [2] Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
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