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Nishiyama Y, Otsuka T, Kato K, Saiki Y, Matsumoto N, Kimura K. Intima-Media Thickness in the Carotid Bifurcation is Related to Silent Brain Infarction: A Cross-Sectional Study. J Atheroscler Thromb 2024; 31:1293-1303. [PMID: 38447967 PMCID: PMC11374541 DOI: 10.5551/jat.64721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
AIMS Carotid intima-media thickness (IMT) measurement is used to assess subclinical atherosclerosis. We aimed to examine the association between the maximum IMT by location and the occurrence of silent brain infarction (SBI). METHODS Overall, 280 Japanese individuals (92 females, 52.6±5 years old) underwent a medical check-up at our hospital in Tokyo in 2015. Carotid IMT was measured at each site on ultrasound images (common carotid artery [CCA], internal carotid artery, or bifurcation). The risk factors for arterial dysfunction were evaluated. SBI was assessed using magnetic resonance imaging (MRI). The cross-sectional relationship between carotid maximum IMT and SBI was evaluated. RESULTS Of the 280 individuals, 18 (6.4%) were diagnosed with SBI on MRI. The mean age of the SBI(-) and SBI(+) groups was 51.9±10.6 and 63.6±18.6 years, respectively. The correlation coefficients between the carotid maximum IMT at each location were very weak (correlation coefficient range: 0.180-0.253). The percentage of participants with SBI increased significantly with increasing maximum CCA and bIMT values. After adjusting for confounders, SBI was found to be significantly associated with the maximum bIMT (per 0.1-mm increase) (adjusted odds ratio [aOR], 1.10; 95% confidence interval [CI]: 1.03-1.17). When bIMT was categorized according to three groups (<1.0 mm, 1.0-<2.0 mm, and ≥ 2.0 mm), a significant SBI risk was also observed with an increase by each category of bIMT (aOR: 3.96, 95% CI: 1.63-9.52, P=0.002). CONCLUSION The maximum bIMT was found to be the main determinant of SBI. A significant SBI risk was associated with an increase in each category of the maximum bIMT. Therefore, the maximum bIMT might be a useful predictor of future stroke in Japanese stroke-free medical check-up participants.
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Affiliation(s)
- Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Graduate School of Medicine, Nippon Medical School
| | - Katsuhito Kato
- Department of Hygiene and Public Health, Graduate School of Medicine, Nippon Medical School
| | - Yoshiyuki Saiki
- Department of Hygiene and Public Health, Graduate School of Medicine, Nippon Medical School
| | - Noriko Matsumoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School
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Bitla A, Manual M, Medooru K, Yadagiri L, Vanajakshamma V, Ram R, Vishnubotla S. Correlates of atherosclerotic vascular disease in stable postrenal transplant patients from South India. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Yamaoka M, Yoshida M, Nakashima A, Doi S, Naito T, Masaki T. N-terminal pro-brain natriuretic peptide predicts hospitalization for ischemic stroke in Japanese hemodialysis patients. Clin Exp Nephrol 2022; 26:1111-1118. [PMID: 35838853 DOI: 10.1007/s10157-022-02254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and stroke in Japanese hemodialysis (HD) outpatients is unclear. Therefore, in this study, we investigate whether high NT-proBNP levels are associated with future stroke events in this population. METHODS This was a multicenter prospective observational study with post hoc analysis. Baseline NT-proBNP levels were measured at the first HD session of the week and classified into tertiles (first tertile: < 2255 pg/mL; second tertile: ≥ 2255 and < 5657 pg/mL; third tertile: ≥ 5657 pg/mL). Overall hospitalization-free survival rates were compared using the Kaplan-Meier method. The association between NT-proBNP level and hospitalization for stroke was assessed using the multivariate Cox proportional hazards models. RESULTS During a 5-year follow-up of 1,229 patients, 103 (8.4%) were hospitalized and 23 (1.9%) died from stroke. The hospitalization-free survival rate for ischemic stroke was lowest in the third tertile (P < 0.01). The crude hazard ratio (HR) of hospitalization was higher in the third tertile compared with the first tertile for both ischemic stroke (HR: 3.92; 95% confidence interval [CI] 2.08-7.37; P < 0.01) and hemorrhagic stroke (HR: 3.75; 95% CI 1.35-10.43; P = 0.01). On multivariate Cox hazard analysis, the adjusted HRs for ischemic stroke were higher in the third tertile. The hospitalization-free survival rates for hemorrhagic stroke and the adjusted HRs did not differ significantly. CONCLUSIONS Elevated NT-proBNP level was associated with hospitalization for ischemic stroke, suggesting that NT-proBNP level is a valid biomarker for predicting hospitalization for ischemic stroke in HD outpatients.
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Affiliation(s)
- Mai Yamaoka
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mahoko Yoshida
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. .,Health Service Center, Hiroshima University, Higashihiroshima, Japan.
| | - Ayumu Nakashima
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | | | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Hayase T. The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Peripheral Arterial Disease. Pulse (Basel) 2021; 9:11-16. [PMID: 34722351 DOI: 10.1159/000515357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/13/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction The cardio-ankle vascular index (CAVI) is a well-known index to evaluate arterial stiffness and predict cardiovascular risk. Methods We investigated whether CAVI can predict severity and extent of peripheral arterial disease. This study was a single-center, retrospective, observational study approved by the Ethics Committee of Yokohama Shintoshi Neurosurgical Hospital. A total of 96 patients (males, 63) with an abnormal ankle-brachial blood pressure index (ABI) of <0.9 and who underwent extremity arteriography at our hospital from 2015 to 2018 were enrolled in this study. We defined that CAVI with a range of <8.0 was normal. Results Coronary angiography and extremity arteriography were performed for patients who had intermittent claudication and abnormal ABI. We divided the affected limbs into 3 categories: above-the-knee artery stenosis, above-the-knee artery chronic total occlusion, and only below-the-knee artery stenosis/occlusion groups. CAVI pseudonormalization was seen in 28, 76, and 19%, respectively. The above-the-knee artery stenosis and the only below-the-knee artery stenosis/occlusion groups had a high odds ratio of abnormalization of CAVI (3.1, 95% confidence interval [CI]: 1.39-7.22; p = 0.05, 4.56, 95% CI: 1.64-14.7). Discussion/Conclusion In the presence of the above-the-knee artery chronic total occlusion, CAVI pseudonormalization was likely to be seen. The presence of CTO in the above-the-knee artery is one cause of pseudonormalized CAVI. In the range of ABI, in which stenotic lesions and obstructive lesions coexist, it may be possible to detect the existence of CTO by a combination of both ABI and CAVI.
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Affiliation(s)
- Taichiro Hayase
- Department of Cardiology, Yokohamashintoshi Neurosurgical Hospital, Yokohama, Japan
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Liu F, Wang Z, Cao X, Pan Y, Zhang E, Zhou J, Zheng L. Relationship between small dense low-density lipoprotein cholesterol with carotid plaque in Chinese individuals with abnormal carotid artery intima-media thickness. BMC Cardiovasc Disord 2021; 21:216. [PMID: 33906606 PMCID: PMC8080368 DOI: 10.1186/s12872-021-02023-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Aim To investigate the relationship of small dense low-density lipoprotein cholesterol (sdLDL-C) to carotid artery intima-media thickness (CA-IMT) and carotid plaque (CAP) in Chinese general population, and to evaluate whether sdLDL-C could be an independent risk factor for individuals with subclinical atherosclerosis. Methods A total of 729 subjects were randomly collected from consecutive individuals from April 2019 to April 2020 for an annual health checkup. CA-IMT > 1.0 mm was defined as abnormal IMT. Plaque stability was measured by ultrasound examination based on the property of the echo. And sdLDL-C levels were detected by LipoPrint system. Multivariate logistic regression analysis was performed to identify factors associated with CA-IMT and carotid plaque. Results The abnormal IMT group had significantly higher sdLDL-C levels than control group (p < 0.0001). And sdLDL-C levels were significantly positively correlated with IMT value (r = 0.1396, p = 0.0021) and presence of carotid plaque (r = 0.14, p = 0.002) in the subjects with abnormal IMT. In addition, subjects with higher levels of sdLDL-C (r = 0.11, p = 0.035) tended to have unstable CAP. After adjustment for age, gender and blood glucose, sdLDL-C level was an independent risk factor of the presence of CAP (OR = 1.59, 95% CI: 1.02–1.83, p = 0.034) in subjects with abnormal IMT. Conclusion SdLDL-C is an independent risk factor of the occurrence of CAP in the Chinese subjects with abnormal IMT. Our findings provide supporting evidence that sdLDL-C might be an alternative way to predict CVD in early stage.
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Affiliation(s)
- Fang Liu
- Health Management Centre, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China
| | - Zheng Wang
- Health Management Centre, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China
| | - Xia Cao
- Health Management Centre, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China
| | - Yingxia Pan
- Shanghai Zhangjiang Institue of Medical Innovation, Shanghai Biotecan Pharmaceuticals Co., Ltd, Shanghai, 201204, China
| | - Erqiang Zhang
- Shanghai Zhangjiang Institue of Medical Innovation, Shanghai Biotecan Pharmaceuticals Co., Ltd, Shanghai, 201204, China
| | - Jiahuan Zhou
- Shanghai Zhangjiang Institue of Medical Innovation, Shanghai Biotecan Pharmaceuticals Co., Ltd, Shanghai, 201204, China.
| | - Lina Zheng
- Health Management Centre, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China.
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Asicioglu E, Velioglu A, Arikan H, Koc M, Tuglular S, Ozener C. Baseline carotid intima-media thickness is associated with cardiovascular morbidity and mortality in peritoneal dialysis patients. Ther Apher Dial 2021; 25:962-969. [PMID: 33511768 DOI: 10.1111/1744-9987.13629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 12/19/2022]
Abstract
Carotid intima-media thickness (CIMT) is an early marker of atherosclerosis and is increased in peritoneal dialysis (PD) patients. Association of CIMT with cardiovascular disease (CVD) or mortality is less clear. Fibroblast growth factor-23 (FGF-23) is a hormone associated with vascular calcification, atherosclerosis, and mortality in the hemodialysis population. We investigated whether baseline CIMT and FGF-23 are associated with CVD and mortality in PD patients. Fifty-five PD patients were included. CVD was defined as ischemic heart disease, stroke, or peripheral artery disease. Intact FGF-23 was measured in plasma. CIMT was measured by ultrasonography. Twenty-one patients developed CVD and 12 died over 47.1 ± 33.8 months. Patients with CVD were older (55.9 ± 10.5 vs. 42.5 ± 12.9 years, P < .01), had lower albumin (3.8 ± 0.5 vs. 4.2 ± 0.3 g/dL, P < .01) and higher CIMT (0.87 ± 0.22 vs. 0.61 ± 0.11 mm, P < .01). Patients with mortality were also older (53.5 ± 11.5 vs. 45.8 ± 13.8 years, P = .05), had lower albumin (3.7 ± 0.6 vs. 4.1 ± 0.3 g/dL, P < .01), higher CRP (15.0 ± 8.5 vs. 7.6 ± 8.4 mg/L, P < .01) and CIMT (0.9 ± 0.3 vs. 0.6 ± 0.1 mm, P < .01). Albumin and CIMT were associated with CVD and CIMT > 0.75 mm was associated with cardiovascular mortality. FGF-23 did not show any correlations. CIMT at baseline is associated with CVD and mortality in PD patients.
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Affiliation(s)
- Ebru Asicioglu
- Department of Nephrology, Marmara University Pendik Teaching Hospital, Istanbul, Turkey
| | - Arzu Velioglu
- Department of Nephrology, Marmara University Pendik Teaching Hospital, Istanbul, Turkey
| | - Hakki Arikan
- Department of Nephrology, Marmara University Pendik Teaching Hospital, Istanbul, Turkey
| | - Mehmet Koc
- Department of Nephrology, Marmara University Pendik Teaching Hospital, Istanbul, Turkey
| | - Serhan Tuglular
- Department of Nephrology, Marmara University Pendik Teaching Hospital, Istanbul, Turkey
| | - Cetin Ozener
- Department of Nephrology, Marmara University Pendik Teaching Hospital, Istanbul, Turkey
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Keryakos HKH, Okaily NI, Boulis MAY, Salama AMS. Osteocalcin and vascular calcification in hemodialysis patients: an observational cohort study. Int Urol Nephrol 2021; 53:1015-1023. [PMID: 33433789 DOI: 10.1007/s11255-020-02753-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vascular calcification contributes to morbidity and mortality in patients with ESRD on maintenance hemodialysis. AIMS To study the relationship between osteocalcin and vascular calcification. METHODS 160 patients with ESRD on maintenance hemodialysis and 60 age-and sex-matched healthy controls were recruited. Serum vitamin K2 and osteocalcin both intact and undercarboxylated were measured. Transthoracic echocardiography was done for valvular calcification and thickening, and carotid duplex was done for carotid intimal medial calcification and thickening. RESULTS Hemodialysis patients have higher median serum vitamin K2 (p < 0.001), higher undercarboxylated osteocalcin (p < 0.001). Only older age, duration of hypertension, and duration of established cardiovascular disease are associated with carotid media-intimal calcification. Old age is a strong predictor of carotid media intimal thickening. Female sex is associated with a valvular thickening. CONCLUSIONS Functional vitamin K deficiency is present in maintenance hemodialysis patients and serum osteocalcin is not associated with cardiovascular calcification.
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Affiliation(s)
- Hesham Kamal Habeeb Keryakos
- Internal Medicine Department, Faculty of Medicine, Minia University, Aswan-Cairo Agricultural Road, El-Minia, 61111, Egypt.
| | - Nagwa Ismail Okaily
- Clinical Pathology Department, Faculty of Medicine, Minia University, El-Minia, Egypt
| | - Mariam Asaad Yacoub Boulis
- Internal Medicine Department, Faculty of Medicine, Minia University, Aswan-Cairo Agricultural Road, El-Minia, 61111, Egypt
| | - Ahmed Mohamed Saadeldin Salama
- Internal Medicine Department, Faculty of Medicine, Minia University, Aswan-Cairo Agricultural Road, El-Minia, 61111, Egypt
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Chen Y, Shang D, Shao J, Dai S, Ge X, Hao C, Zhu T. Prognostic significance of carotid plaque presence in peritoneal dialysis patients and its association with the apolipoprotein B/apolipoprotein A1 ratio. Nephrology (Carlton) 2020; 25:919-928. [PMID: 32691473 DOI: 10.1111/nep.13759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
AIM Atherosclerosis has been reported as a risk factor for cardiovascular disease in the general population. As a phenotype of atherosclerosis, carotid plaque and its influence factors are rarely discussed among dialysis patients. The study aimed to investigate the prognosis-predictive significance of carotid plaques in patients on peritoneal dialysis (PD), and explore risks factors for carotid plaque presence. METHODS It was an observational, prospective study. Patients that had undergone stable PD for at least 3 months were recruited and divided into two subgroups: group with carotid plaques and group without carotid plaques. Cox regression model was used to identify independent predictors of all-cause mortality, cardiovascular events (CVEs), and cardiovascular mortality. Pathogenic factors correlated to the plaque-occurrence were explored by logistic regression and verified by receiver operating characteristic (ROC) curve analysis. RESULTS A total of 233 PD patients were recruited. The cohort was followed for up to 86 months. The carotid plaque presence turned out to be an independent risk factor both of CVEs [hazard ratio (HR): 2.659; 95% confidence interval (CI): 1.231-5.741; P = .013] and cardiovascular mortality (HR: 3.716; 95% CI: 1.168-11.823; P = .026). The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio was significantly associated with the presence of carotid plaques. ROC analysis indicated that the area under the curve of the ApoB/ApoA1 ratio was higher than that of the traditional lipid metabolism index for detecting plaque presence. CONCLUSION Carotid plaque presence can predict CVEs and cardiovascular mortality in PD patients. The ApoB/ApoA1 ratio is significantly correlated to the carotid plaques and the ApoB/ApoA1 ratio had a greater sensitivity than traditional lipid indices for predicting plaque presence.
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Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Da Shang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Shao
- Division of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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Kouis P, Kousios A, Kanari A, Kleopa D, Papatheodorou SI, Panayiotou AG. Association of non-invasive measures of subclinical atherosclerosis and arterial stiffness with mortality and major cardiovascular events in chronic kidney disease: systematic review and meta-analysis of cohort studies. Clin Kidney J 2019; 13:842-854. [PMID: 33542824 PMCID: PMC7849940 DOI: 10.1093/ckj/sfz095] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/05/2019] [Indexed: 01/17/2023] Open
Abstract
Background Non-invasive cardiovascular disease (CVD) risk prediction, in subclinical stages, aiming to stratify patients and tailor interventions remains an unmet need in chronic kidney disease (CKD). In this meta-analysis, we summarize the association of carotid intima-media thickness (cIMT), coronary artery calcium score (CACS) and pulse wave velocity (PWV) with all-cause mortality, cardiovascular (CV) mortality and CV events in non-dialysis CKD and patients on haemodialysis. Methods Systematic review and meta-analysis of prospective cohort studies. Results Out of 27 984 records, a total of 45 studies were eligible for quantitative synthesis; 11 for cIMT, 18 for CACS and 16 for PWV involving 2235, 4904 and 5717 patients, respectively. Meta-analysis was possible from pooled data of five cIMT studies (708 subjects), eight CACS studies (862 subjects) and nine PWV studies (1508 subjects). In dialysis patients, cIMT was associated with all-cause mortality [relative risk (RR) per unit increase: 1.08, 95% confidence interval (CI) 1.00-1.17, I 2: 68%] and CV mortality (RR: 1.29, 95% CI 1.14-1.47, I 2: 0%). High versus low CACS was associated with all-cause mortality (RR: 2.51, 95% CI 1.66-3.79, I 2: 5.7%) and CV events (RR: 3.77 95% CI 2.16-6.58, I 2: 20.2%). High versus low PWV was associated with all-cause (RR: 5.34, 95% CI 3.01-9.47, I 2: 0%) and CV mortality (RR: 8.55, 95% CI 4.37-16.73, I 2: 0%). The combined estimated for all-cause mortality per 1 m/s increment unit in PWV was 1.25 (95% CI 1.17-1.34, I 2: 0%) and for CV mortality was 1.24 (95% CI 1.16-1.34, I 2: 15.5%). In non-dialysis patients, CACS was associated with CV events (RR: 4.02, 95% CI 1.57-10.29, I 2: 63.4%). High versus low PWV was associated with all-cause mortality (RR: 2.52, 95% CI 1.40-4.55, I 2: 62.6%). Conclusions Non-invasive measures of atherosclerosis and arterial stiffening are associated with all-cause and CV mortality as well as CV events among patients with all stages of CKD. These markers could be considered for the evaluation of CV morbidity and mortality risks. Moreover, the results of this meta-analysis support the study of interventions, with effect on these markers of vascular disease, on long-term CVD outcomes.
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Affiliation(s)
- Panayiotis Kouis
- Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.,Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Andreas Kousios
- Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.,Renal and Transplant Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Athina Kanari
- Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Daphne Kleopa
- Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Stephania I Papatheodorou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Andrie G Panayiotou
- Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
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Valdivielso JM, Rodríguez-Puyol D, Pascual J, Barrios C, Bermúdez-López M, Sánchez-Niño MD, Pérez-Fernández M, Ortiz A. Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different? Arterioscler Thromb Vasc Biol 2019; 39:1938-1966. [PMID: 31412740 DOI: 10.1161/atvbaha.119.312705] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of premature mortality, mainly from cardiovascular causes. The association between CKD on hemodialysis and accelerated atherosclerosis was described >40 years ago. However, more recently, it has been suggested that the increase in atherosclerosis risk is actually observed in early CKD stages, remaining stable thereafter. In this regard, interventions targeting the pathogenesis of atherosclerosis, such as statins, successful in the general population, have failed to benefit patients with very advanced CKD. This raises the issue of the relative contribution of atherosclerosis versus other forms of cardiovascular injury such as arteriosclerosis or myocardial injury to the increased cardiovascular risk in CKD. In this review, the pathophysiogical contributors to atherosclerosis in CKD that are shared with the general population, or specific to CKD, are discussed. The NEFRONA study (Observatorio Nacional de Atherosclerosis en NEFrologia) prospectively assessed the prevalence and progression of subclinical atherosclerosis (plaque in vascular ultrasound), confirming an increased prevalence of atherosclerosis in patients with moderate CKD. However, the adjusted odds ratio for subclinical atherosclerosis increased with CKD stage, suggesting a contribution of CKD itself to subclinical atherosclerosis. Progression of atherosclerosis was closely related to CKD progression as well as to the baseline presence of atheroma plaque, and to higher phosphate, uric acid, and ferritin and lower 25(OH) vitamin D levels. These insights may help design future clinical trials of stratified personalized medicine targeting atherosclerosis in patients with CKD. Future primary prevention trials should enroll patients with evidence of subclinical atherosclerosis and should provide a comprehensive control of all known risk factors in addition to testing any additional intervention or placebo.
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Affiliation(s)
- José M Valdivielso
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Diego Rodríguez-Puyol
- Nephrology Unit, Fundación para la investigación del Hospital Universitario Príncipe de Asturias, RedInRen, Alcalá de Henares, Madrid, Spain (D.R.-P.)
| | - Julio Pascual
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Clara Barrios
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Marcelino Bermúdez-López
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Maria Dolores Sánchez-Niño
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
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Niwa H, Takahashi K, Dannoura M, Oomori K, Miyoshi A, Inada T, Miyoshi H. The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index with Macroangiopathy in Patients with Type 2 Diabetes Mellitus. J Atheroscler Thromb 2018; 26:616-623. [PMID: 30487347 PMCID: PMC6629746 DOI: 10.5551/jat.45674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS This study elucidates the association of macroangiopathy development in type 2 diabetes patients with various arteriosclerosis risk factors (ARFs) and results of cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI). METHODS The correlation between current and past macroangiopathy development, with ARFs or CAVI/ABI data, was retrospectively analyzed using multivariate logistic regression in 816 patients with type 2 diabetes at a single center. C-statistics combining some independent variables selected using the stepwise method were evaluated. RESULTS CAVI was significantly correlated with macroangiopathies, including coronary artery disease (CAD), arteriosclerosis obliterans (ASO), and stroke with odds ratios (OR) of 1.20, 1.22, and 1.19, respectively. ABI significantly correlated with ASO and stroke with respective OR of 13.6 and 2.47, but not with CAD. Areas under the receiver operating characteristic curves (ROCs) revealed the accuracy of detecting ASO and stroke was increased by the combination of CAVI+ABI (0.94 and 0.74, respectively). However, areas under the ROC for the presence of CAD can be increased by the combination of CAVI and ARFs especially including dyslipidemia. CONCLUSION CAVI/ABI and some ARFs are useful tools in daily clinical care units to identify the current and past existence of macroangiopathy in patients with type 2 diabetes, but the prediction weights using these factors were different among CAD, ASO, and stroke.
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Affiliation(s)
| | - Kiyohiko Takahashi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Midori Dannoura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kazuno Oomori
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Arina Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | | | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.,Division of Diabetes and Obesity, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
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12
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Sipahi S, Genc AB, Acikgoz SB, Yildirim M, Aksoy YE, Vatan MB, Dheir H, Altındis M. Relationship of salusin-alpha and salusin-beta levels with atherosclerosis in patients undergoing haemodialysis. Singapore Med J 2018; 60:210-215. [PMID: 30311629 DOI: 10.11622/smedj.2018123] [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] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In patients undergoing haemodialysis, cardiovascular mortality and morbidity, characterised by accelerated atherosclerosis and increased inflammation, are elevated. Salusins are newly defined molecules in the atherosclerotic processes, and while salusin-alpha (Sal-α) acts as an antiatherogenic factor, salusin-beta (Sal-β) has a proatherogenic role. Their roles are as yet undefined in patients undergoing haemodialysis. METHODS In this cross-sectional study, salusin levels, carotid intima-media thickness (CIMT) from the common carotid artery and pulse wave velocity (PWV) were measured for 180 patients undergoing haemodialysis and 90 healthy controls. RESULTS Mean Sal-α and Sal-β levels in patients undergoing haemodialysis (Sal-α: 726.4 ± 578.7 pg/mL; Sal-β: 1,080.4 ± 757.1 pg/mL) and healthy controls (Sal-α: 325.8 ± 303.7 pg/mL; Sal-β: 268.1 ± 409.0 pg/mL) were determined. Negative correlation was observed between Sal-α levels and CIMT (patients undergoing haemodialysis: r = -0.330, p < 0.0001; healthy controls: r = -0.223, p = 0.035) and PWV (patients undergoing haemodialysis: r = -0.210, p = 0.005; healthy controls: r = -0.378, p < 0.0001) in both groups. In patients undergoing haemodialysis, positive correlation was observed between Sal-β/Sal-α ratio and CIMT (r = 0.190, p = 0.012) and PWV (r = 0.155, p = 0.041). On subgroup analysis, Sal-α levels were found to be low in patients with diabetes mellitus. CONCLUSION Patients undergoing haemodialysis have higher Sal-β and Sal-α levels, and their higher Sal-β/Sal-α ratio, in comparison with healthy controls, might have cardiovascular risk implications.
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Affiliation(s)
- Savas Sipahi
- Department of Internal Medicine, Division of Nephrology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ahmed Bilal Genc
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Seyyid Bilal Acikgoz
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mehmet Yildirim
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Yakup Ersel Aksoy
- Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mehmet Bulent Vatan
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Hamad Dheir
- Department of Internal Medicine, Division of Nephrology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mustafa Altındis
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
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13
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Dozio E, Corradi V, Proglio M, Vianello E, Menicanti L, Rigolini R, Caprara C, de Cal M, Corsi Romanelli MM, Ronco C. Usefulness of glycated albumin as a biomarker for glucose control and prognostic factor in chronic kidney disease patients on dialysis (CKD-G5D). Diabetes Res Clin Pract 2018; 140:9-17. [PMID: 29596954 DOI: 10.1016/j.diabres.2018.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 12/17/2022]
Abstract
In chronic kidney disease patients on dialysis (CKD-G5D) accurate assessment of glycemic control is vital to improve their outcome and survival. The best glycemic marker for glucose control in these patients is still debated because several clinical and pharmacological factors may affect the ability of the available biomarkers to reflect the patient's glycemic status properly. This review discusses the role of glycated albumin (GA) both as a biomarker for glucose control and as a prognostic factor in CKD-G5D; it also looks at the pros and cons of GA in comparison to the other markers and its usefulness in hemodialysis and peritoneal dialysis.
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Affiliation(s)
- Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Valentina Corradi
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marta Proglio
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Elena Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Roberta Rigolini
- Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Carlotta Caprara
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
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14
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Zhao D, Shao H. Effect of blood purification on serum miR-126 and VEGF levels in the process of atherosclerosis in uremic patients under maintenance hemodialysis. Kaohsiung J Med Sci 2018; 34:447-455. [PMID: 30041762 DOI: 10.1016/j.kjms.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/06/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022] Open
Abstract
This study aims to study the influence of different blood purification approaches on the expression of miR-126 and VEGF serum levels in the development of atherosclerosis in uremic patients under maintenance hemodialysis (MHD). A total of 207 MHD patients with uremia were divided into HD (hemodialysis, n = 60), HDF (hemodiafiltration, n = 72), and HD + HP (hemodialysis + hemoperfusion, n = 75) groups based on different purification approaches. Eighty individuals who underwent physical examinations during the same period constituted the healthy controls. The serum levels of miR-126 and VEGF were examined by qRT-PCR and ELISA both before and after treatment, and the intima media thickness (IMT) value and plaque area were evaluated by color Doppler ultrasound. The serum miR-126 level was down-regulated in MHD patients compared with healthy controls, and this was negatively linked to VEGF. The post-treatment expression level of serum miR-126 in the HDF and HD + HP groups was remarkably increased, but VEGF was decreased in MHD patients, and especially significantly in the HDF group. In addition, IMT and plaque area were obviously improved in the HD group after treatment. Pearson correlation analysis showed a negative correlation of miR-126 with IMT and plaque area, but a positive association between VEGF and IMT and plaque area. miR-126 and VEGF are expected to become a valuable biomarker for monitoring the progression of atherosclerosis in uremic patients undergoing MHD.
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Affiliation(s)
- Dong Zhao
- Department of Nephrology, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Hong Shao
- Department of Nephrology, Jining No. 1 People's Hospital, Jining, Shandong, China.
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15
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Allawi AAD. Malnutrition, inflamation and atherosclerosis (MIA syndrome) in patients with end stage renal disease on maintenance hemodialysis (a single centre experience). Diabetes Metab Syndr 2018; 12:91-97. [PMID: 28964721 DOI: 10.1016/j.dsx.2017.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inflammation and malnutrition play an important role in endothelial dysfunction, atherosclerosis and excessive cardiovascular morbidity and mortality in ESRD patients AIM OF THE STUDY: The primary objective is to determine the prevalence of inflammation, malnutrition and atherosclerosis in patients on maintenance haemodialysis. Secondary objective was to determine the association for atherosclerosis with inflammation and malnutrition. PATIENT AND METHODS One hundred and one adult patients with end stage renal disease on maintenance haemodialysis who are met with the exclusion criteria were enrolled in this cross sectional study from haemodialysis unit of Baghdad teaching hospital over the period of July/2015 - June 2016. All patients were thoroughly examined and many variables were evaluated (age, gender, blood pressure, diabetes mellitus, serum lipid profile, smoking habits, serum albumin, CRP, calcium, Phosphate, Parathyroid hormone and haemoglobin measurements). All patients underwent a carotid Doppler ultrasound study. RESULTS Atherosclerosis was present in 65.3%: 58.4% of patients had malnutrition and 43.6% had inflammation. The association for atherosclerosis and high CRP and low serum albumin is strong and independent of other atherosclerosis risk factors. There is significant inverse and independent correlation between CRP and albumin. CONCLUSION Inflammation (high serum CRP) and malnutrition (low serum albumin) in patients on haemodialysis are significantly associated with carotid atherosclerosis. Inflammation was more prevalent in the malnourished patients than in those with normal nutritional status.
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Affiliation(s)
- Ali Abdulmajid Dyab Allawi
- FRCP London, Assistant Professor Baghdad College of Medicine, University of Baghdad, Consultant Nephrologist and Transplant Physcian, Baghdad, Iraq.
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16
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Borràs Sans M, Pérez-Fontán M, Martinez-Alonso M, Bajo A, Betriu À, Valdivielso JM, Fernández E. The modality of dialysis does not influence atheromatous vascular disease progression or cardiovascular outcomes in dialysis patients without previous cardiovascular disease. PLoS One 2017; 12:e0186921. [PMID: 29095847 PMCID: PMC5667854 DOI: 10.1371/journal.pone.0186921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/10/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is limited and inconclusive information regarding the influence of the modality of renal replacement therapy on the atherosclerotic burden of patients on dialysis. The aim of this study was to compare the prevalence of asymptomatic atheromatous carotid disease, as also its rate of progression and cardiovascular outcomes, in two matched populations of patients treated with hemodialysis (HD) and peritoneal dialysis (PD). METHODS Following a prospective, observational and multicenter design, we compared 237 PD and 237 HD patients without previous cardiovascular disease, included in the NEFRONA study, and matched for age, sex, diabetes and time on dialysis. Carotid ultrasound study was performed at baseline and after two years of follow-up in 6 carotid territories. Atheromatous vascular disease (AVD) progression was defined as any increase in the number of territories with plaques after 2 years. Fatal and non fatal cardiovascular events were also recorded during 36-month of follow-up. MAIN RESULTS At baseline, PD patients presented a worse general cardiovascular risk profile than HD patients. On the contrary, some markers of prevalent atherosclerotic disease (common carotid intima-media thickness and ankle-brachial index) were more favorable in PD patients. During follow-up, we observed no differences either in the rate of progression of atheromatous vascular disease (OR 1.78, 95% CI 0.80-4.06, p = 0.161) or in the incidence of cardiovascular events (OR 1.51, 95% CI 0.85-2.66, p = 0.159), according to the modality of dialysis. CONCLUSION Dialysis modality did not impact on atherosclerotic carotid disease progression or cardiovascular outcomes, in two groups of patients treated with PD or HD.
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Affiliation(s)
- Mercè Borràs Sans
- Department of Nephrology, University Hospital Arnau de Vilanova de Lleida, Lleida,Spain
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | | | - Montserrat Martinez-Alonso
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Auxiliadora Bajo
- Department of Nephrology, University Hospital La Paz, REDinREN del ISCIII, Madrid, Spain
| | - Àngels Betriu
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - José M. Valdivielso
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Elvira Fernández
- Department of Nephrology, University Hospital Arnau de Vilanova de Lleida, Lleida,Spain
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
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17
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Lee JY, Kim YO. Pre-existing arterial pathologic changes affecting arteriovenous fistula patency and cardiovascular mortality in hemodialysis patients. Korean J Intern Med 2017; 32:790-797. [PMID: 28823140 PMCID: PMC5583462 DOI: 10.3904/kjim.2017.268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/06/2017] [Indexed: 01/07/2023] Open
Abstract
The radiocephalic arteriovenous fistula (AVF) provides optimal vascular access for hemodialysis; it has a higher long-term patency rate and fewer complications than other vascular access methods. However, the AVF has a high primary failure rate. The presence of small-diameter vessels at anastomosis sites is an important risk factor for AVF failure. However, in a recent study, despite selecting an adequate artery and vein for creating an AVF by routine preoperative vascular mapping, AVF maturation and primary failure occurred. Thus, pre-existing arteriosclerosis at AVF anastomosis sites likely contributes to AVF failure. In this review, we discuss the relationship between pathologic changes and AVF patency in hemodialysis patients. Because arteriosclerosis of the major arteries such as the coronary and carotid arteries is associated with cardiovascular mortality, we also review the impact of arteriosclerosis of upper arm arteries at AVF anastomosis sites on cardiovascular mortality in hemodialysis patients.
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Affiliation(s)
| | - Young Ok Kim
- Correspondence to Young Ok Kim, M.D. Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 11765, Korea Tel: +82-31-820-3347 Fax: +82-31-820-2719 E-mail:
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18
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Rroji M, Spahia N, Seferi S, Barbullushi M, Spasovski G. Influence of Residual Renal Function in Carotid Modeling as a Marker of Early Atherosclerosis in Dialysis Patients. Ther Apher Dial 2017; 21:451-458. [PMID: 28714271 DOI: 10.1111/1744-9987.12548] [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] [Received: 12/04/2016] [Revised: 01/19/2017] [Indexed: 11/27/2022]
Abstract
Atherosclerosis is frequently present in patients with chronic kidney disease (CKD) treated with dialysis. We evaluated the association between residual renal function (RRF), phosphate level, inflammation and other risk factors in carotid modeling as a marker of early atherosclerosis in peritoneal dialysis (PD) compared with hemodialysis (HD) patients. We studied 39 stable PD and 53 HD patients on renal replacement therapy (RRT) for 3 to 36 months duration. B-mode ultrasonography was used to determine carotid artery intima media thickness (CIMT). We classified patients with atherosclerosis if they have CIMT >10 mm and or presence of plaque. Out of our total dialysis population studied of 92 patients, 16.3% were diabetics and 57.6% were on hemodialysis. Expectedly, PD patients had a higher RRF (P < 0.001), 24 h urine volume (P < 0.001); C-reactive protein (P = 0.047), and a lower serum phosphate (P = 0.01), PTH (P < 0.05), alkaline phosphatase (P < 0.05), and albumin levels (P < 0.001) compared to hemodialysis patients. Atherosclerosis was found in 66.3% of patients and in 100% of a diabetic population. There was no significant difference in the presence of atherosclerosis between PD and HD patients [56.4 vs 73.6% HD, respectively]. Multiple regression analysis showed age, diabetes, HD modality, RRF, phosphate, PTH and pulse pressure as independent parameters associated with atherosclerosis. Apart from the traditional risk factors like age and diabetes, our study showed a link of atherosclerosis with metabolic abnormalities secondary to renal failure. We demonstrated a novel, independent association between RRF and atherosclerosis, underlining the importance of preservation of the RRF in dialysis patients.
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Affiliation(s)
- Merita Rroji
- Department of Nephrology-Dialysis, UHC "Mother Teresa", Tirana, Albania
| | - Nereida Spahia
- Department of Nephrology-Dialysis, UHC "Mother Teresa", Tirana, Albania
| | - Saimir Seferi
- Department of Nephrology-Dialysis, UHC "Mother Teresa", Tirana, Albania
| | | | - Goce Spasovski
- University Department of Nephrology, Medical Faculty, University of Skopje, Skopje, Macedonia
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19
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Kirushnan BB, Rao BS, Annigeri R, Balasubramanian S, Seshadri R, Prakash KC, Vivek V. Impact of Malnutrition, Inflammation, and Atherosclerosis on the Outcome in Hemodialysis Patients. Indian J Nephrol 2017; 27:277-283. [PMID: 28761229 PMCID: PMC5514823 DOI: 10.4103/0971-4065.202830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Malnutrition, inflammation, and atherosclerosis are significant problems in patients on hemodialysis. A prospective, observational study in 100 hemodialysis patients for 2 years was conducted. The primary outcomes were hospitalizations and mortality at the end of 2 years. The mean age was 61 ± 11.3 years and 69% were male. Seven patients did not complete the study (five underwent transplant and two were shifted to other units). Serum albumin was significantly lower in malnourished patients at 6 months from the beginning of the study period (3.58 vs. 3.79 g/dl, P = 0.001). Malnutrition based on subjective global assessment (SGA) was seen in 30 (32%) patients: mild to moderate in 27 (29%) and severe in 3 (3%). Inflammation was seen in 73 (78.5%) patients and intimal-medial thickness of >1.1 mm indicating significant atherosclerosis was seen in 73 (78.5%) patients. Modified SGA score and malnutrition-inflammation score (MIS) were significantly more in the malnourished group. Statistically significant association was seen between hospitalization and mortality in the malnourished population, and the odds ratio of death in malnourished patients was 9.83 (95% confidence interval: 2.8-34.3, P < 0.001). There was a moderate correlation between malnutrition assessed by modified SGA and MIS score (r = 0.54, P < 0.001). Mortality rate was 37% in patients with mild to moderate and 67% in severe malnutrition. Hospital admission was seen in 43 (46%) patients and was significantly more common in malnourished compared to well-nourished patients (77% vs. 32%, P < 0.001). Multiple logistic regression analysis showed that malnutrition by Modified SGA was the only significant variable associated with mortality at 2 years, and addition of MIS score did not improve the predictive ability of the model to modified SGA. We recommend the use of modified SGA and serial serum albumin to monitor nutrition in hemodialysis patients.
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Affiliation(s)
- B B Kirushnan
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - B Subba Rao
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Annigeri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - S Balasubramanian
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Seshadri
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - K C Prakash
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - V Vivek
- Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India
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20
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Lau YC, Proietti M, Guiducci E, Blann AD, Lip GY. Atrial Fibrillation and Thromboembolism in Patients With Chronic Kidney Disease. J Am Coll Cardiol 2016; 68:1452-1464. [DOI: 10.1016/j.jacc.2016.06.057] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/14/2016] [Indexed: 02/06/2023]
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21
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Kajbaf MH, Khorvash F, Mortazavi M, Shahidi S, Moeinzadeh F, Farajzadegan Z, Tirani SA. Does Omega-3 supplementation decrease carotid intima-media thickening in hemodialysis patients? J Res Pharm Pract 2016; 5:252-256. [PMID: 27843961 PMCID: PMC5084482 DOI: 10.4103/2279-042x.192451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: A randomized, double-blind, placebo-controlled clinical trial was performed to assess the effect of omega-3 supplementation (3 g/day) on atherosclerosis progression by measuring carotid intima-media thickness (cIMT) in hemodialysis (HD) patients. Methods: A total of 54 HD patients were randomized into two groups: Intervention group (n = 27), in which patients were given 3 g/day omega-3 for 6 months and placebo group (n = 27), in which patients received placebo using the same administration protocol. All patients underwent a carotid artery ultrasound scan to measure cIMT at baseline and at 6 months. Findings: cIMT decreased significantly in omega-3 group (0.79 ± 0.21 mm at baseline vs. 0.65 ± 0.18 mm at 6 months, P < 0.001). On the other hand, a nonsignificant increase in cIMT was seen in placebo group (0.75 ± 0.17 mm at baseline vs. 0.79 ± 0.17 mm at 6 months, P = 0.12). Moreover, cIMT was statistically significantly different between omega-3 and placebo groups at 6 months (P < 0.001). After 6 months, a statistically significant increase was observed in high-density lipoprotein level in omega-3 group compared to placebo group (P = 0.03). Urea reduction ratio was also statistically significantly higher in omega-3 than placebo group at 6 months (P = 0.03). No significant difference was observed in terms of other variables between the two groups. Conclusion: These data suggested that omega-3 supplementation plays a protective role in the progression of atherosclerosis in HD patients.
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Affiliation(s)
| | - Fariborz Khorvash
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Shahidi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Moeinzadeh
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community and Family Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Amani Tirani
- Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Shen H, Xu L, Lu J, Hao T, Ma C, Yang H, Lu Z, Gu Y, Zhu T, Shen G. Correlation between small dense low-density lipoprotein cholesterol and carotid artery intima-media thickness in a healthy Chinese population. Lipids Health Dis 2015; 14:137. [PMID: 26510458 PMCID: PMC4625741 DOI: 10.1186/s12944-015-0143-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/23/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Small dense low-density lipoprotein cholesterol (sdLDL-C) concentration was useful in the assessment of the presence of cardiovascular diseases (CVD) and its severity. We examined whether SdLDL-C is more closely associated with carotid artery intima-media thickness (CA-IMT), a surrogate measure of atherosclerosis, than LDL-C and traditional CVD risk factors in Chinese healthy subjects. METHODS We measured CA-IMT, blood pressure (BP), sdLDL-C, glucose metabolism and lipid in 183 native Chinese healthy subjects. CA-IMT was assessed by ultrasonography, and sdLDL-C concentrations were measured by a homogenous assay. Pearson's correlation coefficient analyses and Multiple regression analyses were used to examine the relationships between CA-IMT values and other clinical variables. RESULTS The sdLDL-C level was significantly higher in males than in females (p <0.05) and there was an age effect on sdLDL-C (p <0.05). When the effects of age, gender and other traditional CVD risk factors were adjusted using multiple regression analysis. CA-IMT remained significantly associated with sdLDL-C(β = 0.437, p <0.001). CONCLUSIONS There are gender and age differences in sdLDL-C levels among a healthy Chinese population. Moreover, we found adjusted traditional CVD risk factors such as higher age, male sex, and other traditional CVD risk factors, the association between CA-IMT and SdLDL-C remained significant. sdLDL-C is may be a useful predictor in the assessment of CA-IMT in Chinese population.
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Affiliation(s)
- Hao Shen
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Li Xu
- Department of General Surgery, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Jingfen Lu
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Tianbo Hao
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Chunfang Ma
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Honglin Yang
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Zhaoyang Lu
- Department of Ultrasonography, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Yongchun Gu
- Department of Central Laboratory, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Tonghua Zhu
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
| | - Guorong Shen
- Department of Clinical Laboratory Medicine, The First People's Hospital of Wujiang, Affliated Wujiang Hospital of Nantong University, Suzhou, China.
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Patel ML, Radheyshyam, Verma A, Sachan R, Kamal R. Impact of Carotid Intima-Media Thickness on Long-term Outcome in Hemodialysis Patients. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015. [PMID: 26199926 PMCID: PMC4488996 DOI: 10.4103/1947-2714.159339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Chronic kidney disease (CKD) patients on hemodialysis are highly prone to cardiovascular disease, which accounts for roughly half of the mortality in these patients. Atherosclerosis begins many years before the development of clinical manifestations. Measurement of carotid intima-media thickness (CIMT) is a noninvasive procedure to detect early atherosclerotic changes. Aims: The aim of the study was to evaluate the correlation between CIMT and cardiovascular risk factors and to investigate its prognostic significance in CKD patients on hemodialysis. Materials and Methods: This was a prospective study carried out over a period of 18 months. Total 88 patients on hemodialysis and 50 healthy controls were enrolled in the study. Biochemical assay and CIMT was assessed using the high resolution 7.5 MHz sonography technique in all subjects. Results: Significant positive correlation was found with age, blood urea, serum creatinine, serum triglyceride, low-density lipoprotein, serum phosphorus, serum calcium-phosphorus product, serum uric acid, 24 h urine protein, systolic blood pressure, diastolic blood pressure, and body mass index. Negative correlation was found with estimated glomerular filtration rate. Adjusted hazards ratios of all cause and cardiovascular mortality for an increase of 0.1 mm in CIMT was 1.16 (95% confidence interval 0.15-9.09). Patients with CIMT value <0.97 mm had a renal survival rate of 73.4% while patients with value >0.97 mm had a renal survival rate of 16.5%. Conclusion: Uremia is an additive risk factors in those subjects who have raised CIMT despite of traditional cardiovascular risk factors.
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Affiliation(s)
- Munna Lal Patel
- Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Radheyshyam
- Department of Geriatric ICU, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Verma
- Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rekha Sachan
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ritul Kamal
- Department of Statistics, Indian Toxicology and Research Centre, Lucknow, Uttar Pradesh, India
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Liabeuf S, Desjardins L, Diouf M, Temmar M, Renard C, Choukroun G, Massy ZA. The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease. PLoS One 2015; 10:e0131707. [PMID: 26181592 PMCID: PMC4504701 DOI: 10.1371/journal.pone.0131707] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/04/2015] [Indexed: 01/09/2023] Open
Abstract
Background Although a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages. Methods We performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement. Results Vascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%. Conclusion The addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population.
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Affiliation(s)
- Sophie Liabeuf
- INSERM U1088, Jules Verne University of Picardy Amiens, France
- Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France
| | - Lucie Desjardins
- INSERM U1088, Jules Verne University of Picardy Amiens, France
- Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
| | - Mohamed Temmar
- INSERM U1088, Jules Verne University of Picardy Amiens, France
- Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France
| | - Cédric Renard
- Division of Radiology, Amiens University Hospital, Amiens, France
| | - Gabriel Choukroun
- INSERM U1088, Jules Verne University of Picardy Amiens, France
- Division of Nephrology, Amiens University Hospital, Amiens, France
| | - Ziad A. Massy
- INSERM U1088, Jules Verne University of Picardy Amiens, France
- Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France
- * E-mail:
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Sun F, Song Y, Liu J, Ma LJ, Shen Y, Huang J, Zhou YL. Efficacy of losartan for improving insulin resistance and vascular remodeling in hemodialysis patients. Hemodial Int 2015; 20:22-30. [PMID: 26104969 DOI: 10.1111/hdi.12327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Insulin resistance and vascular remodeling are prevalent and predict cardiovascular mortality in hemodialysis patients. Angiotensin II (Ang II) may be involved in both pathogenesis. In the present study, we investigated the effects of the Ang II receptor blocker losartan on insulin resistance, arterial stiffness, and carotid artery structure in hemodialysis patients. Seventy-two hemodialysis patients were randomly assigned to receive either losartan 50 mg qd (n = 36) or β-blocker bisoprolol 5 mg qd (n = 36). At the start and at month 12, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) measurements, and carotid artery ultrasound were performed, and homeostasis model assessment index of insulin resistance (HOMA-IR) was determined. During the study period, bioimpedance method was used to evaluate volume status every 3 months. Home-monitored BPs were measured at least monthly. Ambulatory BP decreased significantly and similarly by either losartan or bisoprolol. Decreases in PWVs in losartan group at the end of month 12 were significantly greater than changes in PWV in bisoprolol group (0.9 ± 0.3 vs. 0.4 ± 0.5 m/s, P = 0.021). Common carotid artery intima-media cross-sectional area decreased significantly only in patients treated with losartan (20.3 ± 4.9 vs. 19.1 ± 5.1 mm(2) , P = 0.001), and HOMA-IR was also reduced in losartan group only (1.9 ± 1.0 vs. 1.7 ± 0.8, P = 0.003). Multiple regression analysis showed significant correlations between changes in PWV and changes in HOMA-IR. With comparable BP-lowering efficacy, losartan achieved better improvement in insulin sensitivity, arterial stiffness, and carotid artery hypertrophy in hemodialysis patients. The regression of arterial stiffness may be in part through attenuation in insulin resistance.
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Affiliation(s)
- Fang Sun
- Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan Song
- Department of Nephrology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing, China
| | - Jing Liu
- Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li-Jie Ma
- Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Shen
- Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing Huang
- Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi-Lun Zhou
- Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China
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Sumida K, Ubara Y, Hoshino J, Hayami N, Suwabe T, Hiramatsu R, Hasegawa E, Yamanouchi M, Sawa N, Fujii T, Takaichi K. Bone histomorphometry in a long-term hemodialysis patient with hypoparathyroidism and sarcoidosis. Osteoporos Int 2015; 26:1435-41. [PMID: 25503527 DOI: 10.1007/s00198-014-2987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
A bone biopsy specimen in a long-term hemodialysis patient with sarcoidosis coexisting with severe hypoparathyroidism has demonstrated that a persistent near physiological level of 1,25-dihydroxyvitamin D3 contributes to the preservation of bone remodeling and has the potential to retard the development of vascular calcification and atherosclerosis. Sarcoidosis-related hypercalcemia and hypoparathyroidism, which is characterized by 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) overproduction, is rarely seen in hemodialysis patients. Herein, we describe a 60-year-old Japanese woman on hemodialysis for 35 years who presented with malaise and hypercalcemia. Severe hypoparathyroidism without parathyroidectomy and a preserved 1,25(OH)2D3 level were detected. Computed tomography showed bilateral axillary lymphadenopathy and minimal aortic and soft tissue calcification. The axillary node biopsy led to a definite diagnosis of sarcoidosis. A bone biopsy specimen obtained from the right iliac crest showed remodeling of normal lamellar bone with scalloped cement lines and clear double labeling by tetracycline on fluorescence microscopy. Histomorphometric analysis revealed that the bone formation rate was preserved (30.0 %/year), together with a decrease of osteoid volume (5.75 %) and fibrous volume (0 %), indicating that the patient did not have adynamic bone disease and only showed mild disease. This is the first documented case of sarcoidosis-related hypercalcemia associated with severe hypoparathyroidism in a long-term hemodialysis patient who underwent bone histomorphometry. Our findings suggest that, in hemodialysis patients with sarcoidosis coexisting with severe hypoparathyroidism, a persistent near physiological level of 1,25(OH)2D3 contributes to the preservation of bone remodeling and has the potential to retard the development of vascular calcification and atherosclerosis.
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Affiliation(s)
- K Sumida
- Nephrology Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan,
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Nakao T, Inaba M, Abe M, Kaizu K, Shima K, Babazono T, Tomo T, Hirakata H, Akizawa T. Best Practice for Diabetic Patients on Hemodialysis 2012. Ther Apher Dial 2015; 19 Suppl 1:40-66. [DOI: 10.1111/1744-9987.12299] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Masanori Abe
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | - Kazo Kaizu
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | - Kenji Shima
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | | | - Tadashi Tomo
- Japanese Society for Dialysis Therapy; Tokyo Japan
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Makulska I, Szczepańska M, Drożdż D, Polak-Jonkisz D, Zwolińska D. Skin autofluorescence as a novel marker of vascular damage in children and adolescents with chronic kidney disease. Pediatr Nephrol 2015; 30:811-9. [PMID: 25409659 PMCID: PMC4372673 DOI: 10.1007/s00467-014-2997-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Skin autofluorescence (sAF) was examined as a marker of the accumulation of advanced glycation end products (AGEs) in tissues of children with chronic kidney disease (CKD) in relation to renal function, dialysis modality and markers of endothelial inflammation and dysfunction. METHODS A total of 76 children with CKD were enrolled in the study, of whom 20 children were on hemodialysis (HD), 20 were on peritoneal dialysis (PD) and 36 were treated conservatively. A control group of 26 healthy subjects was also included in the study. In all children, sAF intensity, carotid intima-media (cIMT) thickness and plasma concentrations of sE-selectin, matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and plasminogen activator inhibitor type 1 (PAI-1) were measured. RESULTS Compared to the controls, children with CKD had significantly elevated sAF levels. sAF in the children with CKD was positively correlated with sE-selectin, MMP-9, TIMP-1, ADMA, SDMA and PAI-1 levels. In the predialysis group (conservative treatment) sAF levels were positively correlated with sE-selectin and ADMA levels and negatively correlated with glomerular filtration rate. Multiple regression analysis showed a significant association of sAF with sE-selectin and MMP-9 in CKD children. CONCLUSIONS The results reveal that AGEs were accumulated in the children with CKD. This accumulation was related to early vascular changes and a number of biochemical vascular risk markers. sAF measurement, as a noninvasive method, may be useful for identification of clinical risk factors of vascular disease in CKD children.
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Affiliation(s)
- Irena Makulska
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland,
| | - Maria Szczepańska
- Department of Pediatrics in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dorota Drożdż
- Dialysis Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Polak-Jonkisz
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
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Sathi S, Mahapatra H, Sunder S, Jayaraman R, Sharma N, Verma H, Krishnamoorthy V, Gupta A, Kanchi P, Daksh S, Pursnani L, Shadab F, Singh M. Nontraditional cardiovascular biomarkers and estimation of cardiovascular risk in predialysis chronic kidney disease patients and their correlations with carotid intima media thickness. Nephrourol Mon 2014; 6:e22112. [PMID: 25738114 PMCID: PMC4330673 DOI: 10.5812/numonthly.22112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 07/27/2014] [Accepted: 08/05/2014] [Indexed: 01/18/2023] Open
Abstract
Background: Cardiovascular biomarkers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), hs-CRP (high sensitivity C-reactive protein), and albuminuria predict underlying heart disease in the general population as well as CKD patients. Objectives: We aimed to study the association of NT-proBNP, cTnT, hs-CRP, and spot urine albumin creatinine ratio with carotid intima media thickness (CIMT) for cardiovascular risk estimation in predialysis CKD (chronic kidney disease) patients. Patients and Methods: This cross-sectional study included a total of 120 adult predialysis CKD patients. Forty patients were allocated in each predialysis CKD group of stages 3, 4, and 5. Serum cTnT and hs-CRP, plasma NT-proBNP, and single spot urine albumin creatinine ratio (ACR) were measured. Ultrasonographic examination of carotid artery was done with 7.5 MHz linear probe in B mode ultrasonography and carotid intima media thickness was measured. Results: Mean values ± standard deviation of plasma NT-proBNP (pg/mL), serum hs-CRP (mg/L), spot urine ACR (mg/g of creatinine), and CIMT (mm) were 585.68 ± 514.84, 5.96 ± 2.52, 719.37 ± 411.36, and 0.78 ± 0.15, respectively in predialysis CKD patients (n = 120). Serum cTnT level was high in 40% of predialysis CKD patients. Among cardiovascular biomarkers, plasma NT-proBNP had maximum strength of correlation (Spearman Rho correlation coefficient; r = 0.575 and P < 0.0001) with the carotid intima media thickness followed by serum cTnT (Spearman Rho correlation coefficient; r = 0.419 and P < 0.0001), spot urine albumin creatinine ratio (Spearman Rho correlation coefficient; r = 0.322 and P < 0.0001), and serum hs-CRP (Spearman Rho correlation coefficient; r = 0.246 and P = 0.007). Conclusions: Nontraditional cardiovascular biomarkers such as plasma NT-proBNP, serum cTnT, serum hs-CRP, and spot urine ACR significantly correlate with CIMT. These biomarkers can estimate the cardiovascular risk in a predialysis CKD population with expected high cardiac morbidity and mortality.
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Affiliation(s)
- Satyanand Sathi
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
- Corresponding author: Satyanand Sathi, Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, P.O.Box: 110001, New Delhi, India. Tel: +91-9654848620, Fax: +91-1125739347, E-mail:
| | - Himanshu Mahapatra
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Sham Sunder
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Rajesh Jayaraman
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Himanshu Verma
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | | | - Anurag Gupta
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Prabhu Kanchi
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Sunil Daksh
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Lalit Pursnani
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Faisal Shadab
- Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Manveer Singh
- Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
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Arroyo D, Betriu A, Martinez-Alonso M, Vidal T, Valdivielso JM, Fernández E. Observational multicenter study to evaluate the prevalence and prognosis of subclinical atheromatosis in a Spanish chronic kidney disease cohort: baseline data from the NEFRONA study. BMC Nephrol 2014; 15:168. [PMID: 25326683 PMCID: PMC4210528 DOI: 10.1186/1471-2369-15-168] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/02/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiovascular events (CVE) are more prevalent in chronic kidney disease (CKD) than in general population, being the main cause of morbimortality. Specific risk factors related to CKD have been suggested, because traditional factors do not fully explain this increase in cardiovascular disease rates. However, the role of atheromatosis, its pathogenesis and evolution are still unclear. The potential use of diagnostic tests to detect subclinical atheromatosis has to be determined. METHODS NEFRONA is a prospective multicenter cohort study. 2445 CKD subjects were enrolled from 81 Spanish hospitals and dialysis clinics, from 2010 to 2012. Eligibility criteria included: 18 to 74 years old, CKD stage 3 or higher, and no previous CVE. 559 non-CKD controls were also recruited. Demographical, clinical and analytical data were collected. Carotid and femoral ultrasounds were performed by a single trained team to measure carotid intima-media thickness (cIMT) and detect atheromatous plaques. Ankle-brachial index (ABI) was measured. RESULTS Differences in age, sex and prevalence and control of cardiovascular risk factors were found between controls and CKD patients. These differences are similar to those described in epidemiological studies.No difference was found regarding cIMT between controls and CKD (when subjects with plaques in common carotid arteries were omitted); earlier CKD stages had higher values. CKD patients had a higher rate of atheromatous plaques, with no difference between stages in the unadjusted analysis. A group of patients had plaques in femoral arteries but were plaque-free in carotid arteries, and would have gone underdiagnosed without the femoral study. The percentage of pathologic ABI was higher in CKD, with higher prevalence in more advanced stages, and a higher rate of ABI >1.4 than <0.9, suggesting more vascular calcification. CONCLUSIONS NEFRONA is the first large study describing the actual prevalence of subclinical atheromatosis across different CKD stages. There is a very high rate of atheromatous plaques and pathologic ABI in CKD. Prospective data will add important information to the pathogenesis and evolution of atheromatosis in CKD, compared to non-CKD subjects.
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Affiliation(s)
- David Arroyo
- Nephrology Department, Hospital Universitari Arnau de Vilanova, Avda, Rovira Roure 80, 25198 Lleida, Spain.
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Kimura H, Tanaka K, Kanno M, Watanabe K, Hayashi Y, Asahi K, Suzuki H, Sato K, Sakaue M, Terawaki H, Nakayama M, Miyata T, Watanabe T. Skin Autofluorescence Predicts Cardiovascular Mortality in Patients on Chronic Hemodialysis. Ther Apher Dial 2014; 18:461-7. [DOI: 10.1111/1744-9987.12160] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hiroshi Kimura
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Kenichi Tanaka
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Makoto Kanno
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Kimio Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Yoshimitsu Hayashi
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Koichi Asahi
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Hodaka Suzuki
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Keiji Sato
- Department of Nephrology; Fujita General Hospital; Kunimi Japan
| | | | - Hiroyuki Terawaki
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Masaaki Nakayama
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
| | - Toshio Miyata
- United Centers for Advanced Research and Translational Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Tsuyoshi Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism; Fukushima Medical University School of Medicine; Fukushima Japan
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Features of atherosclerosis in hemodialysis patients. Kidney Res Clin Pract 2013; 32:177-82. [PMID: 26877938 PMCID: PMC4714184 DOI: 10.1016/j.krcp.2013.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/19/2013] [Accepted: 09/24/2013] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular disease is the main cause of mortality in dialysis patients. Carotid intima–media thickness (CIMT) is used as a surrogate marker of early atherosclerosis. Atherosclerosis can cause vascular access failure. The purpose of this study was to define the clinical features of atherosclerosis in hemodialysis patients based on CIMT and to define the relationship between CIMT and access failure. Methods In this cross-sectional study, the CIMT of 60 patients on hemodialysis was examined using B-mode Doppler ultrasonography between May 2012 and November 2012. Carotid atherosclerosis was defined as a CIMT≥0.9 mm or the incidence of atherosclerotic plaques. Results The patients’ mean age was 54.5±10.6 years, and 60% of the patients were male. The CIMT was 0.81±0.47 mm (range, 0.35–2.50 mm). The group with atherosclerosis was characterized by older age compared with those without atherosclerosis. Patients with atherosclerosis showed much shorter durations of access patency than their counterparts in the nonatherosclerosis group (hazard ratio, 2.822; 95% confidence interval, 1.113–7.156; P=0.029). Moreover, being overweight was associated with a 2.47-fold (95% confidence interval, 1.101–5.548) increased primary access failure. Conclusion This study shows that atherosclerosis is associated with older age. Patients who are overweight and have atherosclerosis may have shortened access patency.
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Association of serum fetuin-A and fetuin-A gene polymorphism in relation to mineral and bone disorders in patients with chronic kidney disease. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2013. [DOI: 10.1016/j.ejmhg.2013.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Association of the cardioankle vascular index and ankle-brachial index with carotid artery intima media thickness in hemodialysis patients. Int J Nephrol 2013; 2013:401525. [PMID: 23864949 PMCID: PMC3707238 DOI: 10.1155/2013/401525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/21/2013] [Accepted: 05/24/2013] [Indexed: 11/21/2022] Open
Abstract
The objectives of the present study are (1) to compare the cardioankle vascular index (CAVI), ankle-brachial index (ABI), and carotid artery intima-media thickness (CA-IMT) between HD patients with and without type 2 diabetes (T2D) or prevalence of cardiovascular (CV) disease and (2) also to evaluate the relationship of these indices with CA-IMT in these patients according to ABI levels. This study consisted of 132 HD patients with T2D and the same number of patients without T2D. The patients with diabetes or prevalence of CV disease had significantly higher CA-IMT and lower ABI values than those without diabetes or prevalence of CV disease, respectively. Although diabetic patients had higher CAVI than those without diabetes, CAVI did not differ between patients with or without prevalence of CV disease. In univariate analysis, CA-IMT was more strongly correlated with ABI than CAVI. However, the opposite was true in patients with an ABI value of more than 0.95. Both indices were significantly correlated with CA-IMT although ABI was a powerful determinant than CAVI. It appears that both indices are associated with CA-IMT in HD patients, especially with an ABI value of more than 0.95.
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Yildiz G, Duman A, Aydin H, Yilmaz A, Hür E, Mağden K, Cetin G, Candan F. Evaluation of association between atherogenic index of plasma and intima-media thickness of the carotid artery for subclinic atherosclerosis in patients on maintenance hemodialysis. Hemodial Int 2013; 17:397-405. [PMID: 23551383 DOI: 10.1111/hdi.12041] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Incidence of cardiovascular diseases in the patients having chronic kidney disease (CKD) is between 25% and 60%. This increased rate is proposed to be associated with "accelerated atherosclerosis." Increased carotid intima-media thickness (CIMT) is a subclinical atherosclerosis marker. Small-dense low-density lipoprotein particles are a strong risk factor for atherosclerosis. It was shown that atherogenic index of plasma (AIP = log(TG/HDL-c)) is correlated with size of the lipoprotein particles. We investigated the correlation between AIP and CIMT which is a subclinical atherosclerosis marker, in hemodialysis (HD) patients. A total of 62 persons with 31 patients under HD therapy and 31 volunteers were included in the study. In all the participants, CIMT was measured and AIP were calculated. AIP and CIMT values of the participants were compared with blood pressures, lipid profiles and the other risk factors. AIP (0.39 ± 0.32) and CIMT (0.57 ± 0.13) were found significantly higher in the patient group than in the controls (0.04 ± 0.36 and 0.45 ± 0.119, respectively); (P = 0.0001 and 0.0001, respectively). There was a significant correlation between AIP and increased CIMT in the patient group (P = 0.0001, r = 0.430). Among the lipid parameters, the strongest correlation was found between CIMT and AIP. We demonstrated the significant increase of AIP and CIMT in HD patients. A correlation was found between AIP and CIMT. AIP was found to show a correlation with a greater number of risk factors, both classical and CKD specific, than CIMT. These data suggest that AIP might be a method which can be used both in diagnosis of subclinical atherosclerosis and in deceleration processes of its progression.
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Affiliation(s)
- Gürsel Yildiz
- Department of Internal Medicine and Nephrology, Atatürk State Hospital, Zonguldak, Turkey.
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Rafieian-Kopaei M, Nasri H. Carotid intima-media thickness and left ventricular hypertrophy in hemodialysis patients. J Renal Inj Prev 2013; 2:129-32. [PMID: 25340151 PMCID: PMC4206028 DOI: 10.12861/jrip.2013.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/29/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction: Two principal findings of cardiovascular disease in end-stage renal disease patients undergoing regular hemodialysis are left ventricular hypertrophy (LVH) and arterial disease due to rapidly progressive atherosclerotic vascular disease that can be characterized by an enlargement and hypertrophy of arteries (intima-media complex thickening; IMT).Objectives: In this study, we sought to evaluate the relationship between left ventricular hypertrophy with intima-media complex thickening in end-stage renal disease patients undergoing regular hemodialysis.
Patients and Methods: Sixty-one patients with end-stage renal disease (ESRD) who were undergoing regular and maintenance hemodialysis treatment (F=23, M=38) were studied. The subjects consisted of 50 non-diabetic hemodialysis patients (F=20, M=30) and 11 diabetic hemodialysis patients (F=3, M=8). For all the subjects, echocardiography and carotid intima-media thickness measuring by B-mode ultrasonography were performed.
Results: In this study, there was a positive correlation between stages of LVH with duration of hemodialysis treatment, stages of hypertension (HTN), and with carotid-IMT. A positive correlation was also seen between stages of LVH and presence of chest pain, and more thickening of the intima-media complex was seen in the diabetic group. Diabetes mellitus was associated with the presence of chest pain, as was positive correlation between stages of HTN with IMT, and a reverse correlation was observed between IMT with the percent of cardiac ejection fraction.
Conclusion:
Prevalence of thickening in intima-media complex is more evident in hemodialysis subjects with LVH. When there is LVH, IMT is similar in severity to the LVH.
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Affiliation(s)
| | - Hamid Nasri
- Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Hirakata H, Nitta K, Inaba M, Shoji T, Fujii H, Kobayashi S, Tabei K, Joki N, Hase H, Nishimura M, Ozaki S, Ikari Y, Kumada Y, Tsuruya K, Fujimoto S, Inoue T, Yokoi H, Hirata S, Shimamoto K, Kugiyama K, Akiba T, Iseki K, Tsubakihara Y, Tomo T, Akizawa T. Japanese Society for Dialysis Therapy Guidelines for Management of Cardiovascular Diseases in Patients on Chronic Hemodialysis. Ther Apher Dial 2012; 16:387-435. [DOI: 10.1111/j.1744-9987.2012.01088.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Neri S, Signorelli SS, Scuderi R, Bruno M, Bertino G, Clementi A, Torrisi I, Fidone F, Pagano AB, Malaguarnera M, Noto R. Carotid intima-media thickness and liver histology in hemodialysis patients with nonalcoholic Fatty liver disease. Int J Angiol 2012; 20:149-56. [PMID: 22942630 DOI: 10.1055/s-0031-1283218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The prevalence of atherosclerotic cardiovascular disease in chronic hemodialysis (HD) patients has been demonstrated to be higher than in healthy people. Severe liver fibrosis is strongly associated with early carotid atherosclerosis and it might reduce the survival of patients who undergo both renal replacement therapy and transplantation. We wanted to assess whether nonalcoholic fatty liver disease (NAFLD) was associated with altered intima-media thickness (IMT) in HD patients as an independent marker of subclinical atherosclerosis. We enrolled 42 patients undergoing HD and 48 patients with normal renal function, all of them with high levels of aminotransferases and an ultrasonographic diagnosis of liver steatosis. The control group consisted of 60 healthy subjects. Laboratory tests for inflammatory and oxidative markers, ultrasonographic liver evaluation, carotid IMT measurement, and liver biopsy were performed. Different degrees of fibrosis were detected in our study cohort. Worse liver histopathological scores and higher plasmatic levels of C-reactive protein, reactive oxygen species, and vascular cell adhesion molecule-1 were found in HD patients. Carotid IMT was significantly higher (p < 0.005) in patients with histological steatosis. HD patients may develop active and progressive chronic hepatitis faster than patients with normal renal function and the thickness of their carotid intima-media might be markedly increased. These two conditions seem to be independent on classical risk factors and on metabolic syndrome. They might be related to the high levels of oxidants and to the inflammatory state, which are typical of patients undergoing HD. Independently related with the traditional risk factors for cardiovascular disease, nonspecific inflammation and oxide-reductive imbalance may play an important role in the progression of NAFLD and atherosclerotic disease in HD patients.
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Hebah HA, Fouad KA. Correlation between ankle brachial index, carotid intima media thickness and left ventricular hypertrophy in patients on maintenance hemodialysis. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2011.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Yadav AK, Lal A, Jha V. Cytotoxic CD4 +CD28 null T Lymphocytes, Systemic Inflammation and Atherosclerotic Risk in Patients with Chronic Kidney Disease. Nephron Clin Pract 2012; 120:c185-93. [DOI: 10.1159/000338352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/15/2012] [Indexed: 11/19/2022] Open
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Mutluay R, Degertekin CK, Poyraz F, Yılmaz MI, Yücel C, Turfan M, Tavil Y, Derici Ü, Arınsoy T, Sindel S. Dialysis type may predict carotid intima media thickness and plaque presence in end-stage renal disease patients. Adv Ther 2012; 29:370-82. [PMID: 22467434 DOI: 10.1007/s12325-012-0011-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Carotid intima media thickness (CIMT) and carotid plaques (CP) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. In this study, the authors aimed to compare the two dialysis modalities for CIMT and CP presence (CPP). METHODS ESRD patients who had been on the same renal replacement therapy for at least 24 months were selected. CIMT, CPP, known risk factors, and laboratory parameters for atherosclerosis were determined for each patient. RESULTS A total of 77 hemodialysis (HD) patients (68% male, 47.6±17.0 years), 61 continuous ambulatory peritoneal dialysis (CAPD) patients (51% male, 45.3±13.9 years), and 36 age- and sex-matched controls (61% male, 43.3±10.6 years) were included. The mean CIMT (m-CIMT) were 0.99±0.24, 0.86±0.22, and 0.60±0.13 mm in the HD, CAPD, and control groups, respectively (HD vs. CAPD, P=0.001; HD vs. control, P<0.001; and CAPD vs. control, P<0.001). The CPP occurred more frequently in the HD group compared to the CAPD group (64% vs. 39%, respectively, P=0.004). The backward linear and logistic regression analysis of potential confounders revealed that both m-CIMT and CPP was independently associated with dialysis type (beta=0.249, P=0.008; and odds ratio [OR]=4.11, 95% CI, 1.72 to 6.73, P=0.015, respectively). CONCLUSION The authors have shown that dialysis type may be an independent predictor of m-CIMT and CPP in long-term ESRD patients.
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Affiliation(s)
- Rüya Mutluay
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
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Paul J, Dasgupta S, Ghosh MK. Carotid artery intima media thickness as a surrogate marker of atherosclerosis in patient with chronic renal failure on hemodialysis. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:77-80. [PMID: 22408752 PMCID: PMC3296323 DOI: 10.4103/1947-2714.93379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with chronic renal failure (CRF), carotid artery intima media thickness (CAIMT) is increased when the patients are on hemodialysis. Vascular events caused by atherosclerosis are the major cause of death in patients undergoing hemodialysis. AIMS This study was done to find out the relationship between carotid artery intima media thickness and hemodialysis in chronic renal failure patients independent of classical risk factors and also the relationship between CAIMT of hemodialyzed patients and nonhemodialyzed CRF patients. MATERIALS AND METHODS In this observational study, CAIMT of 78 CRF patients was examined by B-mode ultrasonography. Glomerular filtration rate (GFR) was calculated by using the "Modification of Diet in Renal Disease" formula. CRF patients, who had been on regular hemodialysis treatment (treated thrice weekly) for at least 6 months, were identified as hemodialyzed patients. Data were analyzed by software Statistical package for the social Sciences (SPSS) (17(th) version). RESULTS There was significant positive correlation between CAIMT and hemodialysis (P=0.045) independent of traditional risk factors. Hemodialyzed patients had higher mean CAIMT (1136.30±21.21 μm, P<0.001) than mean CAIMT of age and sex matched nondialyzed patients (959.30±23.01 μm). CONCLUSION Hemodialysis is an independent risk factor for atherosclerosis in CRF patents. Hemodialyzed patients have significantly higher CAIMT than nondialyzed CRF patients.
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Affiliation(s)
- Jayanta Paul
- Department of Medicine, Burdwan Medical College, West Bengal, India
| | - Somnath Dasgupta
- Department of Medicine, Burdwan Medical College, West Bengal, India
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Sato M, Ogawa T, Sugimoto H, Otsuka K, Nitta K. Relation of carotid intima-media thickness and silent cerebral infarction to cardiovascular events and all-cause mortality in chronic hemodialysis patients. Intern Med 2012; 51:2111-7. [PMID: 22892487 DOI: 10.2169/internalmedicine.51.8044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Silent cerebral infarction (SCI) and increased carotid intima-media thickness (IMT) have been found to be associated with future stroke in the general population. We investigated whether a combination of SCI and increased IMT is a predictor of cardiovascular events and all-cause mortality in chronic hemodialysis (HD) patients. METHODS We performed a retrospective cohort study of 70 HD patients who had one or more risk factors for atherosclerosis but no history of cardiovascular disease. We performed cranial magnetic resonance imaging (MRI) and measured carotid IMT at baseline, and then evaluated the risks of cardiovascular events and all-cause mortality by using Cox proportional hazards models. The Kaplan-Meier method and a log-rank test were used to compare event-free survival. RESULTS SCI was present in 25 patients (35.7%) at baseline. During an average follow-up of 46.3 ± 14.3 months (range: 19 to 56 months), 15 patients (21.4%) died and 16 (22.9%) experienced a new cardiovascular event. The presence of SCI in combination with increased carotid IMT at baseline was independently associated with cardiovascular events and all-cause mortality after adjustment for age, sex, duration of dialysis, and traditional vascular risk factors. CONCLUSION SCI, similar to carotid IMT, is an independent predictor of cardiovascular events and all-cause mortality in chronic HD patients.
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Affiliation(s)
- Masayo Sato
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Japan
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Inaba M, Hayashino Y, Shoji T, Akiba T, Akizawa T, Saito A, Kurokawa K, Fukuhara S. Disappearance of Association in Diabetic Patients on Hemodialysis between Anemia and Mortality Risk: The Japan Dialysis Outcomes and Practice Pattern Study. ACTA ACUST UNITED AC 2012; 120:c91-c100. [DOI: 10.1159/000335979] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 12/16/2011] [Indexed: 01/06/2023]
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Cañas L, Bayés B, Granada ML, Ibernon M, Porrini E, Benítez R, Díaz JM, Lauzurica R, Moreso F, Torres A, Lampreabe I, Serra A, Romero R. Is adiponectin a marker of preclinical atherosclerosis in kidney transplantation? Clin Transplant 2011; 26:259-66. [PMID: 22150949 DOI: 10.1111/j.1399-0012.2011.01490.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED The aim of this study was to analyze the relationship between pre-transplant adiponectin (pre-ADP), abnormalities in glucose homeostasis (AGH) at three months post-transplantation, and preclinical atherosclerosis in non-diabetic patients prior to kidney transplantation (KT). METHODS We carried out a multicenter study in 157 non-diabetic KT patients (66.5% men; age: 50±13 yr). Pre-ADP levels were analyzed using radioimmunoassay. Carotid ultrasound was performed to determine carotid intima-media thickness (c-IMT). Oral glucose tolerance test was carried out to classify patients according ADA criteria. RESULTS Of the patients, 52.8% had AGH. Median pre-ADP was 19.5 (14-27) μg/mL. An inverse correlation was found between ADP and HOMA index (r=-0.432; p<0.001). Median c-IMT was 0.6 (0.48-0.71) mm. Significant inverse correlation existed between ADP and c-IMT on both sides (p<0.05). Patients with c-IMT >0.6 mm had more AGH (p=0.012) and lower ADP levels (p=0.02). We performed a logistic regression analysis using preclinical atherosclerosis (c-IMT ≥0.6 mm) as dependent variable and sex, age, BMI, ADP, AGH, and HOMA index as independent variables of altered c-IMT. Age, pre-ADP, and AGH were independent risk factors for elevated c-IMT. CONCLUSIONS Patients with AGH have a greater presence of preclinical atherosclerosis. ADP has an inverse relationship with AGH and is an independent marker of preclinical atherosclerosis.
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Affiliation(s)
- Laura Cañas
- Nephrology Department, Hospital Germans Trias i Pujol, UAB, Badalona, Spain.
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Nakayama M, Ura Y, Nagata M, Okada Y, Sumida Y, Nishida K, Ikeda H, Kaizu Y. Carotid artery calcification at the initiation of hemodialysis is a risk factor for cardiovascular events in patients with end-stage renal disease: a cohort study. BMC Nephrol 2011; 12:56. [PMID: 21999942 PMCID: PMC3206830 DOI: 10.1186/1471-2369-12-56] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/15/2011] [Indexed: 02/12/2023] Open
Abstract
Background Vascular calcification has been recognized as a risk factor for cardiovascular (CV) events in patients with end-stage renal disease (ESRD). However, the association of carotid artery calcification (CAAC) with CV events remains unknown. The aim of this study was to elucidate whether CAAC is associated with composite CV events in ESRD patients. Methods One-hundred thirty-three patients who had been started on hemodialysis between 2004 and 2008 were included in this retrospective cohort study. These patients received multi-detector computed tomography to assess CAAC at the initiation of hemodialysis. Composite CV events, including ischemic heart disease, heart failure, cerebrovascular diseases, and CV deaths after the initiation of hemodialysis, were examined in each patient. Results CAAC was found in 94 patients (71%). At the end of follow-up, composite CV events were seen in 47 patients: ischemic heart disease in 20, heart failure in 8, cerebrovascular disease in 12, and CV deaths in 7. The incidence of CAAC was 87% in patients with CV events, which was significantly higher than the rate (62%) in those without. Kaplan-Meier analysis showed a significant increase in composite CV events in patients with CAAC compared with those without CAAC (p = 0.001, log-rank test). Univariate analysis using a Cox hazards model showed that age, smoking, common carotid artery intima-media thickness and CAAC were risk factors for composite CV events. In multivariate analysis, only CAAC was a significant risk factor for composite CV events (hazard ratio, 2.85; 95% confidence interval, 1.18-8.00; p = 0.02). Conclusions CAAC is an independent risk factor for CV events in ESRD patients. The assessment of CAAC at the initiation of hemodialysis is useful for predicting the prognosis.
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Affiliation(s)
- Masaru Nakayama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
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van Eps CL, Jeffriess L, Haluska B, Hawley CM, Coombes J, Matsumoto A, Jeffries JK, Johnson DW, Campbell SB, Isbel NM, Mudge DW, Marwick T. Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: an interventional cohort study. BMC Nephrol 2011; 12:51. [PMID: 21962236 PMCID: PMC3202231 DOI: 10.1186/1471-2369-12-51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 10/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD) on cardiovascular structure and function is not known. METHODS Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly) converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly). 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR), carotid intima-media thickness (CIMT), total arterial compliance (TAC) and augmentation index (AIX) were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA) and anti-oxidant enzymes: catalase (CAT), glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity and total antioxidant status (TAS) were measured at baseline, 3 and 6 months. RESULTS Left ventricular mass index (LVMI) remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated. CONCLUSIONS Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in dialysis session duration, frequency or both are most beneficial for improving cardiovascular disease whilst minimizing costs and the impact of dialysis on quality of life.
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Affiliation(s)
- Carolyn L van Eps
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
- School of Medicine, University of Queensland, Ipswich Rd, Brisbane, 4102 Australia
| | - Leanne Jeffriess
- Department of Cardiology, Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
| | - Brian Haluska
- Department of Cardiology, Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
| | - Carmel M Hawley
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
| | - Jeffrey Coombes
- Department of Human Movements, University of Queensland, St Lucia, Brisbane, 4067, Australia
| | - Aya Matsumoto
- Department of Human Movements, University of Queensland, St Lucia, Brisbane, 4067, Australia
| | - Janine K Jeffries
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
| | - David W Johnson
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
- School of Medicine, University of Queensland, Ipswich Rd, Brisbane, 4102 Australia
| | - Scott B Campbell
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
| | - Nicole M Isbel
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
| | - David W Mudge
- Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
- School of Medicine, University of Queensland, Ipswich Rd, Brisbane, 4102 Australia
| | - Thomas Marwick
- Department of Cardiology, Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia
- School of Medicine, University of Queensland, Ipswich Rd, Brisbane, 4102 Australia
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Value of carotid intimal–medial thickness as independent predictor of endothelial dysfunction in uremic patients. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Yilmaz R, Altun B, Ozer N, Hazirolan T, Turgan C. Impact of cytokine genotype on cardiovascular surrogate markers in hemodialysis patients. Ren Fail 2010; 32:806-16. [PMID: 20662694 DOI: 10.3109/0886022x.2010.494798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/AIMS Cytokine gene polymorphisms have been implicated as potential genetic risk factors for cardiovascular diseases (CVDs). Atherosclerosis and left ventricular hypertrophy (LVH) are surrogate markers for CVDs in uremic patients. The aim of this study was to assess the role of cytokine gene polymorphisms in carotid intima-media thickness (CIMT) and left ventricular mass index (LVMI) progression in nondiabetic hemodialysis (HD) patients. METHODS About 102 nondiabetic patients on maintenance HD were included in this study. Patients were followed up for 2 years. Genetic polymorphisms of TNF-alpha (-308 G/A, -238A/G) and IL-10 (-1082 A/G, -819 C/T, -592 A/C) were determined by polymerase chain reaction. Biochemical parameters and inflammatory markers and ambulatory blood pressure (BP) measurements were determined during the study period. CIMT and LVMI were also determined at baseline and after the first and second year. RESULTS Cardiovascular risk factors did not differ between TNF-alpha -308 high-/low-producer genotype groups. However, CIMT and LVMI progression were detected at higher levels in patients with high-producer genotypes (AA+AG) than in patients with the low-producer genotype (GG) during the study period. The TNF-alpha -308 G/A polymorphism was closely associated with C-reactive protein (CRP), a marker of systemic inflammation in the study population. Analysis also showed that the combination of high production of TNF-alpha and low production of IL-10 was associated with higher average IMT and LVMI progression and elevated average CRP levels compared with a combination of low production of TNF-alpha and high production of IL-10. CONCLUSION Polymorphisms in inflammatory genes may represent an additional factor affecting inflammation and CVD progression in nondiabetic HD patients.
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Affiliation(s)
- Rahmi Yilmaz
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Association of Vascular Risk Factors With Carotid Intima Media Thickness After Kidney Transplant. Transplantation 2010. [DOI: 10.1097/tp.0b013e3181f62fe4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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