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Khan S, Araji G, Yetiskul E, Keesari PR, Haddadin F, Khamis Z, Chowdhry V, Niazi M, Afif S, Dhar M, El-Sayegh S. Systemic oncological therapy in breast cancer patients on dialysis. World J Clin Oncol 2024; 15:730-744. [PMID: 38946836 PMCID: PMC11212603 DOI: 10.5306/wjco.v15.i6.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024] Open
Abstract
The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease (ESRD) over time. However, this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer. Breast cancer treatment typically involves surgery, radiation, and systemic therapies, with approaches tailored to cancer type, stage, and patient preferences. However, renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions. This review emphasizes the need for optimized dosing and administration strategies for systemic breast cancer treatments in dialysis patients, aiming to ensure both efficacy and safety. Additionally, challenges in breast cancer screening and diagnosis in this population, including soft-tissue calcifications, are highlighted.
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Affiliation(s)
- Salman Khan
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Ghada Araji
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Ekrem Yetiskul
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Praneeth Reddy Keesari
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Fadi Haddadin
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Zaid Khamis
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Varun Chowdhry
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Muhammad Niazi
- Department of Hematology and Oncology, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Sarah Afif
- Department of Internal Medicine, CUNY School of Medicine, New York, NY 10031, United States
| | - Meekoo Dhar
- Department of Hematology and Oncology, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
| | - Suzanne El-Sayegh
- Department of Internal Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY 10305, United States
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Erkan M, Ozcan SGG. Breast arterial calcification is associated with sarcopenia in peri- and post-menopausal women. Clin Imaging 2024; 110:110143. [PMID: 38696996 DOI: 10.1016/j.clinimag.2024.110143] [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] [Received: 01/16/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE Breast arterial calcification (BAC) refers to medial calcium deposition in breast arteries and is detectable via mammography. Sarcopenia, which is characterised by low skeletal muscle mass and quality, is associated with several serious clinical conditions, increased morbidity, and mortality. Both BAC and sarcopenia share common pathologic pathways, including ageing, diabetes, and chronic kidney disease. Therefore, this study evaluated the relationship between BAC and sarcopenia as a potential indicator of sarcopenia. METHODS This study involved women aged >40. BAC was evaluated using digital mammography and was defined as vascular calcification. Sarcopenia was assessed using abdominal computed tomography. The cross-sectional skeletal mass area was measured at the third lumbar vertebra level. The skeletal mass index was obtained by dividing the skeletal mass area by height in square meters(m2). Sarcopenia was defined as a skeletal mass index of ≤38.5 cm2/m2. A multivariable model was used to evaluate the relationship between BAC and sarcopenia. RESULTS The study involved 240 participants. Of these, 36 (15 %) were patients with BAC and 204 (85 %) were without BAC. Sarcopenia was significantly higher among the patients with BAC than in those without BAC (72.2 % vs 17.2 %, P < 0.001). The multivariable model revealed that BAC and age were independently associated with sarcopenia (odds ratio[OR]: 7.719, 95 % confidence interval[CI]: 3.201-18.614, and P < 0.001 for BAC and OR: 1.039, 95 % CI: 1.007-1.073, P = 0.01 for age). CONCLUSION BAC is independently associated with sarcopenia. BAC might be used as an indicator of sarcopenia on screening mammography.
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Affiliation(s)
- Merve Erkan
- Department of Radiology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah. Polis Okulu Karsisi, Emniyet Cad, 16310 Yildirim, Bursa, Turkey.
| | - Seray Gizem Gur Ozcan
- Department of Radiology, Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah. Polis Okulu Karsisi, Emniyet Cad, 16310 Yildirim, Bursa, Turkey
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Roshan MP, Cury RC, Lampen-Sachar K. Assessing cardiovascular risk with mammography and non-contrast chest CT: A review of the literature and clinical implications. Clin Imaging 2023; 103:109983. [PMID: 37716018 DOI: 10.1016/j.clinimag.2023.109983] [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] [Received: 06/21/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of mortality and disability globally. In the United States, about 7.2% of adults aged 20 and older are affected by CAD. However, due to its progression over decades, CAD is often undetected and unnoticed until plaque ruptures. This leads to partial or complete artery blockage, resulting in myocardial infarction. Thus, new screening methods for early detection of CAD are needed to prevent and minimize the morbidity and mortality from CAD. Vascular calcifications seen on mammography and non-contrast chest CT (NCCT) can be used for the early detection of CAD and are an accurate predictor of cardiovascular risk. This paper aims to review the basic epidemiology, pathophysiology, imaging findings, and correlation of long-term cardiovascular outcomes with vascular calcifications on mammography and NCCT.
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Affiliation(s)
- Mona P Roshan
- Herbert Wertheim College of Medicine, Florida International University Miami, FL 33199, USA
| | - Ricardo C Cury
- Herbert Wertheim College of Medicine, Florida International University Miami, FL 33199, USA; Baptist Health of South Florida and Radiology Associates of South Florida, Miami, FL 33176, USA
| | - Katharine Lampen-Sachar
- Herbert Wertheim College of Medicine, Florida International University Miami, FL 33199, USA; Baptist Health of South Florida and Radiology Associates of South Florida, Miami, FL 33176, USA.
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Fusaro M, Pereira L, Bover J. Current and Emerging Markers and Tools Used in the Diagnosis and Management of Chronic Kidney Disease-Mineral and Bone Disorder in Non-Dialysis Adult Patients. J Clin Med 2023; 12:6306. [PMID: 37834950 PMCID: PMC10573159 DOI: 10.3390/jcm12196306] [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: 08/02/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Chronic kidney disease (CKD) is a significant public health concern associated with significant morbidity and has become one of the foremost global causes of death in recent years. A frequent comorbidity of CKD is secondary hyperparathyroidism (SHPT), exemplified by high serum parathyroid hormone (PTH) levels. The mineral metabolism disturbances resulting from CKD and progression to SHPT are currently considered part of the definition of chronic kidney disease-mineral and bone disorder (CKD-MBD). However, CKD-MBD does not only include abnormalities in laboratory-measured parameters; it is a complex condition characterized by dysregulation of bone turnover, mineralization, growth and strength, accompanied by vascular or another soft-tissue calcification. Together, this increases the risk of bone fractures, cardiovascular disease, and overall mortality in CKD-MBD patients. Monitoring serum markers is essential in diagnosing SHPT and CKD-MBD, and there are several recognized indicators for prognosis, optimal clinical management and treatment response in late-stage kidney disease patients receiving dialysis. However, far fewer markers have been established for patients with non-dialysis CKD. This review provides an overview of current and emerging markers and tools used in the diagnosis and management of CKD-MBD in non-dialysis adult patients.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR)—Institute of Clinical Physiology (IFC), Via G. Moruzzi 1, 56124 Pisa, Italy
- Department of Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Luciano Pereira
- Institute of Investigation and Innovation in Health, University of Porto, 4200-135 Porto, Portugal
- INEB—National Institute of Biomedical Engineering, University of Porto, 4150-180 Porto, Portugal
- DaVita Kidney Care, 4200-448 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-250 Porto, Portugal
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol (HGiTP), 08916 Barcelona, Spain
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Nielsen MB, Dahl JN, Laursen R, Jespersen B, Ivarsen P, Winther S, Birn H. In a real-life setting, risk factors, coronary artery calcium score, and coronary stenosis at computed tomography angiography are associated with major adverse cardiovascular events and all-cause mortality among kidney transplant candidates. Am J Transplant 2023; 23:1194-1208. [PMID: 37172693 DOI: 10.1016/j.ajt.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Kidney failure is associated with an increased risk of cardiovascular disease and death. This single-center, a retrospective study evaluated the association between risk factors, coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), major adverse cardiovascular events (MACEs), and all-cause mortality in kidney transplant candidates. Data on clinical risk factors, MACE, and all-cause mortality were collected from patient records. A total of 529 kidney transplant candidates were included (median follow-up of 4.7 years). CACS was evaluated in 437 patients and CTA in 411. Both the presence of ≥3 risk factors, CACS of ≥400, as well as multiple-vessel stenoses or left main artery disease predicted MACE (hazard ratio, 2.09; [95% confidence interval, 1.35-3.23]; 4.65 [2.20-9.82]; 3.70 [1.81-7.57]; 4.90 [2.40-10.01]) and all-cause mortality (harad ratio, 4.44; [95% confidence interval, 2.54-7.76]; 4.47 [2.22-9.02]; 2.82 [1.34-5.94]; 5.41 [2.81-10.41]) in univariate analyses. Among patients eligible for CACS and CTA (n = 376), only CACS and CTA were associated with both MACE and all-cause mortality. In conclusion, risk factors, CACS, and CTA provide information on the risk of MACE and mortality in kidney transplant candidates. An additional value of CACS and CTA compared with risk factors was observed for the prediction of MACE in a subpopulation undergoing both CACS and CTA.
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Affiliation(s)
- Marie Bodilsen Nielsen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark.
| | - Jonathan Nørtoft Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Rasmus Laursen
- Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Henrik Birn
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Kosciuszek ND, Kalta D, Singh M, Savinova OV. Vitamin K antagonists and cardiovascular calcification: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:938567. [PMID: 36061545 PMCID: PMC9437425 DOI: 10.3389/fcvm.2022.938567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Many patients treated with Vitamin K antagonists (VKA) for anticoagulation have concomitant vascular or valvular calcification. This meta-analysis aimed to evaluate a hypothesis that vascular and valvular calcification is a side-effect of VKA treatment. Methods We conducted a systematic literature search to identify studies that reported vascular or valvular calcification in patients treated with VKA. The associations between VKA use and calcification were analyzed with random-effects inverse variance models and reported as odds ratios (OR) and 95% confidence intervals (95% CI). In addition, univariate meta-regression analyses were utilized to identify any effect moderators. Results Thirty-five studies were included (45,757 patients; 6,251 VKA users). The median follow-up was 2.3 years [interquartile range (IQR) of 1.2–4.0]; age 66.2 ± 3.6 years (mean ± SD); the majority of participants were males [77% (IQR: 72–95%)]. VKA use was associated with an increased OR for coronary artery calcification [1.21 (1.08, 1.36), p = 0.001], moderated by the duration of treatment [meta-regression coefficient B of 0.08 (0.03, 0.13), p = 0.0005]. Extra-coronary calcification affecting the aorta, carotid artery, breast artery, and arteries of lower extremities, was also increased in VKA treated patients [1.86 (1.43, 2.42), p < 0.00001] and moderated by the author-reported statistical adjustments of the effect estimates [B: −0.63 (−1.19, −0.08), p = 0.016]. The effect of VKA on the aortic valve calcification was significant [3.07 (1.90, 4.96), p < 0.00001]; however, these studies suffered from a high risk of publication bias. Conclusion Vascular and valvular calcification are potential side effects of VKA. The clinical significance of these side effects on cardiovascular outcomes deserves further investigation.
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Affiliation(s)
- Nina D. Kosciuszek
- New York Institute of Technology, College of Osteopathic Medicine, Academic Medicine Scholar Program, OldWestbury, NY, United States
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Daniel Kalta
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Mohnish Singh
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Olga V. Savinova
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
- *Correspondence: Olga V. Savinova
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