Baseline carotid intima-media thickness is associated with cardiovascular morbidity and mortality in peritoneal dialysis patients

Serum fibroblast growth factor 23 concentration and the risk of mortality in patients undergoing peritoneal dialysis

BACKGROUND

Fibroblast growth factor 23 (FGF23) is a phosphate-regulating hormone that is secreted in large amounts early in chronic kidney disease. In this cohort, we aimed to investigate the association between serum FGF23 concentration and mortality in patients undergoing peritoneal dialysis (PD).

METHODS

Serum FGF23 level was determined by enzyme-linked immunosorbent assay (ELISA) in a large 15-year prospective cohort study of PD patients with stored serum samples at baseline. Kaplan-Meier survival curves and Cox proportional hazards models were performed to characterise the relationship of FGF23 with mortality.

RESULTS

A total of 737 incident PD patients were analysed. The baseline median FGF23 concentration was 683.2 (518.5-896.2) pg/mL. Age, serum phosphorus, high-density lipoprotein cholesterol and high-sensitivity C-reactive protein were independently correlated with serum FGF23 concentration. During a median follow-up of 66.7 (41.1-95.4) months, 171 of the 737 participants (23.2%) died, including 84 (49.1%) cardiovascular disease-related and 50 (29.2%) infection-related deaths. Multivariable Cox regression analysis showed that the adjusted hazard ratios of the highest tertile of serum FGF23 compared with those in the lowest tertile were 1.36 (95% confidence interval (CI): 0.89-2.07; p = 0.154), 0.75 (95% CI: 0.40-1.38; p = 0.353) and 2.66 (95% CI: 1.15-6.15; p = 0.022) for all-cause, cardiovascular disease-related and infection-related mortality, respectively.

CONCLUSION

High serum FGF23 concentration is associated with a higher risk of infection-related death for incident PD patients.

The Role of Dyslipidemia in Atherogenesis in Peritoneal Dialysis Patients

Background

To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling.

Materials and Methods

We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography.

Results

A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001).

Conclusion

We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.

Arterial calcifications and osteoprotegerin in chronic hemodialysis patients: impact on 6-year survival

AIM

The association between end-stage renal disease and cardiovascular mortality may be influenced through vascular alterations, in particular atherosclerosis and vascular calcification. The study goal was to assess the impact of each type of arterial intimal calcifications (AIC) and arterial medial calcifications (AMC), of osteoprotegerin (OPG), mineral metabolism markers and other features on all-cause and cardiovascular mortality in chronic hemodialysis patients.

METHODS

Ultrasound was performed in 87 patients on the carotid and femoral arteries, and the severity of AIC and AMC was assessed calculating a score according to the extension of calcification. We analyzed the link between AIC, AMC, OPG, mineral markers and mortality after 6 years of follow-up.

RESULTS

The cutoff value for OPG determined using ROC was 4.9 pmol/l for all-cause and cardiovascular mortality. Patients with higher serum OPG levels presented higher mortality rates. Our study revealed that AIC, high OPG, low ankle-arm index, presence of diabetes, smoking status, and lack of arteriovenous fistula are associated with all-cause and cardiovascular mortality in univariate regression analysis. Multivariate analysis identified AIC scoring based on the segmentation method as an independent predictor of all-cause and cardiovascular mortality, along with increased OPG levels. AMC scoring was not a predictor of mortality.

CONCLUSIONS

Identifying and scoring AIC on ultrasound and measuring OPG levels, as a basis of the HD patient assessment may become valuable tools in clinical work, as these have an impact on death toll.

Relation between carotid intimal medial thickness and left ventricular mass and left ventricular mass indices in maintenance hemodialysis patients

Left ventricular hypertrophy (LVH) is a risk factor of cardiovascular morbidity in dialysis patients. The association between LV mass and carotid intimal medial thickness (CIMT) could be due to increased hemodynamic load in dialysis patients. The relationship between CIMT and LVM indices in hemodialysis (HD) patients was investigated. This is a cross-sectional study including 65 HD patients, divided into two groups: Group 1 with CIMT ≤ 1 mm (N = 29), Group 2 with CIMT > 1 mm (N = 36). Echocardiographic evaluation of the LVM, CIMT measurement using B-mode ultrasonography, patients' basic clinical and biochemical data were recorded. Patients with CIMT > 1 mm (Group 2) showed significantly higher LVM, LVM/BSA (body surface area), and LVM/Ht^2.7 (height). Regarding linear regression, CIMT was found to be an independent predictor for LVM, LVM/BSA, and LVM/Ht^2.7 . LVM, LVMI, and LVM/Ht^2.7 are significantly elevated in HD patients with CIMT > 1 mm group. CIMT was found to be the independent predictor for LVH in maintenance HD patients.