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Kanbay M, Copur S, Tanriover C, Yavuz F, Galassi A, Ciceri P, Cozzolino M. The pathophysiology and management of vascular calcification in chronic kidney disease patients. Expert Rev Cardiovasc Ther 2023; 21:75-85. [PMID: 36716079 DOI: 10.1080/14779072.2023.2174525] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Vascular calcification (VC) which is the pathological mineral deposition in the vascular system, predominantly at the intimal and medial layer of the vessel wall, is an important comorbidity in patients with chronic kidney disease (CKD) leading to significant morbidity and mortality while necessitating appropriate treatment. Our review aims to provide an in-depth analysis of the current understanding of VC. AREAS COVERED In this review, we first discuss the pathophysiology of VC in CKD patients, then we explain the methods to predict and assess VC. Afterwards, we provide the currently available as well as the potential therapeutic approaches of VC. We finally discuss our understanding regarding the current situation surrounding VC in our expert opinion section. EXPERT OPINION Predicting, assessing and treating VC is crucial and the future advances in the field of research surrounding VC will potentially occur in one or more of these three areas of clinical management. There is a current lack of evidence and consensus regarding specific therapeutic options for alleviating VC and this situation may not necessitate VC to be determined, detected, and documented before the available options are implemented. Regardless, the prediction and assessment of VC is still important and requires further improvement together with the developments in therapeutic alternatives. The future has the potential to bring better research which would guide and improve the management of this patient group. A more specialized approach consisting of targeted therapies and more tailored management plans for patients with CKD and VC is on the horizon.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.,Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Furkan Yavuz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Andrea Galassi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Paola Ciceri
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, 20142 Milan, Italy
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Pan FF, Xu CC, Hu TJ, Fu GX, Zhong Y. Carotid plague formation is associated with ankle-brachial index in elderly people. Aging Clin Exp Res 2020; 32:2217-2223. [PMID: 31760610 DOI: 10.1007/s40520-019-01415-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
AIMS This study aimed at examining whether ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were independently associated with carotid Intima-media thickness (CIMT) or carotid artery plaque (CAP) in elderly people. METHODS A cross-sectional analysis was performed in 155 individuals aged over 75 years who underwent the measurements of ABI and baPWV. Low ABI was defined as ABI ≤ 1.0. High baPWV was defined as baPWV > 2000 cm/s. The CIMT and CAP were measured with a B-mode tomographic ultrasound system. RESULTS Neither ABI nor baPWV was associated with CIMT in this elderly population. The group with low ABI (≤ 1.0) was significantly associated with a higher prevalence of carotid plaque (P = 0.001), while the relationship between baPWV and prevalence of carotid plaque was not found. Linear regression analysis showed that the value of ABI was significantly associated with the thickness of carotid plaque. Even in the full adjusted model, each 0.01unit ABI decreasing still increased 0.1663 mm of carotid plaque thickness (P = 0.004). Logistic Regression Analysis demonstrated that ABI lower than 1.0 had predictive value in the formation of carotid plaque with top quartile thickness (OR 2.834, 95% CI 1.131-7.099, P = 0.026). Furthermore, individuals with low ABI (≤ 1.0) were more likely to form hypoechoic carotid plaques according to ultrasonography. CONCLUSION Low ABI but not high baPWV was associated with the formation of carotid plaque. Furthermore, ABI was significantly associated with the thickness and morphology of carotid plaque in elderly people.
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Evaluation of carotid artery elasticity in patients with uremia by echo tracking. J Med Ultrason (2001) 2018; 45:591-596. [PMID: 29453675 DOI: 10.1007/s10396-018-0868-z] [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: 05/29/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to compare the carotid artery wall elasticity between patients with uremia and controls using echo tracking (ET). METHODS Ninety-three patients with uremia and 35 control subjects (Group A) were enrolled in this study. In the ET mode, the carotid artery elasticity parameters including stiffness index (β), pressure-strain elasticity modulus (EP), arterial compliance (AC), and one-point pulse wave velocity (PWVβ) were measured, and carotid intima-media thickness (IMT) was measured with B-mode ultrasonography. The patients were classified into three groups: Group B (normal IMT), Group C (thickened IMT), and Group D (one single atheroma plaque). RESULTS β, EP, and PWVβ were significantly higher in Group B, C, and D (especially in group D) than those of the control group (P < 0.05), and there were significant differences between Group A and Group B, while AC was lower than in controls, but there were no statistically significant differences among the four groups. CONCLUSIONS ET is a noninvasive method that can demonstrate a loss in carotid artery elasticity in uremia patients with normal IMT.
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Cozzolino M, Brancaccio D. Hyperphosphatemia in Dialysis Patients: The Therapeutic Role of Lanthanum Carbonate. Int J Artif Organs 2018; 30:293-300. [PMID: 17520565 DOI: 10.1177/039139880703000403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phosphate overload is a dramatic consequence in end-stage renal disease (ESRD) patients. Recent studies have well documented that abnormalities in mineral and bone metabolism in these patients are associated with increased cardiovascular morbidity and mortality. Elevated serum phosphate and calcium-phosphate product levels play an important role in the pathogenesis of secondary hyperparathyroidism and extra-skeletal calcification in dialysis patients. Furthermore, inorganic phosphate may cause vascular calcification directly through a real “ossification” of the tunica media in the vasculature of ESRD patients. The “classical” treatment of secondary hyperparathyroidism and hyperphosphatemia in ESRD patients consists of either calcium- or aluminum-based phosphate binders and calcitriol administration. Unfortunately, this “old generation” therapy is not free of complications. This review paper suggests that new calcium- and aluminum-free phosphate binders, such as lanthanum carbonate, can be used to treat hyperphosphatemia and secondary hyperparathyroidism in ESRD patients.
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Affiliation(s)
- M Cozzolino
- Renal Division, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan - Italy.
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Vascular calcification and cardiac function according to residual renal function in patients on hemodialysis with urination. PLoS One 2017; 12:e0185296. [PMID: 28953969 PMCID: PMC5617191 DOI: 10.1371/journal.pone.0185296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Vascular calcification is common and may affect cardiac function in patients with end-stage renal disease (ESRD). However, little is known about the effect of residual renal function on vascular calcification and cardiac function in patients on hemodialysis. Methods This study was conducted between January 2014 and January 2017. One hundred six patients with residual renal function on maintenance hemodialysis for 3 months were recruited. We used residual renal urea clearance (KRU) to measure residual renal function. First, abdominal aortic calcification score (AACS) and brachial-ankle pulse wave velocity (baPWV) were measured in patients on hemodialysis. Second, we performed echocardiography and investigated new cardiovascular events after study enrollment. Results The median KRU was 0.9 (0.3–2.5) mL/min/1.73m2. AACS (4.0 [1.0–10.0] vs. 3.0 [0.0–8.0], p = 0.05) and baPWV (1836.1 ± 250.4 vs. 1676.8 ± 311.0 cm/s, p = 0.01) were significantly higher in patients with a KRU < 0.9 mL/min/1.73m2 than a KRU ≥ 0.9 mL/min/1.73m2. Log-KRU significantly negatively correlated with log-AACS (ß = -0.29, p = 0.002) and baPWV (ß = -0.19, P = 0.05) after factor adjustment. The proportion of left ventricular diastolic dysfunction was significantly higher in patients with a KRU < 0.9 mL/min/1.73m2 than with a KRU ≥ 0.9 mL/min/1.73m2 (67.9% vs. 49.1%, p = 0.05). Patients with a KRU < 0.9 mL/min/1.73m2 showed a higher tendency of cumulative cardiovascular events compared to those with a KRU ≥ 0.9 ml/min/1.73m2 (P = 0.08). Conclusions Residual renal function was significantly associated with vascular calcification and left ventricular diastolic dysfunction in patients on hemodialysis.
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Stróżecki P, Serafin Z, Adamowicz A, Flisiński M, Włodarczyk Z, Manitius J. Coronary artery calcification and large artery stiffness in renal transplant recipients. Adv Med Sci 2015; 60:240-5. [PMID: 25951498 DOI: 10.1016/j.advms.2015.04.002] [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] [Received: 01/27/2015] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Coronary artery calcification (CAC) is an independent predictor of cardiovascular (CV) events in renal transplant recipients (RTR). Carotid-femoral pulse wave velocity (PWV), a non-invasive measure of large artery stiffness, also predicts CV events in RTR. The study investigated the relationship between CAC and PWV in RTR and assessed the performance of PWV measurement in predicting CAC. PATIENTS/METHODS The study was performed as cross-sectional analysis in 104 RTR. CAC was determined as total calcium score (CS) and calcium mass (CM). Carotid-femoral PWV was also measured. Sensitivity, specificity and receiver operating characteristic (ROC) curve were used to assess the performance of PWV as diagnostic test for presence of CAC. RESULTS CAC was found in 69% of participants. PWV was higher in RTR with CAC than in RTR without CAC (10.2±2.2 vs. 8.6±15; p<0.001). In univariate analysis CS was significantly correlated with age, duration of hypertension, waist circumference, PWV, hemoglobin concentration, and serum glucose. In multiple linear regression analysis CS was independently associated with age only, but not with PWV. Sensitivity and specificity of PWV>7.6m/s as cut-off for detecting CAC>0 was 0.889 and 0.406, respectively. Sensitivity and specificity of PWV>10.2m/s as cut-off for detecting severe CAC (CS>400) was 0.319 and 0.969, respectively. CONCLUSIONS The study confirmed high prevalence of coronary artery calcification in renal transplant recipients. The study does not support the hypothesis that aortic stiffness is independently associated with coronary artery calcification in RTR. PWV measurement may be useful in excluding severe CAC in RTR.
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Meuwese CL, Olauson H, Qureshi AR, Ripsweden J, Barany P, Vermeer C, Drummen N, Stenvinkel P. Associations between Thyroid Hormones, Calcification Inhibitor Levels and Vascular Calcification in End-Stage Renal Disease. PLoS One 2015; 10:e0132353. [PMID: 26147960 PMCID: PMC4492991 DOI: 10.1371/journal.pone.0132353] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/13/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction Vascular calcification is a common, serious and elusive complication of end-stage renal disease (ESRD). As a pro-calcifying risk factor, non-thyroidal illness may promote vascular calcification through a systemic lowering of vascular calcification inhibitors such as matrix-gla protein (MGP) and Klotho. Methods and Material In 97 ESRD patients eligible for living donor kidney transplantation, blood levels of thyroid hormones (fT3, fT4 and TSH), total uncarboxylated MGP (t-ucMGP), desphospho-uncarboxylated MGP (dp-ucMGP), descarboxyprothrombin (PIVKA-II), and soluble Klotho (sKlotho) were measured. The degree of coronary calcification and arterial stiffness were assessed by means of cardiac CT-scans and applanation tonometry, respectively. Results fT3 levels were inversely associated with coronary artery calcification (CAC) scores and measures of arterial stiffness, and positively with dp-ucMGP and sKlotho concentrations. Subfractions of MGP, PIVKA-II and sKlotho did not associate with CAC scores and arterial stiffness. fT4 and TSH levels were both inversely associated with CAC scores, but not with arterial stiffness. Discussion The positive associations between fT3 and dp-ucMGP and sKlotho suggest that synthesis of MGP and Klotho is influenced by thyroid hormones, and supports a link between non-thyroidal illness and alterations in calcification inhibitor levels. However, the absence of an association between serum calcification inhibitor levels and coronary calcification/arterial stiffness and the fact that MGP and Klotho undergo post-translational modifications underscore the complexity of this association. Further studies, measuring total levels of MGP and membrane bound Klotho, should examine this proposed pathway in further detail.
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Affiliation(s)
| | - Hannes Olauson
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - Jonaz Ripsweden
- Medical Imaging and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Cees Vermeer
- VitaK, Maastricht University, Maastricht, The Netherlands
| | - Nadja Drummen
- VitaK, Maastricht University, Maastricht, The Netherlands
| | - Peter Stenvinkel
- Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Meuwese CL, Carrero JJ, Cabezas-Rodríguez I, Heimburger O, Barany P, Lindholm B, Qureshi AR, Ripsweden J, Dekker FW, Stenvinkel P. Nonthyroidal illness: a risk factor for coronary calcification and arterial stiffness in patients undergoing peritoneal dialysis? J Intern Med 2013; 274:584-93. [PMID: 23815158 DOI: 10.1111/joim.12107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Low triiodothyronine levels, as part of the nonthyroidal illness syndrome, are common in dialysis patients and have repeatedly been shown to be associated with increased (cardiovascular) mortality rates. We hypothesized that increased vascular calcification may mediate this relationship. METHODS A total of 84 patients from the Stockholm region receiving maintenance peritoneal dialysis were included in the study. Serum concentrations of free triiodothyronine (fT3), thyroxine and thyroid-stimulating hormone were measured. Coronary artery calcium (CAC) scores were assessed by cardiac computed tomography scans. Surrogates of arterial stiffness included aortic diastolic and systolic blood pressures, pulse pressure, augmentation pressure and Buckberg's subendocardial viability ratio measured by pulse waveform analyses. Patients were subsequently followed, and events of death and censoring were recorded. Thyroid hormone concentrations were associated with CAC scores, measures of arterial stiffness and all-cause mortality. The associations between CAC scores and arterial stiffness surrogates and mortality were also determined to evaluate a possible causal pathway. RESULTS Both CAC scores and arterial stiffness surrogates were substantially higher in individuals with low fT3 levels. These associations persisted in multivariate logistic and linear regression analyses. During a median (interquartile range) follow-up of 32 (22-42) months, 24 patients died. Both fT3 levels below the median value [HR crude 4.1, 95% confidence interval (CI) 1.4-12.6] and CAC scores above the median value (HR crude 5.8, 95% CI 1.7-20.1) were strongly associated with mortality. CONCLUSIONS In patients undergoing peritoneal dialysis, fT3 levels were strongly associated with arterial stiffness, coronary artery calcification and mortality. We speculate that the association between nonthyroidal illness and mortality may be partly mediated by acceleration of vascular calcification.
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Affiliation(s)
- Christiaan L Meuwese
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands; Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Zoccali C, Mallamaci F. Low triiodothyronine: a pathway to coronary calcification in patients maintained on peritoneal dialysis. J Intern Med 2013; 274:581-3. [PMID: 23957300 DOI: 10.1111/joim.12125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Zoccali
- Division of Nephrology, Dialysis and Transplantation, CNR-IBIM, Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
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Breznik S, Ekart R, Hren M, Rupreht M, Balon BP. Radiographic Assessment of Vascular Calcification, Aortic Pulse Wave Velocity, Ankle-Brachial Index and Fibroblast Growth Factor-23 in Chronic Hemodialysis Patients. Ther Apher Dial 2013; 17:378-83. [DOI: 10.1111/1744-9987.12082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Silva Breznik
- Department of Radiology; University Clinical Centre Maribor; Maribor; Slovenia
| | - Robert Ekart
- Department of Dialysis; University Clinical Centre Maribor; Maribor; Slovenia
| | - Martin Hren
- Department of Dialysis; University Clinical Centre Maribor; Maribor; Slovenia
| | - Mitja Rupreht
- Department of Radiology; University Clinical Centre Maribor; Maribor; Slovenia
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Wu HT, Hsu PC, Liu AB, Chen ZL, Huang RM, Chen CP, Tang CJ, Sun CK. Six-channel ECG-based pulse wave velocity for assessing whole-body arterial stiffness. Blood Press 2012; 21:167-76. [PMID: 22519467 DOI: 10.3109/08037051.2012.681853] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the proposal of different means of non-invasive arterial stiffness assessment, none offers simultaneous information on whole-body peripheral arterial condition. We investigated the validity of applying a six-channel electrocardiogram-based pulse wave velocity (ECG-PWV) measurement system for this purpose. METHODS The study consisted of two parts. Part One enrolled hypertensive (Group 1, n = 32) and normal (Group 2, n = 32) subjects, whereas Part Two recruited diabetic (Group 3, n = 50) and normal (Group 4, n = 50) subjects. To validate the application of ECG-PWV in assessing peripheral arterial stiffness in different parts of body, ECG-PWV data were compared with three other parameters including the cardio-ankle vascular index (CAVI), pulse wave velocity-digital volume pulse (PWV-DVP) and intima-media thickness (IMT). RESULTS ECG-PWV in healthy subjects in Part One correlated significantly with CAVI and PWV-DVP (p < 0.05), whereas ECG-PWV and CAVI were significantly different between the hypertensive and normal subjects. Moreover, comparison of IMT and ECG-PWV from different sites showed significant correlation only between IMT and ECG-PWV from earlobe (r = 0.495, p = 0.004). No significant association, however, was noted between IMT and CAVI. For Part Two, significant differences existed between diabetic and normal subjects in body weight, waist circumference, level of HbA1c, fasting blood sugar, serum creatinine and ECG-PWV from the foot. However, no significant difference was noted in PWV-DVP between two groups. CONCLUSIONS Six-channel ECG-PWV measurement system showed remarkable correlation with IMT in hypertensive subjects and with key anthropometric and biochemical parameters in diabetic patients, suggesting its validity in assessing whole-body arterial stiffness in subjects with peripheral arterial diseases within 10 min.
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Affiliation(s)
- Hsien-Tsai Wu
- Department of Electrical Engineering, National Dong Hwa University, Hualien, Taiwan
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Karohl C, D'Marco Gascón L, Raggi P. Noninvasive imaging for assessment of calcification in chronic kidney disease. Nat Rev Nephrol 2011; 7:567-77. [PMID: 21862991 DOI: 10.1038/nrneph.2011.110] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vascular calcification is highly prevalent in patients with chronic kidney disease and has a progressive course. Several cardiovascular and uremia-related risk factors, such as abnormalities in mineral metabolism, contribute to the development of vascular calcification, although the pathophysiological mechanisms are still unclear. The presence and extent of vascular calcification is associated with an increased risk of cardiovascular events and mortality. By contrast, patients who do not have calcification seem to have a good prognosis, with minimal or no calcification progression over an extended period of time. A number of noninvasive imaging methods are available to detect vascular calcification and may help clinicians to make therapeutic decisions. Cardiac CT remains the reference standard to detect and quantify coronary artery, aortic and cardiac valve calcification. However, the high cost of equipment, the inability to perform in-office testing and the expertise required limit its use on a routine basis. Other imaging methods, such as planar X-ray, ultrasound and echocardiography, are appropriate alternatives to evaluate vascular and valvular calcification. In this review, we discuss the noninvasive imaging methods most frequently used to assess vascular and valvular calcification, with their advantages and limitations.
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Affiliation(s)
- Cristina Karohl
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Avenida Paulo Gama 110, Porto Alegre, RS 90040-060, Brazil
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Goldsmith D. The case against routine screening for vascular calcification in chronic kidney disease. Semin Dial 2010; 23:280-2. [PMID: 20636922 DOI: 10.1111/j.1525-139x.2010.00729.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ketteler M, Biggar PH. Review article: Getting the balance right: assessing causes and extent of vascular calcification in chronic kidney disease. Nephrology (Carlton) 2009; 14:389-94. [PMID: 19563380 DOI: 10.1111/j.1440-1797.2009.01149.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vascular calcification is part of the definition of chronic kidney disease-mineral and bone disorder (CKD-MBD). It is also a surrogate parameter of cardiovascular and all-cause mortality risk in the CKD population. However, vascular calcification is not a homogenous entity, but a rather complex manifestation influenced by derangements of calcium and phosphate homeostasis, by dysregulated calcification inhibitors and promoters, and by the type of arterial disease (atherosclerosis vs arteriosclerosis). Despite the clear-cut risk association between the presence of vascular calcification and mortality, it is currently not well defined, how this knowledge about calcification should be translated into active clinical management. Further, the choice of the appropriate imaging test is a matter of debate. This article attempts to provide an update on insights into the pathophysiology of vascular calcification processes and a subjective view of the clinical consequences of management of CKD patients at risk.
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Affiliation(s)
- Markus Ketteler
- Division of Nephrology, Klinikum Coburg, Ketschendorfer Strasse 33, Coburg, Germany.
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Akamatsu M, Ogawa T, Fujiu A, Matsuda N, Nitta K. Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients. Clin Exp Nephrol 2009; 13:651-8. [PMID: 19680594 DOI: 10.1007/s10157-009-0220-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 07/15/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIM Atherosclerosis is evaluated by carotid mean intima-media thickness (mean IMT), pulse wave velocity (PWV), and the aortic calcification index (ACI). We have attempted to examine if these atherosclerotic parameters are associated with each other and which parameters are closely related to cardiac function in chronic HD patients. METHODS The mean IMT, PWV and ACI were examined in 69 maintenance HD patients using carotid ultrasonography, a blood volume plethysmographic apparatus and abdominal CT, respectively. Echocardiographic studies were also performed for measuring left ventricular (LV) geometry. Serum total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, albumin, C-reactive protein (CRP), calcium and phosphate were measured. RESULTS The mean IMT correlated positively with ACI (r = 0.461, P < 0.0001) and tended to be correlated with PWV, but did not reach statistical significance. The PWV value correlated positively with ACI (r = 0.494, P <or= 0.0001). The mean IMT correlated positively with the LV mass index (r = 0.273, P = 0.0228), and fractional shortening (FS) correlated negatively with PWV value (r = -0.293, P = 0.0141) and ACI score (r = -0.289, P = 0.0158). Multivariate analyses indicated that the LV mass index was independently associated with mean IMT (P = 0.0231) as well as systolic blood pressure (P < 0.0001), pulse pressure (P < 0.0001) and hemoglobin (P = 0.016), and FS is independently associated with ACI (P = 0.0162) as well as PWV (P = 0.0144) and CRP (P = 0.0375). CONCLUSION Atherosclerosis and reduced LV function are associated with increased vascular calcification and arterial stiffness in chronic HD patients.
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Affiliation(s)
- Mayuko Akamatsu
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Jaroszynski A, Czekajska-Chechab E, Drelich-Zbroja A, Zapolski T, Ksiazek A. Spatial QRS-T angle in peritoneal dialysis patients: association with carotid artery atherosclerosis, coronary artery calcification and troponin T. Nephrol Dial Transplant 2009; 24:1003-1008. [PMID: 18978067 DOI: 10.1093/ndt/gfn581] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Abnormal values of the spatial angle between the directions of ventricular depolarization and repolarization (QRS-T) predict potently arrhythmic events and mortality in various patients groups. The study was designed to estimate QRS-T in a group of peritoneal dialysis (PD) patients, and to assess the possible association between QRS-T and coronary artery calcification (CAC), atherosclerosis, and some biochemical measurements. METHODS The angular differences between the maximum spatial QRS and T vectors were reconstructed from ECGs in 57 selected PD patients and in 54 controls. In patients CAC score was performed by using multi-row computed tomography. Atherosclerotic disease was assessed by measuring carotid arteries' intima-media thickness (IMT) and plaque score (sum of the maximum thicknesses in mm of all plaques on both sides) by using an ultrasound scanner. RESULTS QRS-T was higher in patients compared with controls (34.79% B111.97 and 14.95% B17.87 respectively; P < 0.001). Median CAC score equalled 104.5 Agatson units (Au) (range, 0-2478). IMT was 0.832% B10.208, and atherosclerotic plaques were detected in 82.5% of patients. The plaque score was 7.97% B14.49. QRS-T was higher in patients with CAC score >400 Au compared with patients with CAC score <400 Au (P = 0.011). The results of univariate linear regression analysis showed correlation between QRT-T and dialysis duration (r = 0.305, P = 0,020), LVMI (r = 0.311, P = 0.017), HDL (r = -0.361, P = 0.006), cTnT (r = 0.442, P < 0.001), plaque score (r = 0.403, P = 0.001) and CAC score (r = 0.451, P < 0.001). On multivariate analysis, CAC score, plaque score and troponine T were found to be independent predictors of QRS-T values. CONCLUSIONS QRS-T is high in PD patients and is mainly associated with coronary artery calcium burden, atherosclerosis and troponin T elevation. The possible clinical importance of the higher QRS-T in PD patients remains to be confirmed in further studies.
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Affiliation(s)
- Andrzej Jaroszynski
- Nephrology Department, Medical University of Lublin, 20-950 Lublin, ul Jaczewskiego 8, Poland.
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Wykretowicz A, Gerstenberger P, Guzik P, Milewska A, Krauze T, Adamska K, Rutkowska A, Wysocki H. Arterial stiffness in relation to subclinical atherosclerosis. Eur J Clin Invest 2009; 39:11-6. [PMID: 19087126 DOI: 10.1111/j.1365-2362.2008.02057.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased arterial stiffness or arteriosclerosis, represents a physiological part of ageing. Atherosclerosis is a process that does not affect the arterial bed uniformly but has a variable local distribution and is frequently superimposed on stiffened vessels. We therefore addressed the question of whether any correlation exists between the general characteristics of arterial stiffness or wave reflection and subclinical atherosclerosis as assessed by carotid intima-media thickness (IMT) in a sample of healthy subjects. METHODS A total of 116 healthy subjects (mean age 55 years, 43 female) were evaluated. Arterial stiffness and wave reflection was assessed with the use of digital volume pulse analysis (DVP) and pulse wave analysis (PWA). Subclinical atherosclerosis was assessed by measurement of IMT. RESULTS Stiffness Index (SI(DVP)), the measure of general arterial stiffness correlated significantly with IMT (r = 0.37, P < 0.01). IMT correlated significantly with age (r = 0.5, P < 0.0001), waist to hip ratio (WHR) (r = 0.39, P < 0.0001) and mean blood pressure (BPmean) (r = 0.4, P < 0.0001). IMT did not correlate with measures of wave reflection. SI(DVP) correlated significantly with age (r = 0.32, P < 0.005), WHR (r = 0.36, P < 0.0001), BPmean (r = 0.36, P < 0.0001) and measurements of wave reflection. However analysis of a model which included variables that significantly influenced SI(DVP) and IMT, such as age, WHR and mean BP showed that arterial stiffness is not independently associated with subclinical atherosclerosis. CONCLUSIONS The indices of subclinical atherosclerosis, arterial stiffness and wave reflection, indicate different aspects of vascular status in otherwise healthy subjects.
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Affiliation(s)
- A Wykretowicz
- Department of Internal Medicine, Division of Cardiology-Intensive Therapy, University School of Medicine, Poznan, Poland.
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Walker M, Campbell BR, Azer K, Tong C, Fang K, Cook JJ, Forrest MJ, Kempadoo K, Wright SD, Saltzman JS, MacIntyre E, Hargreaves R. A novel 3-dimensional micro-ultrasound approach to automated measurement of carotid arterial plaque volume as a biomarker for experimental atherosclerosis. Atherosclerosis 2008; 204:55-65. [PMID: 19135672 DOI: 10.1016/j.atherosclerosis.2008.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 08/23/2008] [Accepted: 09/01/2008] [Indexed: 10/21/2022]
Abstract
Improved methods for non-invasive in vivo assessment are needed to guide development of animal models of atherosclerosis and to evaluate target engagement and in vivo efficacy of new drugs. Using novel 3D-micro-ultrasound technology, we developed and validated a novel protocol for 3D acquisition and analysis of imaging to follow lesion progression in atherosclerotic mice. The carotid arteries of ApoE receptor knockout mice and normal control mice were imaged within the proximal 2mm from the aortic branch point. Plaque volume along that length was quantified using a semi-automated 3D segmentation algorithm. Volumes derived by this method were compared to those calculated using 3-D histology post-mortem. Bland-Altman comparison revealed close correlation between these two measures of plaque volume. Furthermore, using a segmentation technique that captures early positive and 33 week negative remodeling, we found evidence that plaque volume increases linearly over time. Each animal and each plaque served as its own control, allowing accurate comparison. The high fidelity anatomical registration of this protocol provides increased spatial resolution and therefore greater sensitivity for measurement of plaque wall size, an advance over 2-dimensional measures of intimal-medial-thickening. Further, 3-dimensional analysis ensures a point of registration that captures functional markers in addition to the standard structural markers that characterize experimental atherosclerosis. In conclusion, this novel imaging protocol provides a non-invasive, accurate surrogate marker for experimental atherosclerosis over the life of the entire lesion.
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Affiliation(s)
- Matthew Walker
- Department of Imaging Research, Merck & Co. Inc., Rahway, NJ 07065, USA. matthew
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DeLoach SS, Berns JS. Arterial stiffness and vascular calcification in dialysis patients: new measures of cardiovascular risk. Semin Dial 2007; 20:477-9. [PMID: 17897262 DOI: 10.1111/j.1525-139x.2007.00332.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie S DeLoach
- Renal-Electrolyte and Hypertension Division, Hospital of University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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