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Yu Z, Yang H, Shou B, Cheng Z, Jiang C, Xu J. Association between pulse pressure and carotid plaques in old adults with uncontrolled hypertension: results from a community-based screening in Hangzhou, China. BMC Cardiovasc Disord 2024; 24:249. [PMID: 38734608 PMCID: PMC11088081 DOI: 10.1186/s12872-024-03914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. METHODS 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547-2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237-1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. CONCLUSIONS Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis.
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Affiliation(s)
- Zhecong Yu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Haifeng Yang
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, P. R. China
| | - Biqi Shou
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, P. R. China
| | - Zongxue Cheng
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Caixia Jiang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Jue Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China.
- Institute for Chronic Noncommunicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China.
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Tawfik AM, Tawfik HM. Nontraditional risk factors in chronic kidney disease: correlation between creatinine clearance, Framingham risk score, endothelial dysfunction, and inflammation. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:29. [PMID: 35308655 PMCID: PMC8919167 DOI: 10.1186/s43162-022-00110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease became a public health problem increasing healthcare burden. Our aim was to detect the relationship between cardiovascular risk, endothelial dysfunction, inflammation, and kidney function in chronic kidney disease patients and to detect the nontraditional factors affecting the decline in kidney functions. Methods A cross-sectional study including 30 male and female patients with chronic kidney disease stages 3–5. Creatinine clearance and Framingham risk score points were calculated. Carotid intimal medial thickness was measured as well as absolute flow mediated dilatation in brachial artery. Highly sensitive C-reactive protein, parathyroid hormone, kidney function tests, and lipid profile were measured. Results Framingham risk score points and carotid intimal medial thickness increased significantly with decreasing creatinine clearance (p 0.0025, 0.0285) respectively. A significant correlation was found between highly sensitive C-reactive protein and Framingham risk score points but not with carotid intimal medial thickness (p 0.0043, 0.2229) respectively. An inverse correlation was found between creatinine clearance and highly sensitive C-reactive protein (p 0.0174). Absolute flow mediated dilatation in brachial artery decreases with increasing Framingham risk score points and decreasing creatinine clearance (p 0.0044, 0.0269) respectively. Conclusion There is correlation between chronic kidney disease and impaired vascular function, subclinical atherosclerosis, and heightened inflammatory response. Chronic kidney disease patients are at increased risk of cardiovascular events with higher [10-]year cardiovascular risk.
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Demirci R, Sevinc C. The Relationship Between Carotid Intima Media Thickness, Inflammation and GLA Rich Protein Levels in Chronic Kidney Disease. Int J Gen Med 2021; 14:5119-5126. [PMID: 34511994 PMCID: PMC8420775 DOI: 10.2147/ijgm.s331758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
AIM Vascular calcification is a common complication in CKD. Studies conducted in patients with end-stage renal disease (ESRD) showed that calcification in vascular structures is an important component of the atherosclerosis process. GLA rich protein (GRP) has been suggested as a potential marker for vascular calcification. We investigated the relationship between GRP levels, carotid intima media thickness and inflammatory parameters in patients with predialysis stage 3, 4 and 5 CKD. MATERIAL AND METHODS A total of 106 patients aged ≥18 years with CKD stage 3, stage 4 and non-dialysis stage 5 and 25 healthy volunteers were enrolled in the study. Patients with obesity, uncontrolled hypertension, coronary artery disease, with active cancer or liver disease, malignant hematologic disorders, acute renal failure, acute or chronic infections were excluded. As the control group, healthy volunteers without any known illness, regular drug use, smoking, alcohol use, and obesity were recruited. RESULTS Patients were divided into two groups as those with CIMT below 0.90 mm and those with CIMT 0.90 mm and above. There was no significant difference between the two groups in terms of the presence of HT and DM. While the CRP values of the group with high CIMT were found to be significantly higher (p=0.005), the GLA rich protein levels of this group were found to be significantly higher (p=0.019). CONCLUSION In our study, it was determined that there was a positive correlation between GRP levels and CIMT in patients with predialysis CKD, and GRP levels were higher in patients with CIMT above 0.90 mm. These findings suggest that GRP levels can be used as a cardiovascular event biomarker in patients with CKD.
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Affiliation(s)
- Recep Demirci
- Department of Nephrology, University of Health Science, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Can Sevinc
- Department of Nephrology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Xiong J, Yu Z, Zhang D, Huang Y, Yang K, Zhao J. A Nomogram for Identifying Subclinical Atherosclerosis in Chronic Kidney Disease. Clin Interv Aging 2021; 16:1303-1313. [PMID: 34267510 PMCID: PMC8275156 DOI: 10.2147/cia.s312129] [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: 03/23/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Atherosclerosis contributes substantially to cardiovascular mortality in patients with chronic kidney disease (CKD). But precise risk model for subclinical atherosclerosis in the CKD population is still lacking. The study aimed to develop and validate a nomogram for screening subclinical atherosclerosis among CKD patients without dialysis. Patients and Methods A total of 1452 CKD stage 1‒5 has been recruited in this cross-sectional study. Subclinical atherosclerosis was diagnosed with carotid ultrasonography. Patients were divided into the training set and validation set. The risk factors of atherosclerosis were identified by the training set and confirmed by the validation set. The receiver operating characteristic (ROC) curves and decision curve analyses (DCA) were executed to evaluate the accuracy of fitted logistic models in training and validation sets. Finally, a nomogram based on constructed logistic regression model in all participants was plotted. Results A total of 669 (46.1%) patients were diagnosed with subclinical carotid atherosclerosis. Binary logistic regression analysis showed that males, age, hypertension, diabetes, CKD stages, calcium, platelet, and albumin were risk factors for atherosclerosis. The accuracy of fitted logistic models was evaluated by the area under the ROC curve (AUC), which showed good predictive accuracy in the training set (AUC=0.764 (95% Confidence interval (CI): 0.733–0.794) and validation set (AUC=0.808 (95% CI: 0.765–0.852). A high net benefit was also proven by the DCA. Finally, these predictors were all included to generate the nomogram. Conclusion This proposed nomogram shows excellent predictive ability and might have a significant clinical implication for detecting subclinical atherosclerosis in patients with CKD.
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Affiliation(s)
- Jiachuan Xiong
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Zhikai Yu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Daohai Zhang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Yinghui Huang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Ke Yang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Jinghong Zhao
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
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Anguiano L, Riera M, Pascual J, Valdivielso JM, Barrios C, Betriu A, Clotet S, Mojal S, Fernández E, Soler MJ. Circulating angiotensin converting enzyme 2 activity as a biomarker of silent atherosclerosis in patients with chronic kidney disease. Atherosclerosis 2016; 253:135-143. [PMID: 27615597 DOI: 10.1016/j.atherosclerosis.2016.08.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/21/2016] [Accepted: 08/23/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Circulating Angiotensin Converting Enzyme 2 (ACE2) activity in chronic kidney disease (CKD) patients without previous history of cardiovascular disease (CVD) has been associated with classical risk factors (older age, diabetes and male gender). Furthermore, silent atherosclerosis has been described as a pathological link between CKD and CVD. We analyzed baseline ACE2 activity in non-dialysis CKD stages 3-5 (CKD3-5) patients as a biomarker of renal progression, silent atherosclerosis and CV events after 2 years of follow-up. METHODS Prospective study of 1458 CKD3-5 subjects without any previous CV event included in the Spanish multicenter NEFRONA study. Association between baseline circulating ACE2 activity and renal parameters, carotid/femoral echography, atheromatous disease, ankle-brachial index, intima-media thickness, need of renal replacement therapy, cardiovascular events and mortality at 24 months of follow-up were analyzed. RESULTS Patients with an increase in the number of territories with plaques at 24 months showed significantly higher levels of baseline ACE2 activity as compared to stable patients (29.6 (20.6-47.6)RFU/μL/h versus 35.7 (24.5-56), p < 0.001). Multivariate linear regression analysis showed that male gender, pathological ankle-brachial index and progressive silent atherosclerosis defined as an increased number of territories with plaques at 24 months were associated with increased baseline ACE2 activity. Male gender, older age, diabetes, smoking and increased baseline circulating ACE2 were independent predictors of atherosclerosis at 24 months of follow-up. CONCLUSIONS In CKD3-5 patients, higher circulating ACE2 activity at baseline is associated with higher risk for silent atherosclerosis, suggesting that ACE2 may serve as a biomarker to predict CV risk before CVD is established.
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Affiliation(s)
- Lidia Anguiano
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Marta Riera
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Clara Barrios
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Angels Betriu
- Nephrology Research Laboratory, Institute for Biomedical Research, IRB, Lleida, Spain; Department of Nephrology and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Sergi Clotet
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Sergi Mojal
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Elvira Fernández
- Nephrology Research Laboratory, Institute for Biomedical Research, IRB, Lleida, Spain; Department of Nephrology and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - María José Soler
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain.
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Gracia M, Betriu À, Martínez-Alonso M, Arroyo D, Abajo M, Fernández E, Valdivielso JM. Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD. Clin J Am Soc Nephrol 2015; 11:287-96. [PMID: 26668022 DOI: 10.2215/cjn.01240215] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 11/02/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Ultrasonographic detection of subclinical atheromatosis is a noninvasive method predicting cardiovascular events. Risk factors predicting atheromatosis progression in CKD are unknown. Predictors of atheromatosis progression were evaluated in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our multicenter, prospective, observational study included 1553 patients with CKD (2009-2011). Carotid and femoral ultrasounds were performed at baseline and after 24 months. A subgroup of 476 patients with CKD was also randomized to undergo ultrasound examination at 12 months. Progression of atheromatosis was defined as an increase in the number of plaque territories analyzed by multivariate logistic regression. RESULTS Prevalence of atheromatosis was 68.7% and progressed in 59.8% of patients after 24 months. CKD progression was associated with atheromatosis progression, suggesting a close association between pathologies. Variables significantly predicting atheromatosis progression, independent from CKD stages, were diabetes and two interactions of age with ferritin and plaque at baseline. Given that multiple interactions were found between CKD stage and age, phosphate, smoking, dyslipidemia, body mass index, systolic BP (SBP), carotid intima-media thickness, plaque at baseline, uric acid, cholesterol, 25-hydroxy vitamin D (25OH vitamin D), and antiplatelet and phosphate binders use, the analysis was stratified by CKD stages. In stage 3, two interactions (age with phosphate and plaque at baseline) were found, and smoking, diabetes, SBP, low levels of 25OH vitamin D, and no treatment with phosphate binders were positively associated with atheromatosis progression. In stages 4 and 5, three interactions (age with ferritin and plaque and plaque with smoking) were found, and SBP was positively associated with atheromatosis progression. In dialysis, an interaction between body mass index and 25OH vitamin D was found, and age, dyslipidemia, carotid intima-media thickness, low cholesterol, ferritin, and uric acid were positively associated with atheromatosis progression. CONCLUSIONS Atheromatosis progression affects more than one half of patients with CKD, and predictive factors differ depending on CKD stage.
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Affiliation(s)
- Marta Gracia
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Àngels Betriu
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | | | - David Arroyo
- Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - María Abajo
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | | | - José M Valdivielso
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain;
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Liu YW, Su CT, Song EJ, Tsai WC, Li YH, Tsai LM, Chen JH, Sung JM. The role of echocardiographic study in patients with chronic kidney disease. J Formos Med Assoc 2015; 114:797-805. [DOI: 10.1016/j.jfma.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 05/18/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022] Open
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Cardiovascular risk in chronic kidney disease patients: intima-media thickness predicts the incidence and severity of histologically assessed medial calcification in radial arteries. BMC Nephrol 2015; 16:78. [PMID: 26037625 PMCID: PMC4453281 DOI: 10.1186/s12882-015-0067-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 05/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background The objective of the study was to determine the relationship between common carotid artery intima-media thickness (CCA-IMT) and histologically assessed calcification of radial artery in relation to clinical features and laboratory markers of bone and mineral metabolism, inflammation, and oxidative stress in patients with stage 5 chronic kidney disease (CKD). Methods The study comprised 59 patients (36 hemodialyzed, 23 predialysis). CCA-IMT was measured by ultrasonography; the biochemical parameters examined were assessed using routine laboratory methods, ELISA micro-plate immunoassays and spectrophotometry. Fragments of radial artery obtained during creation of hemodialysis access were cryosectioned and stained for calcifications using von Kossa method and alizarin red. Results Glucose, osteoprotegerin, pentraxin 3 and Framingham risk score significantly correlated with CCA-IMT. In multiple regression analysis, OPG positively predicted CCA-IMT. Radial artery calcifications were found in 34 patients who showed higher CCA-IMT (0.98 ± 0.13 vs 0.86 ± 0.14 mm; P = 0.006). Higher CCA-IMT values were also associated with more advanced calcifications. CCA-IMT and the presence of plaques in common carotid artery were positive predictors of radial artery calcifications, independent of dialysis status, Framingham risk score, CRP and Ca x Pi [OR for calcifications 2.19 (1.08-4.45) per 0.1 mm increase in CCA-IMT]. The presence of radial artery calcifications was a significant predictor of mortality, independent of dialysis status and Framingham risk score [HR 3.16 (1.03-9.64)]. Conclusions In CKD patients, CCA-IMT examination can be used as a surrogate measure to assess the incidence and severity of arterial medial calcification which is associated with poor clinical outcome in these patients.
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Colbert G, Jain N, de Lemos JA, Hedayati SS. Utility of traditional circulating and imaging-based cardiac biomarkers in patients with predialysis CKD. Clin J Am Soc Nephrol 2015; 10:515-29. [PMID: 25403922 PMCID: PMC4348678 DOI: 10.2215/cjn.03600414] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac biomarkers, such as cardiac troponin T (cTnT), brain natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-pro-BNP), are commonly used to diagnose acute coronary syndrome and congestive heart failure exacerbation in symptomatic patients. Levels of these biomarkers are frequently chronically elevated in asymptomatic patients with ESRD who are receiving maintenance dialysis. Other imaging biomarkers commonly encountered in nephrologists' clinical practice, such as coronary artery calcium measured by computed tomography, left ventricular hypertrophy, and carotid intima-media thickness, are also frequently abnormal in asymptomatic patients with ESRD. This article critically reviews the limited observational data on associations between cTnT, BNP, NT-pro-BNP, coronary artery calcium, left ventricular hypertrophy, and carotid intima-media thickness with cardiovascular events and death in non-dialysis-dependent patients with CKD. Although sufficient evidence suggests that these biomarkers may be used for prognostication, the diagnostic utility of cTnT, BNP, and NT-pro-BNP remain challenging in patients with CKD. Decreased renal clearance may affect the plasma levels of these biomarkers, and upper reference limits were originally derived in patients without CKD. Until better data are available, higher cutoffs, or a rise in level compared with previous values, have been proposed to help distinguish acute myocardial infarction from chronic elevations of cTnT in symptomatic patients with CKD. Additionally, it is not known whether these biomarkers are modifiable and amenable to interventions that could change hard clinical outcomes in patients with CKD not yet undergoing long-term dialysis.
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MESH Headings
- Biomarkers/blood
- Calcinosis/diagnostic imaging
- Carotid Intima-Media Thickness
- Coronary Artery Disease/complications
- Coronary Artery Disease/diagnostic imaging
- Humans
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnostic imaging
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/therapy
- Natriuretic Peptide, Brain/blood
- Peptide Fragments/blood
- Renal Dialysis
- Tomography, X-Ray Computed
- Troponin T/blood
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/complications
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Affiliation(s)
| | | | - James A de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - S Susan Hedayati
- Division of Nephrology and Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas
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