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Tang X, Qian H, Lu S, Huang H, Wang J, Li F, Bian A, Ye X, Yang G, Ma K, Xing C, Xu Y, Zeng M, Wang N. Predictive nomogram model for severe coronary artery calcification in end-stage kidney disease patients. Ren Fail 2024; 46:2365393. [PMID: 38874139 PMCID: PMC11232636 DOI: 10.1080/0886022x.2024.2365393] [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: 01/18/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION The Agatston coronary artery calcification score (CACS) is an assessment index for coronary artery calcification (CAC). This study aims to explore the characteristics of CAC in end-stage kidney disease (ESKD) patients and establish a predictive model to assess the risk of severe CAC in patients. METHODS CACS of ESKD patients was assessed using an electrocardiogram-gated coronary computed tomography (CT) scan with the Agatston scoring method. A predictive nomogram model was established based on stepwise regression. An independent validation cohort comprised of patients with ESKD from multicentres. RESULTS 369 ESKD patients were enrolled in the training set, and 127 patients were included in the validation set. In the training set, the patients were divided into three subgroups: no calcification (CACS = 0, n = 98), mild calcification (0 < CACS ≤ 400, n = 141) and severe calcification (CACS > 400, n = 130). Among the four coronary branches, the left anterior descending branch (LAD) accounted for the highest proportion of calcification. Stepwise regression analysis showed that age, dialysis vintage, β-receptor blocker, calcium-phosphorus product (Ca × P), and alkaline phosphatase (ALP) level were independent risk factors for severe CAC. A nomogram that predicts the risk of severe CAC in ESKD patients has been internally and externally validated, demonstrating high sensitivity and specificity. CONCLUSION CAC is both prevalent and severe in ESKD patients. In the four branches of the coronary arteries, LAD calcification is the most common. Our validated nomogram model, based on clinical risk factors, can help predict the risk of severe coronary calcification in ESKD patients who cannot undergo coronary CT analysis.
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Affiliation(s)
- Xinfang Tang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Department of Nephrology, the Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Hanyang Qian
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Department of Nephrology, Nanjing Tongren Hospital, Nanjing, China
| | - Shijiu Lu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Hui Huang
- Center for Medical Big Data, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jing Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Fan Li
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Department of Nephrology, Nanjing BenQ Medical Center, Nanjing, China
| | - Anning Bian
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Department of Critical Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoxue Ye
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Guang Yang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Kefan Ma
- Department of Imaging, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yi Xu
- Department of Imaging, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ming Zeng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ningning Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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Mohamed ON, Mohamed MRM, Hassan IG, Alakkad AF, Othman A, Setouhi A, Issa AS. The Relationship of Fetuin-A with Coronary Calcification, Carotid Atherosclerosis, and Mortality Risk in Non-Dialysis Chronic Kidney Disease. J Lipid Atheroscler 2024; 13:194-211. [PMID: 38826181 PMCID: PMC11140250 DOI: 10.12997/jla.2024.13.2.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/24/2023] [Accepted: 01/09/2024] [Indexed: 06/04/2024] Open
Abstract
Objective This study investigated the relationship of fetuin-A with coronary calcification, carotid atherosclerosis, and mortality risk in non-dialysis chronic kidney disease (CKD). Methods The study included 135 adult patients with CKD at stages 3-5, who were divided into coronary artery calcification (CAC) and non-CAC groups. We excluded current smokers and individuals with diabetes mellitus, inflammatory conditions, liver diseases, acute kidney failure, chronic hemodialysis, and cancer. We conducted kidney function tests, complete blood counts, and measured serum levels of fetuin-A, tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), total cholesterol (TC), total triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Cardiac spiral computed tomography was used to calculate the CAC score, employing the Agatston method. Carotid ultrasonography was performed to assess carotid intima-media thickness (CIMT) and to detect the presence of plaques. Results CAC patients had considerably higher levels of TNF-α (p<0.001), IL-6 (p<0.001), hs-CRP (p=0.006), TC, TG, parathyroid hormone (PTH) (p<0.001) and phosphorus (p<0.001) than non-CAC patients. They also had significantly lower levels of fetuin-A (p<0.001). Fetuin-A was considerably lower in CKD subgroups as CKD progressed. Fetuin-A (p=0.046), age (p=0.009), TNF-α (p=0.027), IL-6 (p=0.005), TG (p=0.002), PTH (p=0.002), and phosphorus (p=0.004) were significant predictors of CAC. CAC and fetuin-A were strong predictors of all-cause mortality and cardiovascular (CV) mortality. Fetuin-A was a significant predictor of CIMT (p=0.045). Conclusion Fetuin-A reliably predicted CAC and CIMT. Fetuin-A and CAC emerged as significant risk factors for all-cause and CV mortality in non-dialysis CKD.
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Affiliation(s)
- Osama Nady Mohamed
- Department of Internal Medicine, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Israa Gamal Hassan
- Department of Internal Medicine, Faculty of Medicine, Minia University, Minya, Egypt
| | - Atef Farouk Alakkad
- Department of Internal Medicine, Faculty of Medicine, Minia University, Minya, Egypt
| | - Ashraf Othman
- Department of Clinical Pathology, Faculty of Medicine, Minia University, Minya, Egypt
| | - Amr Setouhi
- Department of Cardiology, Faculty of Medicine, Minia University, Minya, Egypt
| | - Ahmed S. Issa
- Department of Radiology, Faculty of Medicine, Minia University, Minya, Egypt
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Wungu CDK, Susilo H, Alsagaff MY, Witarto BS, Witarto AP, Pakpahan C, Gusnanto A. Role of klotho and fibroblast growth factor 23 in arterial calcification, thickness, and stiffness: a meta-analysis of observational studies. Sci Rep 2024; 14:5712. [PMID: 38459119 PMCID: PMC10923819 DOI: 10.1038/s41598-024-56377-8] [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: 09/08/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
This meta-analysis was conducted to clarify the role of klotho and fibroblast growth factor 23 (FGF-23) in human arterial remodeling across recent studies, in terms of arterial calcification, thickness, and stiffness. A systematic literature search was conducted on five databases for articles up to December 2023. Arterial calcification, thickness, and stiffness were determined using the calcification score and artery affected, carotid intima-media thickness (CIMT), and pulse wave velocity (PWV), respectively. Sixty-two studies with a total of 27,459 individuals were included in this meta-analysis. Most studies involved chronic kidney disease patients. Study designs were mostly cross-sectional with only one case-control and nine cohorts. FGF-23 was positively correlated with arterial calcification (r = 0.446 [0.254-0.611], p < 0.0001 and aOR = 1.36 [1.09-1.69], p = 0.006), CIMT (r = 0.188 [0.02-0.354], p = 0.03), and PWV (r = 0.235 [0.159-0.310], p < 0.00001). By contrast, Klotho was inversely correlated with arterial calcification (r = - 0.388 [- 0.578 to - 0.159], p = 0.001) and CIMT (r = - 0.38 [- 0.53 to - 0.207], p < 0.00001). In conclusion, FGF-23 and Klotho were associated with arterial calcification, thickness, and stiffness, clarifying their role in arterial remodeling processes.
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Affiliation(s)
- Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Division of Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia.
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, 60115, Indonesia.
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia.
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya, 60115, Indonesia.
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya, 60115, Indonesia
| | | | - Andro Pramana Witarto
- Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Cennikon Pakpahan
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Arief Gusnanto
- School of Mathematics, University of Leeds, Leeds, LS2 9JT, UK
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Cozzolino M, Maffei Faccioli F, Cara A, Boni Brivio G, Rivela F, Ciceri P, Magagnoli L, Galassi A, Barbuto S, Speciale S, Minicucci C, Cianciolo G. Future treatment of vascular calcification in chronic kidney disease. Expert Opin Pharmacother 2023; 24:2041-2057. [PMID: 37776230 DOI: 10.1080/14656566.2023.2266381] [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: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is one of the global leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Vascular calcification (VC) is a major cause of CVD in this population and is the consequence of complex interactions between inhibitor and promoter factors leading to pathological deposition of calcium and phosphate in soft tissues. Different pathological landscapes are associated with the development of VC, such as endothelial dysfunction, oxidative stress, chronic inflammation, loss of mineralization inhibitors, release of calcifying extracellular vesicles (cEVs) and circulating calcifying cells. AREAS COVERED In this review, we examined the literature and summarized the pathophysiology, biomarkers and focused on the treatments of VC. EXPERT OPINION Even though there is no consensus regarding specific treatment options, we provide the currently available treatment strategies that focus on phosphate balance, correction of vitamin D and vitamin K deficiencies, avoidance of both extremes of bone turnover, normalizing calcium levels and reduction of inflammatory response and the potential and promising therapeutic approaches liketargeting cellular mechanisms of calcification (e.g. SNF472, TNAP inhibitors).Creating novel scores to detect in advance VC and implementing targeted therapies is crucial to treat them and improve the future management of these patients.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Federico Maffei Faccioli
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Anila Cara
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giulia Boni Brivio
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Francesca Rivela
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Paola Ciceri
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Lorenza Magagnoli
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Galassi
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Simona Barbuto
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Serena Speciale
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Carlo Minicucci
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Abstract
Patients with chronic kidney disease (CKD) exhibit tremendously elevated risk for cardiovascular disease, particularly ischemic heart disease, due to premature vascular and cardiac aging and accelerated ectopic calcification. The presence of cardiovascular calcification associates with increased risk in patients with CKD. Disturbed mineral homeostasis and diverse comorbidities in these patients drive increased systemic cardiovascular calcification in different manifestations with diverse clinical consequences, like plaque instability, vessel stiffening, and aortic stenosis. This review outlines the heterogeneity in calcification patterning, including mineral type and location and potential implications on clinical outcomes. The advent of therapeutics currently in clinical trials may reduce CKD-associated morbidity. Development of therapeutics for cardiovascular calcification begins with the premise that less mineral is better. While restoring diseased tissues to a noncalcified homeostasis remains the ultimate goal, in some cases, calcific mineral may play a protective role, such as in atherosclerotic plaques. Therefore, developing treatments for ectopic calcification may require a nuanced approach that considers individual patient risk factors. Here, we discuss the most common cardiac and vascular calcification pathologies observed in CKD, how mineral in these tissues affects function, and the potential outcomes and considerations for therapeutic strategies that seek to disrupt the nucleation and growth of mineral. Finally, we discuss future patient-specific considerations for treating cardiac and vascular calcification in patients with CKD-a population in need of anticalcification therapies.
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Affiliation(s)
- Joshua D. Hutcheson
- Department of Biomedical Engineering, Florida International University, Miami, FL (J.D.H.)
| | - Claudia Goettsch
- Department of Internal Medicine I, Division of Cardiology, Medical Faculty, RWTH Aachen University, Germany (C.G.)
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Liu C, Tang L, Zhou Y, Tang X, Zhang G, Zhu Q, Zhou Y. Immune-associated biomarkers identification for diagnosing carotid plaque progression with uremia through systematical bioinformatics and machine learning analysis. Eur J Med Res 2023; 28:92. [PMID: 36823662 PMCID: PMC9948329 DOI: 10.1186/s40001-023-01043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Uremia is one of the most challenging problems in medicine and an increasing public health issue worldwide. Patients with uremia suffer from accelerated atherosclerosis, and atherosclerosis progression may trigger plaque instability and clinical events. As a result, cardiovascular and cerebrovascular complications are more likely to occur. This study aimed to identify diagnostic biomarkers in uremic patients with unstable carotid plaques (USCPs). METHODS Four microarray datasets (GSE37171, GSE41571, GSE163154, and GSE28829) were downloaded from the NCBI Gene Expression Omnibus database. The Limma package was used to identify differentially expressed genes (DEGs) in uremia and USCP. Weighted gene co-expression network analysis (WGCNA) was used to determine the respective significant module genes associated with uremia and USCP. Moreover, a protein-protein interaction (PPI) network and three machine learning algorithms were applied to detect potential diagnostic genes. Subsequently, a nomogram and a receiver operating characteristic curve (ROC) were plotted to diagnose USCP with uremia. Finally, immune cell infiltrations were further analyzed. RESULTS Using the Limma package and WGCNA, the intersection of 2795 uremia-related DEGs and 1127 USCP-related DEGs yielded 99 uremia-related DEGs in USCP. 20 genes were selected as candidate hub genes via PPI network construction. Based on the intersection of genes from the three machine learning algorithms, three hub genes (FGR, LCP1, and C5AR1) were identified and used to establish a nomogram that displayed a high diagnostic performance (AUC: 0.989, 95% CI 0.971-1.000). Dysregulated immune cell infiltrations were observed in USCP, showing positive correlations with the three hub genes. CONCLUSION The current study systematically identified three candidate hub genes (FGR, LCP1, and C5AR1) and established a nomogram to assist in diagnosing USCP with uremia using various bioinformatic analyses and machine learning algorithms. Herein, the findings provide a foothold for future studies on potential diagnostic candidate genes for USCP in uremic patients. Additionally, immune cell infiltration analysis revealed that the dysregulated immune cell proportions were identified, and macrophages could have a critical role in USCP pathogenesis.
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Affiliation(s)
- Chunjiang Liu
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Liming Tang
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Yue Zhou
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Xiaoqi Tang
- grid.415644.60000 0004 1798 6662Department of General Surgery, Division of Vascular Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, 312000 China
| | - Gang Zhang
- grid.412679.f0000 0004 1771 3402Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Anhui Public Health Clinical Center, Hefei, 230000 Anhui China
| | - Qin Zhu
- Hepatobiliary CenterKey Laboratory of Liver TransplantationNHC Key Laboratory of Living Donor Liver Transplantation, The First Affiliated Hospital of Nanjing Medical UniversityChinese Academy of Medical SciencesNanjing Medical University), Nanjing, 210000, Jiangsu, China.
| | - Yufei Zhou
- Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Kolonko A, Ficek R, Styrc B, Sobolewski M, Stankowska R, Chudek J, Więcek A. Divergent Occurrence of Carotid Intima-Media Thickness and Carotid Arteries Plaques in Stable Kidney Transplant Recipients. Rev Cardiovasc Med 2022; 23:386. [PMID: 39076672 PMCID: PMC11270383 DOI: 10.31083/j.rcm2312386] [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: 07/26/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 10/13/2023] Open
Abstract
Background Carotid atherosclerosis is one of the main cerebrovascular complications in kidney transplant recipients (KTRs). We analyzed the relationships between carotid intima-media thickness (IMT) and the occurrence and characteristics of carotid plaques in a cohort of KTRs. Methods In 500 KTRs (aged 49.9 ± 12.0 years), IMT was measured and carotid plaques were semi-qualitatively assessed. Concomitantly, biochemical and hormonal inflammatory, vascular and calcium-phosphate metabolism parameters were also assessed. Results In 10.2% of patients, a side-to-side IMT difference > 0.1 mm was observed, whereas 26.8% of patients with no plaques in one carotid artery had at least one contralateral calcified plaque. Multivariate logistic regression analysis revealed that age ( r partial = 0.409; p < 0.001), male sex ( r partial = 0.199; p < 0.001), and coronary artery disease ( r partial = 0.139; p < 0.01) independently increased IMT ( R 2 = 0.25). For the occurrence of calcified carotid plaques, age ( r partial = 0.544; p < 0.001), male gender ( r partial = 0.127; p < 0.05), and the duration of renal insufficiency prior to transplantation ( r partial = 0.235; p < 0.001) were confirmed as independent variables. Conclusions Substantial side-to-side differences in IMT values and carotid plaques distribution are present in a large percentage of stable KTRs. In addition, there are different clinical risk factors profiles associated with IMT and the presence of calcified plaques. Vascular and calcium-phosphate metabolism biomarkers were not associated with any carotid atherosclerosis characteristics.
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Affiliation(s)
- Aureliusz Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
| | - Rafał Ficek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
| | - Beata Styrc
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
| | - Michał Sobolewski
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
| | - Roksana Stankowska
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, 40-027 Katowice, Poland
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Wang Y, Gao L. Inflammation and Cardiovascular Disease Associated With Hemodialysis for End-Stage Renal Disease. Front Pharmacol 2022; 13:800950. [PMID: 35222026 PMCID: PMC8867697 DOI: 10.3389/fphar.2022.800950] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic kidney disease (CKD) and cardiac insufficiency often co-exist, particularly in uremic patients on hemodialysis (HD). The occurrence of abnormal renal function in patients with cardiac insufficiency is often indicative of a poor prognosis. It has long been established that in patients with cardiac insufficiency, poorer renal function tends to indicate poorer cardiac mechanics, including left atrial reserve strain, left ventricular longitudinal strain, and right ventricular free wall strain (Unger et al., Eur J Heart Fail, 2016, 18(1), 103-12). Similarly, patients with chronic kidney disease, particularly uremic patients on HD, often have cardiovascular complications in addition to abnormal endothelial function with volume overload, persistent inflammatory states, calcium overload, and imbalances in redox responses. Cardiac insufficiency due to uremia is therefore mainly due to multifaceted non-specific pathological changes rather than pure renal insufficiency. Several studies have shown that the risk of adverse cardiovascular events is greatly increased and persistent in all patients treated with HD, especially in those who have just started HD treatment. Inflammation, as an important intersection between CKD and cardiovascular disease, is involved in the development of cardiovascular complications in patients with CKD and is indicative of prognosis (Chan et al., Eur Heart J, 2021, 42(13), 1244-1253). Therefore, only by understanding the mechanisms underlying the sequential development of inflammation in CKD patients and breaking the vicious circle between inflammation-mediated renal and cardiac insufficiency is it possible to improve the prognosis of patients with end-stage renal disease (ESRD). This review highlights the mechanisms of inflammation and the oxidative stress that co-exists with inflammation in uremic patients on dialysis, as well as the mechanisms of cardiovascular complications in the inflammatory state, and provides clinical recommendations for the anti-inflammatory treatment of cardiovascular complications in such patients.
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Affiliation(s)
| | - Lu Gao
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Jilin, China
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Sørensen JR, Diederichsen AC, Lindholt JS. Association of cause of uremia with degree of iliac artery calcification. Int J Urol 2022; 29:343-350. [PMID: 35040217 DOI: 10.1111/iju.14784] [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: 07/28/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We aimed to investigate whether the cause of uremia is associated with degree of calcification, and to report the proportion excluded from kidney transplantation due to iliac artery calcification. METHOD We enrolled 306 patients with a pre-transplant computed tomography scan who went through the comprehensive assessment program in 2013-2015. Calcification score was measured for each iliac artery segment and patient records viewed for a variety of variables. Interobserver variation was assessed for 135 paired observations. RESULTS The patients' mean age was 55.5 years. Of the 306 patients, 133 did not undergo transplantation, and for 21 of these, heavy calcification was the primary explanation for this. External iliac artery calcification was positively associated with male sex, age, systolic blood pressure, diabetes and cardiovascular disease, and differed significantly among the causes of uremia subgroups; the least calcification was seen in patients with autoimmune causes, and the highest in those with diabetic causes. Similarly, the proportion of patients who underwent renal transplantation differed significantly with regard to causes of uremia (ranging from 72.3% for autoimmune disease to 40.6% for diabetic nephropathy). CONCLUSION The degree of iliac artery calcification differs according to the cause of uremia and influences the likelihood of receiving a kidney transplantation.
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Affiliation(s)
- Jan R Sørensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jes S Lindholt
- Department of, Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
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Al Sayed N, Almahmeed W, Alnouri F, Al Waili K, Sabbour H, Sulaiman K, Zubaid M, Ray KK, Al-Rasadi K. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East – 2021 update. Atherosclerosis 2021; 343:28-50. [DOI: 10.1016/j.atherosclerosis.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
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Chen C, Zhang J, Zhou Z, Liu J, Li C, Liu C. Impact of serum albumin level and variability on short-term cardiovascular-related and all-cause mortality in patients on maintenance hemodialysis. Medicine (Baltimore) 2021; 100:e27666. [PMID: 34713862 PMCID: PMC8556057 DOI: 10.1097/md.0000000000027666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
Studies have shown that low serum albumin (Salb) levels are associated with a high risk of mortality among patients on maintenance hemodialysis (MHD); however, the impact of Salb variability on short-term cardiovascular mortality remains unclear. Herein, we investigated the association between Salb levels and Salb variability on short-term all-cause and cardiovascular-related mortality in patients on MHD.Eligible patients on MHD at Chongqing General Hospital between June 2017 and June 2020 were recruited in this study. Patients were grouped by Salb levels (normal Salb, ≥3.8 g/dL; low Salb, 3.4-3.8 g/dL; and lower Salb, 2-3.4 g/dL) and Salb variability (decreased, >5% loss; increased, >5% gain; and steady, 5% loss to 5% gain). Associations between Salb levels, Salb variability, and all-cause and cardiovascular-related mortality were analyzed using Cox regression models. A survival analysis was performed using the Kaplan-Meier analysis.We enrolled a total of 181 patients on MHD with an average age of 65 years (interquartile range [IQR], 53-75 years). The mean Salb level was 3.8 ± 0.6 g/dL (IQR 2.9-4.4 g/dL), and the median Salb variability was 2.6% per year (IQR, -4.1 to 6.5). Fifty-two (29%) patients died, including 31 (17%) patients who died due to cardiovascular-related causes. Compared with the other groups, the lower Salb group had higher all-cause mortality (P < .01). Cox regression analyses revealed that lower Salb levels and decreased Salb variability were independently associated with all-cause mortality (hazard ratio [HR] = 1.95, 95% confidence interval [CI] 1.103-3.452; HR = 2.245, 95% CI 1.084-4.650), whereas increased Salb variability was independently associated with cardiovascular-related mortality (HR = 2.919, 95% CI 1.178-7.234; P < .05).Lower Salb levels were an independent predictor of all-cause mortality in patients on MHD. Increased Salb variability was strongly associated with cardiovascular-related mortality in the same population, especially in the short-term and in patients with normal Salb levels. Significantly elevated Salb variability should be evaluated to reduce cardiovascular-related mortality.
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Affiliation(s)
- Chun Chen
- Department of Nephrology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Jing Zhang
- Intensive Care Unit, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Zemei Zhou
- Department of Nephrology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Jiguo Liu
- Department of Nephrology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Chunyin Li
- Department of Nephrology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Chun Liu
- Department of Nephrology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
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12
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Lankinen R, Hakamäki M, Hellman T, Koivuviita NS, Metsärinne K, Järvisalo MJ. Progression of Aortic Calcification in Stage 4-5 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation. Kidney Blood Press Res 2021; 47:23-30. [PMID: 34818248 DOI: 10.1159/000518670] [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: 05/11/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Abdominal aortic calcification (AAC) is common in chronic kidney disease (CKD) patients and associated with increased mortality. Comparative data on the AAC score progression in CKD patients transitioning from conservative treatment to different modalities of renal replacement therapy (RRT) are lacking and were examined. METHODS 150 study patients underwent lateral lumbar radiograph to study AAC in the beginning of the study before commencing RRT (AAC1) and at 3 years of follow-up (AAC2). We examined the associations between repeated laboratory tests taken every 3 months, echocardiographic and clinical variables and AAC increment per year (ΔAAC), and the association between ΔAAC and outcomes during follow-up. RESULTS At the time of AAC2 measurement, 39 patients were on hemodialysis, 39 on peritoneal dialysis, 39 had a transplant, and 33 were on conservative treatment. Median AAC1 was 4.8 (0.5-9.0) and median AAC2 8.0 (1.5-12.0) (p < 0.0001). ΔAAC was similar across the treatment groups (p = 0.19). ΔAAC was independently associated with mean left ventricular mass index (LVMI) (log LVMI: β = 0.97, p = 0.02) and mean phosphorus through follow-up (log phosphorus: β = 1.19, p = 0.02) in the multivariable model. Time to transplantation was associated with ΔAAC in transplant recipients (per month on the waiting list: β = 0.04, p = 0.001). ΔAAC was associated with mortality (HR 1.427, 95% confidence interval 1.044-1.950, p = 0.03). CONCLUSION AAC progresses rapidly in patients with CKD, and ΔAAC is similar across the CKD treatment groups including transplant recipients. The increment rate is associated with mortality and in transplant recipients with the time on the transplant waiting list.
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Affiliation(s)
- Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina S Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland.,Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland.,Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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13
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Järvisalo MJ, Jokihaka V, Hakamäki M, Lankinen R, Helin H, Koivuviita NS, Hellman T, Metsärinne K. Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4-5 patients transitioning to dialysis and transplantation-A prospective cohort study. PLoS One 2021; 16:e0258055. [PMID: 34591943 PMCID: PMC8483312 DOI: 10.1371/journal.pone.0258055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Oral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline. Methods Altogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly. Results PTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, p<0.0001) mortality, as well as, incident MACEs (HR 1.071 95% CI 1.031–1.113, p = 0.0004) in the multivariable Cox models adjusted for age and kidney transplantation or CKD treatment modality during follow-up. Conclusions Radiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.
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Affiliation(s)
- Mikko J. Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
- Department of Anaesthesiology and Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, Turku, Finland
- * E-mail:
| | - Viljami Jokihaka
- Department of Radiology, Dental Radiology, Turku University Hospital, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Heidi Helin
- Department of Radiology, Dental Radiology, Turku University Hospital, Turku, Finland
| | - Niina S. Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
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14
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Kobayashi N, Takahara M, Iida O, Soga Y, Kodama A, Hirano K, Nakano M, Yamauchi Y, Komai H, Azuma N. Impact of Dialysis Vintage and Renal Biomarkers on Mortality in Dialysis-Dependent Patients With Critical Limb Ischemia Undergoing Revascularization. J Endovasc Ther 2021; 28:716-725. [PMID: 34137657 DOI: 10.1177/15266028211025029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Revascularization of both endovascular therapy (EVT) and surgical reconstruction improve clinical outcomes of patients with critical limb ischemia (CLI); however, treatment of dialysis-dependent patients with CLI is still challenging. This study aimed to investigate the impact of dialysis-related parameters on the risk of mortality in dialysis-dependent patients undergoing revascularization for CLI. MATERIALS AND METHODS We retrospectively identified 274 dialysis-dependent patients with CLI (196 males; mean age 71 years), who underwent revascularization, from the clinical database of the surgical reconstruction vs peripheral intervention in patients with critical limb ischemia (SPINACH) study, which was a prospective, multicenter, observational study. Of these patients, 175 patients underwent EVT and 99 patients received surgical reconstruction. The current study evaluated the impact of dialysis vintage and renal biomarkers on the mortality rate of dialysis-dependent patients with CLI undergoing revascularization. RESULTS During a mean follow-up period of 1.7 ± 1.1 years, 147 deaths were observed. The 3-year overall survival rate and its standard error were estimated to be 40.5% ± 8.1% using the Kaplan-Meier method. A Cox proportional hazard analysis revealed that dialysis vintage ≥4 years, serum creatinine levels <4.7 mg/dL, serum urea nitrogen ≥88 mg/dL, and calcium-phosphate product ≥62.6 mg2/dL2 were independent risk factors for mortality after adjustment for the detailed mortality risk score developed in the SPINACH study. Adding these parameters to the original mortality risk score slightly, but not significantly, increased the area under the time-dependent receiver operating characteristics curve from 0.74 (95% CI, 0.67 to 0.81) to 0.77 (0.71 to 0.84) (p=0.084), whereas continuous net reclassification improvement reached 0.75 (0.12 to 0.90) (p=0.027). CONCLUSION We found that long dialysis vintage, low serum creatinine, high serum urea nitrogen, and high calcium-phosphate product were independently associated with the increased risk of mortality in dialysis-dependent patients with CLI undergoing revascularization.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine and Department of Metabolic Medicine, University Graduate School of Medicine, Suita, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan
| | | | | | - Hiroyoshi Komai
- Department of Vascular Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
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15
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Toussaint ND, Pedagogos E, Lioufas NM, Elder GJ, Pascoe EM, Badve SV, Valks A, Block GA, Boudville N, Cameron JD, Campbell KL, Chen SSM, Faull RJ, Holt SG, Jackson D, Jardine MJ, Johnson DW, Kerr PG, Lau KK, Hooi LS, Narayan O, Perkovic V, Polkinghorne KR, Pollock CA, Reidlinger D, Robison L, Smith ER, Walker RJ, Wang AYM, Hawley CM. A Randomized Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD). J Am Soc Nephrol 2020; 31:2653-2666. [PMID: 32917784 PMCID: PMC7608977 DOI: 10.1681/asn.2020040411] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hyperphosphatemia is associated with increased fibroblast growth factor 23 (FGF23), arterial calcification, and cardiovascular mortality. Effects of phosphate-lowering medication on vascular calcification and arterial stiffness in CKD remain uncertain. METHODS To assess the effects of non-calcium-based phosphate binders on intermediate cardiovascular markers, we conducted a multicenter, double-blind trial, randomizing 278 participants with stage 3b or 4 CKD and serum phosphate >1.00 mmol/L (3.10 mg/dl) to 500 mg lanthanum carbonate or matched placebo thrice daily for 96 weeks. We analyzed the primary outcome, carotid-femoral pulse wave velocity, using a linear mixed effects model for repeated measures. Secondary outcomes included abdominal aortic calcification and serum and urine markers of mineral metabolism. RESULTS A total of 138 participants received lanthanum and 140 received placebo (mean age 63.1 years; 69% male, 64% White). Mean eGFR was 26.6 ml/min per 1.73 m2; 45% of participants had diabetes and 32% had cardiovascular disease. Mean serum phosphate was 1.25 mmol/L (3.87 mg/dl), mean pulse wave velocity was 10.8 m/s, and 81.3% had abdominal aortic calcification at baseline. At 96 weeks, pulse wave velocity did not differ significantly between groups, nor did abdominal aortic calcification, serum phosphate, parathyroid hormone, FGF23, and 24-hour urinary phosphate. Serious adverse events occurred in 63 (46%) participants prescribed lanthanum and 66 (47%) prescribed placebo. Although recruitment to target was not achieved, additional analysis suggested this was unlikely to have significantly affected the principle findings. CONCLUSIONS In patients with stage 3b/4 CKD, treatment with lanthanum over 96 weeks did not affect arterial stiffness or aortic calcification compared with placebo. These findings do not support the role of intestinal phosphate binders to reduce cardiovascular risk in patients with CKD who have normophosphatemia. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Australian Clinical Trials Registry, ACTRN12610000650099.
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Affiliation(s)
- Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Eugenia Pedagogos
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Western Health, Melbourne, Victoria, Australia
| | - Nicole M Lioufas
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Western Health, Melbourne, Victoria, Australia
| | - Grahame J Elder
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Sunil V Badve
- St. George Hospital, Sydney, New South Wales, Australia
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Neil Boudville
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Katrina L Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Randall J Faull
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Central Northern Adelaide Renal and Transplantation Services, Adelaide, South Australia, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | | | - Meg J Jardine
- Concord Repatriation and General Hospital, Concord, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Peter G Kerr
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | - Kenneth K Lau
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
| | | | - Om Narayan
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kevan R Polkinghorne
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Carol A Pollock
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura Robison
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Edward R Smith
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Robert J Walker
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Carmel M Hawley
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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16
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Warfarin Accelerates Aortic Calcification by Upregulating Senescence-Associated Secretory Phenotype Maker Expression. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2043762. [PMID: 33149806 PMCID: PMC7603623 DOI: 10.1155/2020/2043762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/20/2020] [Indexed: 01/07/2023]
Abstract
Warfarin, a vitamin K antagonist (VKA), is known to promote arterial calcification (AC). In the present study, we conducted a case-cohort study within the Multi-Ethnic Study of Atherosclerosis (MESA); 6655 participants were included. From MESA data, we found that AC was related to both age and vitamin K; furthermore, the score of AC increased with SASP marker including interlukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) rising. Next, a total of 79 warfarin users in our center developed significantly more calcified coronary plaques as compared to non-VKA users. We investigated the role of warfarin in phosphate-induced AC in different ages by in vitro experimental study. Furthermore, dose-time-response of warfarin was positively correlated with AC score distribution and plasma levels of the SASP maker IL-6 among patients < 65 years, but not among patients ≥ 65 years. In addition, in vitro research suggested that warfarin treatment tended to deteriorate calcification in young VSMC at the early stage of calcification. Our results suggested that aging and warfarin-treatment were independently related to increased AC. Younger patients were more sensitive to warfarin-related AC than older patients, which was possibly due to accumulated warfarin-induced cellular senescence.
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17
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Fibroblast growth factor 23 (FGF23) level is associated with ultrafiltration rate in patients on hemodialysis. Heart Vessels 2020; 36:414-423. [PMID: 33000285 PMCID: PMC7872991 DOI: 10.1007/s00380-020-01704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/18/2020] [Indexed: 11/18/2022]
Abstract
Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that regulates renal phosphate reabsorption and vitamin D synthesis in renal proximal tubules. High circulating FGF23 levels are associated with increased mortality in patients with chronic kidney disease and those on dialysis. Current data also suggest higher circulating levels of FGF23 are associated with cardiovascular mortality, vascular calcification, and left ventricular hypertrophy; however, evidence on the role of FGF23 in patients on dialysis is incomplete, and some of the data, especially those on cardiovascular disease (CVD), are controversial. This study aimed to evaluate factors associated with FGF23 in hemodialysis patients with or without CVD. Randomly selected 76 patients on maintenance hemodialysis at a single hemodialysis center were enrolled. After the exclusion of eight patients with extremely outlying FGF23 levels, 68 patients, including 48 males and 46 patients with a CVD history, were included in the study. The mean age was 64.4 ± 12.1 years, and the mean dialysis duration was 12.7 ± 7.1 years. Dialysis duration, time-averaged concentration of urea (TAC-urea), ultrafiltration rate (UFR), blood pressure during hemodialysis session, laboratory data, and echocardiographic parameters including interventricular septum thickness (IVST), left ventricular mass indices (LVMI), and ejection fraction were included in univariate and multivariate analyses. The median lgFGF23 levels in the overall cohort and in those with and without CVD were 2.14 (interquartile range, IQR − 0.43 to − 4.23), 2.01 (− 0.52 to 4.12), and 2.59 (0.07 to 4.32), respectively, and there was no difference between the patients with and without CVD (p = 0.14). The univariate analysis revealed that FGF23 was significantly associated with age (r = − 0.12, p < 0.01), duration of hemodialysis (r = − 0.11, p < 0.01), TAC-urea (r = 0.29, p = 0.01), UFR (r = 0.26, p = 0.04), alkaline phosphatase (ALP; r = − 0.27, p = 0.03), corrected serum calcium (cCa; r = 0.32, p < 0.01), serum phosphate (iP, r = 0.57, p < 0.01), intact parathyroid hormone (iPTH; r = 0.38, p < 0.01), IVST (r = 0.30, p = 0.01), and LVMI (r = 0.26, p = 0.04). In multivariate regression analysis, FGF23 was significantly associated with cCa (F = 25.6, p < 0.01), iP (F = 22.5, p < 0.01), iPTH (F = 19.2, p < 0.01), ALP (F = 5.34, p = 0.03), and UFR (F = 3.94, p = 0.05). In addition, the univariate analysis after the categorization of patients according to CVD indicated that FGF23 was significantly associated with cCa (r = 0.34, p = 0.02), iP (r = 0.41, p < 0.01), iPTH (r = 0.39, p = 0.01), and TAC-urea (r = 0.45, p < 0.01) in patients with CVD, whereas only IVST (r = 0.53, p = 0.04) was associated with FGF23 in those without CVD. FGF23 levels in hemodialysis patients were extremely high and associated not only with mineral bone disease-related factors but also with UFR. Additionally, dialysis efficacy might be associated with lower FGF23 levels in patients with CVD.
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18
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Djuric P, Dimkovic N, Schlieper G, Djuric Z, Pantelic M, Mitrovic M, Jankovic A, Milanov M, Kuzmanovic Pficer J, Floege J. Sodium thiosulphate and progression of vascular calcification in end-stage renal disease patients: a double-blind, randomized, placebo-controlled study. Nephrol Dial Transplant 2020; 35:162-169. [PMID: 31764989 DOI: 10.1093/ndt/gfz204] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/18/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sodium thiosulphate (NaTS) is mostly used in haemodialysis (HD) patients with calcific uraemic arteriolopathy. This double-blind, randomized, placebo-controlled study assessed the effect of NaTS on progression of cardiovascular calcifications in HD patients. METHODS From 65 screened patients, we recruited 60 patients with an abdominal aorta Agatston calcification score ≥100. Thirty patients were randomized to receive NaTS 25 g/1.73 m2 and 30 patients to receive 100 mL of 0.9% sodium chloride intravenously during the last 15 min of HD over a period of 6 months. The primary endpoint was the absolute change of the abdominal aortic calcification score. RESULTS The abdominal aortic calcification score and calcification volume of the abdominal aorta increased similarly in both treatment groups during the trial. As compared with the saline group, patients receiving NaTS exhibited a reduction of their iliac artery calcification score (-137 ± 641 versus 245 ± 755; P = 0.049), reduced pulse wave velocity (9.6 ± 2.7 versus 11.4 ± 3.6; P = 0.000) and a lower carotid intima-media thickness (0.77 ± 0.1 versus 0.83 ± 00.17; P = 0.033) and had better preservation of echocardiographic parameters of left ventricular hypertrophy. No patient of the NaTS group developed new cardiac valve calcifications during the trial as compared with 8 of 29 patients in the saline group. By univariate analysis, NaTS therapy was the only predictor of not developing new valvular calcifications. No adverse events possibly related to NaTS infusion were noted. CONCLUSIONS While NaTS failed to retard abdominal aortic calcification progress, it positively affected calcification progress in iliac arteries and heart valves as well as several other cardiovascular functional parameters.
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Affiliation(s)
- Petar Djuric
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Nada Dimkovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Georg Schlieper
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
| | - Zivka Djuric
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Milan Pantelic
- Center for Radiology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Beograd, Serbia
| | - Aleksandar Jankovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Marko Milanov
- Clinical Department for Cardiology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Jovana Kuzmanovic Pficer
- Department for Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Jürgen Floege
- Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Lankinen R, Hakamäki M, Metsärinne K, Koivuviita NS, Pärkkä JP, Hellman T, Kartiosuo N, Raitakari OT, Järvisalo MJ. Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease. Am J Nephrol 2020; 51:726-735. [PMID: 32777781 DOI: 10.1159/000509582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study. METHODS One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients. RESULTS The duration of follow-up was 42 ± 17 months (range 134-2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e' ratio, and albumin. CONCLUSION Stress ergometry performance, abdominal aortic calcification score, E/e' of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.
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Affiliation(s)
- Roosa Lankinen
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland,
| | - Kaj Metsärinne
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina S Koivuviita
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi P Pärkkä
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Noora Kartiosuo
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Center, Turku University Hospital and University of Turku, Turku, Finland
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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20
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Mizuiri S, Nishizawa Y, Yamashita K, Ono K, Naito T, Tanji C, Usui K, Doi S, Masaki T, Shigemoto K. Relationship of matrix Gla protein and vitamin K with vascular calcification in hemodialysis patients. Ren Fail 2019; 41:770-777. [PMID: 31538831 PMCID: PMC7011966 DOI: 10.1080/0886022x.2019.1650065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 01/07/2023] Open
Abstract
Objective: This study evaluated associations of serum matrix Gla protein (MGP), plasma vitamin K1, and plasma vitamin K2 with coronary artery calcium score (CACS) and cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients. Methods: Subjects comprised 112 MHD patients aged 30-60 years and 40 age-matched healthy subjects. Total MGP, vitamin K1, vitamin K2, and lipid profile were examined in all subjects; other clinical data, medication use, and CACS were assessed only in MHD patients. Determinants of MGP in all subjects were identified by regression analysis. Factors associated with CACS and CVD in MHD patients were identified by regression analysis and logistic analysis, respectively. Results: Lower plasma levels of vitamin K1 corrected for triglycerides [0.39 (0.24-0.70) vs. 0.77 (0.48-1.34) ng/mg, p < 0.001], higher frequency of plasma vitamin K2 ≤ 0.05 ng/ml (p = 0.23), and higher serum total MGP (288.4 ± 44.2 vs. 159.7 ± 40.6 ng/ml, p < 0.0001) were observed in MHD patients than in healthy controls. Total MGP level was significantly associated with levels of vitamin K1 corrected for triglycerides (p <0 .001) and vitamin K2 ≤ 0.05 ng/ml (p < 0.05) in all subjects. Total MGP level was significantly associated with presence of CVD (p <0 .05), but not CACS, in MHD patients. Conclusion: The end-stage renal disease on hemodialysis is a deficiency state of vitamin K. Total MGP was significantly higher in MHD patients compared to healthy subjects and total MGP was associated with the presence of CVD, but not CACS, in MHD patients.
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Affiliation(s)
- Sonoo Mizuiri
- Division of Nephrology, Ichiyokai Harada
Hospital, Hiroshima, Japan
| | | | | | - Kyoka Ono
- Division of Nephrology, Ichiyokai Harada
Hospital, Hiroshima, Japan
| | | | - Chie Tanji
- Ichiyokai Ichiyokai Clinic,
Hiroshima, Japan
| | - Koji Usui
- Ichiyokai Ichiyokai Clinic,
Hiroshima, Japan
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University
Hospital, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University
Hospital, Hiroshima, Japan
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Chen HC, Wang WT, Hsi CN, Chou CY, Lin HJ, Huang CC, Chang CT. Abdominal aortic calcification score can predict future coronary artery disease in hemodialysis patients: a 5-year prospective cohort study. BMC Nephrol 2018; 19:313. [PMID: 30409161 PMCID: PMC6225627 DOI: 10.1186/s12882-018-1124-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal aortic calcification (AAC) has been known to be associated with cardiovascular mortality in hemodialysis. However, the association between AAC and future coronary artery disease (CAD) occurrence is not clear. We aimed to clarify the association of AAC severity and the occurrence of future CAD events in hemodialysis patients. METHODS Hemodialysis (HD) patients were recruited in this prospective cohort study. AAC severity was quantified by AAC score, which was measured by lateral lumbar radiography. We used receiver operation curve (ROC) analysis to find the cutoff AAC value for CAD prediction. CAD-free survival was analyzed by Kaplan-Meier study. RESULTS There were 303 patients recruited for study with a median (interquartile range) follow-up of 95 (65-146) months. The AAC score in patients with occurrence of new CAD [9 (3-15.25), n = 114] was higher than in patients without new CAD occurrence [5 (1-9) n = 189], p < 0.001. Multivariate hazard ratio of AAC score for CAD was 1.039 (p = 0.016). ROC study showed that an AAC score of 5.5 had a sensitivity of 0.658 and a specificity of 0.587 in the prediction of new CAD occurrence. Patients with AAC score above 5.5 had significantly higher cumulative incidence of CAD than patients with AAC score below 5.5. Age, diabetes, prior history of CAD, and longer dialysis vintage were major factors associated with higher AAC score. CONCLUSIONS AAC score can predict the occurrence of future CAD events in HD patients. The best cut-off value of AAC score is 5.5. AAC score greater than 5.5 is a reliable abdominal aortic calcification marker, and can predict future CAD in ESRD patients. Major contributive factors for higher AAC score were age, presence of diabetes, prior history of CAD, and longer dialysis vintage.
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Affiliation(s)
- Hung-Chih Chen
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Wei-Ting Wang
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chieh-Ning Hsi
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Hsuan-Jen Lin
- Division of Nephrology, Asia University Hospital, Taichung, Taiwan
| | - Chiu-Ching Huang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, 40447 Taiwan
| | - Chiz-Tzung Chang
- College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, China Medical University Hospital, Taichung, 40447 Taiwan
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Barrett H, O'Keeffe M, Kavanagh E, Walsh M, O'Connor EM. Is Matrix Gla Protein Associated with Vascular Calcification? A Systematic Review. Nutrients 2018; 10:E415. [PMID: 29584693 PMCID: PMC5946200 DOI: 10.3390/nu10040415] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/13/2018] [Accepted: 03/23/2018] [Indexed: 12/19/2022] Open
Abstract
Specific patient cohorts are at increased risk of vascular calcification. Functional matrix-gla protein (MGP), a tissue-derived vitamin K dependent protein, is reported to be an important inhibitor of vascular calcification and may have clinical potential to modify the progression of vascular calcification through regulation of functional MGP fractions. This systematic review examines twenty-eight studies which assess the relationship between circulating protein expressions of MGP species and vascular calcification in different arterial beds. The included studies examined participants with atherosclerosis, chronic kidney disease (CKD), diabetes, healthy participants, vitamin K supplementation, measured plasma vitamin K levels and vitamin K antagonist usage. The current review reports conflicting results regarding MGP fractions with respect to local calcification development indicating that a multifaceted relationship exists between the MGP and calcification. A primary concern regarding the studies in this review is the large degree of variability in the calcification location assessed and the fraction of MGP measured. This review suggests that different underlying molecular mechanisms can accelerate local disease progression within the vasculature, and specific circulating fractions of MGP may be influenced differently depending on the local disease states related to vascular calcification development. Further studies examining the influence of non-functional MGP levels, with respect to specific calcified arterial beds, are warranted.
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Affiliation(s)
- Hilary Barrett
- Centre for Applied Biomedical Engineering Research (CABER), School of Engineering, Bernal Institute, University of Limerick, Limerick V94 F858, UK.
| | - Mary O'Keeffe
- School of Natural Sciences and Department of Biological Sciences, University of Limerick, Limerick V94 F858, UK.
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Limerick V94 F858, UK.
| | - Michael Walsh
- Centre for Applied Biomedical Engineering Research (CABER), School of Engineering, Bernal Institute, University of Limerick, Limerick V94 F858, UK.
- Health Research Institute (HRI), University of Limerick, Limerick V94 F858, UK.
| | - Eibhlís M O'Connor
- School of Natural Sciences and Department of Biological Sciences, University of Limerick, Limerick V94 F858, UK.
- Health Research Institute (HRI), University of Limerick, Limerick V94 F858, UK.
- Alimentary Pharmabiotic Centre, Microbiome Institute, University College Cork, Cork T12 YN60, UK.
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Prevalence of abdominal artery calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol 2017; 49:2061-2069. [PMID: 28936714 DOI: 10.1007/s11255-017-1685-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To systematically determine the prevalence of abdominal artery calcification (AAC) in dialysis patients with end-stage renal disease (ESRD) and identify reasons for heterogeneity. METHODS We searched PubMed, EMBASE, and Web of Science from database inception to March 2017. Cross-sectional or cohort (only used baseline data) studies reporting estimates of AAC prevalence in dialysis adult patients with ESRD were included. We performed a random-effects meta-analysis to generate pooled prevalence estimates. Subgroup analyses were used to compare differences within categorical variables (geographic region, AAC detection instruments, dialysis methods, study design, and sample size), and meta-regression analyses to assess the impact of continuous variables (participants' age, duration of dialysis, and male proportion). RESULTS A total of 44 studies with 9883 dialysis patients were included. The pooled prevalence for AAC was 68.5% (95% CI 63-73.9%). Subgroup analyses suggested that AAC prevalence varied significantly by geographical region and AAC detection instruments, not by dialysis methods, study design and sample size. Meta-regression analysis suggested that positive correlations were found between AAC prevalence and the age of participants as well as the male proportion (r = 1.01477, P = 0.002 and r = 2.034413, P = 0.01, respectively), but not with the duration of dialysis (P = 0.576). CONCLUSION The pooled and nearest estimate of AAC prevalence among dialysis patients was as high as 65%. Geographical region, AAC detection instruments, age of participants, and male proportion potentially lead to the high variance of the reported prevalence. Considering the high AAC prevalence, effective treatment for preventing vascular calcification in these patients is badly needed.
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24
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El Baz TZ, Khamis OA, El-Shehaby A, Chahine H, Alaa Al-Din Ahmed A, Alsawasany MA. Relationship between serum osteoprotegerin and vascular calcifications in hemodialysis patients. Egypt Heart J 2017; 69:149-155. [PMID: 29622969 PMCID: PMC5839346 DOI: 10.1016/j.ehj.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 02/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Uremia is a vasculopathic process, and both cardiac calcification and vascular calcification seen from the early stages of chronic kidney disease. Osteoprotegerin could play a crucial role in atherosclerotic plaque formation, maturation and calcification. The goal of this study was to determine the relationship of serum osteoprotegerin with vascular calcification in patients with end stage kidney disease who were maintained on regular hemodialysis. METHODS Sixty clinically stable chronic renal failure patients undergoing regular hemodialysis were enrolled in this cross sectional study. Thirty patients (mean age 56.7 ± 10.5 years) with abdominal aortic calcification were selected by basal abdominal X-ray who underwent multi-slice computerized tomography scan to measure coronary artery calcification score; and thirty patients (mean age 56.5 ± 8.4 years) without abdominal aortic calcification. All patients were evaluated by serum calcium, phosphorus, albumin, lipid profile, intact parathyroid hormone (iPTH), serum creatinine, serum urea, serum uric acid, serum C-reactive protein, and hemoglobin. Serum osteoprotegerin samples were collected before dialysis and estimated by the ELISA kit. RESULTS Serum osteoprotegerin level was significantly higher in patients with vascular calcification than in those without calcifications. Serum osteoprotegerin correlated positively with serum phosphorus, calcium phosphorus product, alkaline phosphatase, iPTH, C-reactive protein, serum uric acid, low-density lipoprotein (LDL) and left ventricular mass index (LVMI) (p < 0.005), and negatively with hemoglobin, ejection fraction (p < 0.005) and HDL (p < 0.05). CONCLUSIONS These findings suggest that osteoprotegerin may be involved in the development of vascular calcification in hemodialysis patients.
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Affiliation(s)
- Tarek Z. El Baz
- Internal Medicine, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Osama A. Khamis
- Internal Medicine, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Amal El-Shehaby
- Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hussein Chahine
- Internal Medicine, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
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25
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Chavent B, Maillard N, Boutet C, Albertini JN, Duprey A, Favre JP. Prognostic Value of Aortoiliac Calcification Score in Kidney Transplantation Recipients. Ann Vasc Surg 2017; 44:245-252. [PMID: 28479451 DOI: 10.1016/j.avsg.2017.03.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Kidney recipients are increasingly older with arterial disease and extended arterial calcifications. In a kidney transplantation population, the prognosis value of aortic and iliac calcifications remains poorly explored. We aimed to assess the impact of pretransplantation aortoiliac vascular calcifications on patients, grafts survival, and cardiovascular events. METHODS This retrospective study included kidney transplantation patients from 2006 to 2012 for whom we had available presurgery abdominal computed tomography results (n = 100). We designed a score to quantify aortoiliac calcifications. Primary end points were patient and graft survival. Secondary end points were renal function and cardiovascular morbidity. Predictive performances of calcification score were assessed using area under receiver-operating characteristic curves. Patients were classified in quartiles depending on global calcium score value. RESULTS The cumulated rate of death and graft loss was 13% with no significant differences for survival between quartiles. No significant difference was observed in renal function (P = 0.4). Seventeen cardiovascular events were registered with a significant correlation between calcium score elevation and need of cardiovascular surgery during the follow-up (P = 0.01). Global calcium score had a predictive value of 74.5% (95% confidence interval 0.62-0.87) with 71% sensitivity and 73% specificity. CONCLUSIONS Aortoiliac calcifications do not decrease patient and graft survival. High calcium score predict cardiovascular events and procedures during the follow-up.
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Affiliation(s)
- Bertrand Chavent
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Nicolas Maillard
- Department of Nephrology and Kidney Transplantation, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Noël Albertini
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Ambroise Duprey
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Pierre Favre
- Department of Cardiovascular Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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Ichii T, Morimoto R, Okumura T, Ishii H, Tatami Y, Yamamoto D, Aoki S, Hiraiwa H, Furusawa K, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Suzuki S, Yasuda Y, Murohara T. Impact of Renal Functional/Morphological Dynamics on the Calcification of Coronary and Abdominal Arteries in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2017; 24:1092-1104. [PMID: 28392544 PMCID: PMC5684475 DOI: 10.5551/jat.39271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Fast-progressing vascular calcification (VC) is accompanied by renal atrophy and functional deterioration along with atherosclerosis in patients with chronic kidney disease (CKD). However, the relationship between VC progression and renal functional and/or morphological changes remains unclear. Methods: We included 70 asymptomatic patients with CKD without hemodialysis in our study. To identify temporal variations, the coronary artery calcification score (CACS), abdominal aortic calcification index (ACI), and renal parenchymal volume index (RPVI) were determined via spiral computed tomography scans taken during the study. We investigated significant factors related to annualized variations of CACS (ΔCACS/y) and ACI (ΔACI/y). Results: During the follow-up period (4.6 years), median values of CACS [in Agatston units (AU)] and ACI increased from 40.2 to 113.3 AU (p = 0.053) and from 13.2 to 21.7% (p = 0.036), respectively. Multivariate analysis revealed that CACS at baseline (p < 0.001) and diabetes mellitus (DM) status (p = 0.037) for ΔCACS/y and ACI at baseline (p = 0.017) and hypertension (HT) status (p = 0.046) for ΔACI/y were significant independent predictors. Furthermore, annualized RPVI variation was significantly related to both ΔCACS/y and ΔACI/y (R = −0.565, p < 0.001, and R = −0.289, p = 0.015, respectively). On the other hand, independent contributions of the estimated glomerular filtration rate (eGFR) and annualized eGFR variation to VC progression were not confirmed. Conclusion: The degree of VC at baseline, DM, HT, and changes in renal volume, but not eGFR, had a strong impact on VC progression in patients with CKD.
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Affiliation(s)
- Takeo Ichii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine.,Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yosuke Tatami
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Dai Yamamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Soichiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yoshinari Yasuda
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Znorko B, Oksztulska-Kolanek E, Michałowska M, Kamiński T, Pawlak K. Does the OPG/RANKL system contribute to the bone-vascular axis in chronic kidney disease? A systematic review. Adv Med Sci 2017; 62:52-64. [PMID: 28189120 DOI: 10.1016/j.advms.2016.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/20/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023]
Abstract
Vascular calcification (VC) is highly prevalent in patients with chronic kidney disease (CKD) and is strongly associated with cardiovascular mortality and morbidity. Accumulating evidence over the past decade has challenged the hypothesis of close interaction between bone and VC what raises the possibility of a common underlying pathophysiological mechanism. Lately, bone regulatory proteins such as: osteoprotegerin (OPG) and Receptor Activator for Nuclear Factor κB Ligand (RANKL) has attracted attention of researchers as a possible key mediators of bone-vascular calcification imbalance. The literature search was carried out using the MEDLINE/PubMed database and a combination of keywords and MeSH terms, and only papers published since January 2005 to July 2016 were selected. The search resulted in 562 potential articles. After selection according to the eligibility criteria, 107 studies fulfilled were included (102 full texts and 5 was case reports). OPG and RANKL plays essential role in the regulation of bone metabolism and may be regarded as a possible link between VC, bone and mineral metabolism in CKD patients. Further studies are required to determine the diagnostic significance of these proteins in evaluation of progression and severity of VC process in CKD patients. Finally, the efficacy and safety, especially in regard to VC, of anti-RANKL therapy in CKD patients requires well-designed prospective, randomized trials.
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Affiliation(s)
- Beata Znorko
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Oksztulska-Kolanek
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, Bialystok, Poland
| | | | - Tomasz Kamiński
- Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland
| | - Krystyna Pawlak
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, Bialystok, Poland.
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28
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Demir P, Erdenen F, Aral H, Emre T, Kose S, Altunoglu E, Dolgun A, Inal BB, Turkmen A. Serum Osteoprotegerin Levels Related With Cardiovascular Risk Factors in Chronic Kidney Disease. J Clin Lab Anal 2016; 30:811-817. [PMID: 26991325 PMCID: PMC6807210 DOI: 10.1002/jcla.21941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 12/22/2015] [Accepted: 01/07/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To evaluate osteoprotegerin (OPG) levels in relation to cardiovascular (CV) risk factors in patients with chronic kidney disease (CKD) on different regimens of renal replacement therapy. METHODS A total of 143 patients with CKD and 30 healthy controls were included in this study and divided into five categories, including predialysis patients with chronic renal failure (preD; n = 36), chronic peritoneal dialysis patients (PD; n = 36), hemodialysis patients (HD; n = 35), renal transplant patients (RT; n = 36), and controls (n = 30). Data on demographics, concomitant diseases and CV risk factors, serum OPG levels, and correlates of serum OPG levels were determined. RESULTS Serum OPG (pmol/l) levels were significantly higher in HD (P <0.001 for each), PD (P <0.001 for each), and preD (P <0.01 vs. control, P <0.05 vs. RT) groups than RT and control groups. Diabetics than nondiabetics in HD (P = 0.008), PD (P = 0.024), and RT (P = 0.004) groups and males than females in PD group (P = 0.021) had higher OPG levels. Serum OPG levels were associated positively with age in HD (P <0.001), PD (P = 0.001), and in overall population (P <0.001). CONCLUSION Our findings revealed increased serum levels of OPG in dialysis and preD patients compared to RT and controls. In the patient groups receiving two dialysis treatment, the levels were worse, indicating a more pronounced vascular injury. Age, C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C), and cystatin C (CysC) in CKD patients, CRP and PTH in the control subjects, and age and BMI in the overall population were the significant correlates of serum OPG levels.
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Affiliation(s)
- Pinar Demir
- Department of Internal Medicine, Ministry of Health Okmeydani Research and Training Hospital, Istanbul, Turkey
| | - Fusun Erdenen
- Department of Internal Medicine, Ministry of Health Istanbul Research and Training Hospital, Istanbul, Turkey.
| | - Hale Aral
- Department of Medical Biochemistry, Ministry of Health Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Turker Emre
- Department of Internal Medicine, Ministry of Health Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Sennur Kose
- Department of Internal Medicine, Ministry of Health Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Esma Altunoglu
- Department of Internal Medicine, Ministry of Health Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Anil Dolgun
- Department of Biostatistics, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Berrin Bercik Inal
- Department of Medical Biochemistry, Ministry of Health Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Aydin Turkmen
- Department of Nephrology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Al Sayed N, Al Waili K, Alawadi F, Al-Ghamdi S, Al Mahmeed W, Al-Nouri F, Al Rukhaimi M, Al-Rasadi K, Awan Z, Farghaly M, Hassanein M, Sabbour H, Zubaid M, Barter P. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East. Int J Cardiol 2016; 225:268-283. [PMID: 27741487 DOI: 10.1016/j.ijcard.2016.09.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. METHODS A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. RESULTS The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. CONCLUSIONS These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East.
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Affiliation(s)
- Nasreen Al Sayed
- Gulf Diabetes Specialist Center, P.O. Box 21686, Manama, Bahrain.
| | - Khalid Al Waili
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Saeed Al-Ghamdi
- Department of Medicine, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
| | - Fahad Al-Nouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Mona Al Rukhaimi
- Dubai Medical College, P.O. Box 22331, Dubai, United Arab Emirates.
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Zuhier Awan
- King Abdulaziz University, Jeddah 22254, Saudi Arabia.
| | | | | | - Hani Sabbour
- Shaikh Khalifa Medical City, Cardiac Sciences Institute, Abu Dhabi, United Arab Emirates.
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
| | - Philip Barter
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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Kuźniewski M, Fedak D, Dumnicka P, Stępień E, Kuśnierz-Cabala B, Cwynar M, Sułowicz W. Osteoprotegerin and osteoprotegerin/TRAIL ratio are associated with cardiovascular dysfunction and mortality among patients with renal failure. Adv Med Sci 2016; 61:269-275. [PMID: 27128817 DOI: 10.1016/j.advms.2016.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 01/06/2016] [Accepted: 03/04/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE The high prevalence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) is observed especially in those undergoing dialysis. Osteoprotegerin (OPG) and its ligands, receptor activator of nuclear factor kappa-B ligand (RANKL) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) have been associated with cardiovascular complications. Our aim was to study their role as cardiovascular risk factors in stage 5 CKD patients. PATIENTS AND METHODS OPG, RANKL and TRAIL concentrations were measured in 69 hemodialyzed CKD patients and 35 healthy volunteers. In CKD patients, cardiovascular dysfunction was assessed with aortic pulse wave velocity (AoPWV), carotid artery intima-media thickness (CCA-IMT), coronary artery calcium score (CACS) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentrations. Cardiovascular and overall mortality data were collected during a 7-years follow-up. RESULTS OPG plasma concentrations were higher in CKD patients comparing to controls. Total soluble RANKL was lower and OPG/RANKL ratio higher in patients. Soluble TRAIL concentrations did not differ between the groups and OPG/TRAIL ratio was higher in CKD patients. OPG and OPG/TRAIL positively predicted long-term mortality (all-cause and cardiovascular) in CKD patients. OPG positively correlated with AoPWV, CCA-IMT and NT-proBNP whereas OPG/TRAIL with AoPWV and NT-proBNP. Described relationships were independent of classical and non-classical cardiovascular risk factors, with exception of age. CONCLUSIONS Our study confirmed the role of OPG as a biomarker of cardiovascular dysfunction and a predictor of mortality in stage 5 CKD. OPG/TRAIL ratio can be proposed as a predictor of cardiovascular dysfunction and mortality.
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Affiliation(s)
- Marek Kuźniewski
- Chair and Department of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Fedak
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University Medical College, Kraków, Poland.
| | - Ewa Stępień
- Department of Medical Physics, M. Smoluchowski Institute of Physics, Jagiellonian University, Kraków, Poland
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Cwynar
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Władysław Sułowicz
- Chair and Department of Nephrology, Jagiellonian University Medical College, Kraków, Poland
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31
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Higgins CL, Isbilir S, Basto P, Chen IY, Vaduganathan M, Vaduganathan P, Reardon MJ, Lawrie G, Peterson L, Morrisett JD. Distribution of alkaline phosphatase, osteopontin, RANK ligand and osteoprotegerin in calcified human carotid atheroma. Protein J 2016; 34:315-28. [PMID: 26307009 DOI: 10.1007/s10930-015-9620-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Ectopic vascular calcification is a significant component of atherosclerotic disease. Osteopontin (OPN), Osteoprotegerin (OPG), Receptor Activator of NFκB Ligand (RANKL), and alkaline phosphatase (ALP) are each thought to play central roles in the calcification or demineralization of atherosclerotic lesions. Abnormalities in the balance of these proteins may lead to perturbations in bone remodeling and arterial calcification. The purpose of this study was to measure the distribution of these proteins in human carotid lesions and to elucidate possible mechanism(s) whereby they control the deposition or depletion of arterial calcification. Thirty-three patients who had undergone carotid endarterectomy (CEA) within the previous 18 months and 11 control patients were enrolled. CEA specimens were analyzed by EBCT for calcification content in terms of Agatston (AGAT) and Volume scores. CEA specimens were then cut into 5 mm segments which were homogenized and extracted. Extracts were analyzed for tissue levels of calcium, phosphorus, ALP, OPN, RANKL, and OPG. Fasting blood samples were analyzed for the same components. In CEA tissue segments, the calcification levels (CHA AGAT) were inversely associated with the levels of OPG (r = -0.432/-0.579, p < 0.05) and positively associated with the levels of RANKL (r = 0.332/0.415, p < 0.05). In turn, the tissue levels of OPG were associated with homologous serum levels of OPG (r = 0.820/0.389, p < 0.001), and the tissue levels of RANKL were associated with the serum levels of homologous RANKL (r = 0.739/0.666, p < 0.0001). This study suggests that serum levels of OPG and RANKL may be useful biomarkers for estimating the degree of calcification in carotid atherosclerotic lesions.
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Affiliation(s)
| | - Salim Isbilir
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Pamela Basto
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Iou Yih Chen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Muthiah Vaduganathan
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, A601, 6565 Fannin St., Houston, TX, 77030, USA
| | - Periyanan Vaduganathan
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, A601, 6565 Fannin St., Houston, TX, 77030, USA
| | - Michael J Reardon
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, A601, 6565 Fannin St., Houston, TX, 77030, USA
| | - Gerald Lawrie
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, A601, 6565 Fannin St., Houston, TX, 77030, USA
| | - Leif Peterson
- Department of Public Health, The Methodist Hospital Research Institute, Houston, TX, USA
| | - Joel D Morrisett
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA. .,Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, A601, 6565 Fannin St., Houston, TX, 77030, USA.
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Mann A, Makkar V, Mann S, Dhamija P, Soundarajan P. Fetuin-A and vascular calcification in Indian end-stage renal disease population. Indian J Nephrol 2016; 26:33-8. [PMID: 26937076 PMCID: PMC4753739 DOI: 10.4103/0971-4065.157007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Fetuin-A levels, its correlation with vascular calcification and other biochemical markers of chronic kidney disease-mineral and bone disorder (CKD-MBD) has not been studied in Indian end-stage renal disease population. Forty patients on dialysis for more than 3 months were studied. Biochemical parameters of CKD-MBD, highly sensitive-C reactive protein (hs-CRP), lipid profile and fetuin-A levels were estimated. Multi-slice computed tomography (MSCT) at the level of L1-L4 was done, and calcification score calculated using AJ 130 smart score. Levels of fetuin-A were correlated with calcification score and biochemical markers of CKD-MBD. Mean fetuin-A levels were 0.33 ± 0.098 g/l. Positive correlation of abdominal aortic calcification scores was found with age (P < 0.01) and duration of dialysis (P = 0.018). No correlation was detected between MSCT score, calcium phosphate product, intact parathyroid hormone, vitamin D, triglycerides and fetuin-A, and there was no correlation between fetuin-A levels, age, dialysis duration and calcium phosphate product but a significant correlations with vitamin D3 (P = 0.034), serum albumin (P = 0.002) was detected. Inverse correlation with hs-CRP was obtained. Patients with ischemic heart disease had numerically lower levels of fetuin-A (P = 0.427) and numerically higher MSCT score (P = 0.135). Patients with low hs-CRP (<10) had numerically higher fetuin-A levels (P = 0.090) and significantly low MSCT scores (P = 0.020). Calcium deposition seen on MSCT increases with age and duration of dialysis but is not related to fetuin-A levels. Inconclusive relationship exists with other parameters of CKD-MBD. Large controlled studies are needed to establish the role of fetuin-A in vascular calcification in Indian population.
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Affiliation(s)
- A. Mann
- Department of Nephrology, PGIMS, Rohtak, Haryana, India
| | - V. Makkar
- Department of Nephrology, DMCH, Ludhiana, Punjab, India
| | - S. Mann
- Department of Obstetrics and Gynaecology, PGIMS, Rohtak, Haryana, India
| | - P. Dhamija
- Department of Pharmacology, AIIMS, Rishikesh, Uttarakhand, India
| | - P. Soundarajan
- Department of Nephrology, SRMC, Chennai, Tamil Nadu, India
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33
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Wyskida K, Żak-Gołąb A, Łabuzek K, Suchy D, Ficek R, Pośpiech K, Olszanecka-Glinianowicz M, Okopień B, Więcek A, Chudek J. Daily intake and serum concentration of menaquinone-4 (MK-4) in haemodialysis patients with chronic kidney disease. Clin Biochem 2015; 48:1246-51. [PMID: 26282719 DOI: 10.1016/j.clinbiochem.2015.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/04/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023]
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Kujawa-Szewieczek A, Kolonko A, Chudek J, Więcek A. No effect of pretransplantation bilateral nephrectomy on the resistive indices measured in the kidney allograft. Transplant Proc 2015; 46:2602-5. [PMID: 25380876 DOI: 10.1016/j.transproceed.2014.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cirrhotic kidney is the cause of sympathetic nervous system and the renin-angiotensin system activation leading to increased vascular resistance and arterial hypertension. The impact of unilateral or bilateral nephrectomy (UN or BN) performed before kidney transplantation on kidney graft intrarenal resistance has not been assessed yet. The aim of this study is to assess the intrarenal resistance parameters measured by Doppler ultrasound in the transplanted kidney in either nephrectomized or non-nephrectomized kidney transplant recipients. METHODS Among 686 consecutive successful first cadaveric kidney graft recipients transplanted from 1998 to 2012, we identified 43 patients who underwent BN and 49 patients who underwent UN. Patients with acute rejection episodes within an early post-transplantation period were excluded. We have analyzed both pulsatility (PI) and resistance (RI) indices measured within the kidney graft before discharge from the hospital. RESULTS The prevalence of hypertension in the follow-up period after transplantation was significantly lower in the BN group (65.1% versus 81.0% in other groups). Neither BN nor UN influenced the PI or RI values. The mean PI and RI values were 1.50 (1.38-1.61) and 0.75 (0.73-0.78) in BN, 1.48 (1.37-1.58) and 0.76 (0.73-0.79) in UN, and 1.47 (1.43-1.50) and 0.74 (0.73-0.75) in non-nephrectomized patients, respectively. The results of multivariate analysis confirmed the lack of influence of nephrectomy on kidney graft resistive indices. CONCLUSION BN before transplantation resulted in lower frequency of hypertension, but it did not affect the intrarenal vascular resistance measured in the kidney graft.
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Affiliation(s)
- A Kujawa-Szewieczek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - A Kolonko
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - J Chudek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland; Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - A Więcek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland.
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35
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Shikada T, Washio M, Nishizaki A, Kakino T, Ooe K, Ishibashi Y, Sagara S, Morishige K, Tashiro H. Risk factors for coronary artery calcification in Japanese patients. J Cardiol 2015; 66:36-40. [PMID: 25448727 DOI: 10.1016/j.jjcc.2014.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/11/2014] [Accepted: 09/08/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Tomoki Shikada
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Masakazu Washio
- Department of Community Health and Clinical Epidemiology, St. Mary's College, Kurume, Japan
| | | | | | - Kensuke Ooe
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan
| | | | | | | | - Hideki Tashiro
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan.
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36
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Zhang Q, Sun L, Jin L. Association Between Angiotensin-Converting Enzyme 2 and Coronary Artery Calcification in Patients on Maintenance Hemodialysis Therapy. Ther Apher Dial 2015; 19:466-70. [PMID: 26112236 DOI: 10.1111/1744-9987.12298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/05/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Qiankun Zhang
- Department of Nephrology; Lishui Center Hospital; Lishui Zhejiang China
| | - Lina Sun
- Department of Nephrology; Lishui Center Hospital; Lishui Zhejiang China
| | - Lie Jin
- Department of Nephrology; Lishui Center Hospital; Lishui Zhejiang China
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37
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Rolla R, De Mauri A, Valsesia A, Vidali M, Chiarinotti D, Bellomo G. Lipoprotein profile, lipoprotein-associated phospholipase A2 and cardiovascular risk in hemodialysis patients. J Nephrol 2015; 28:749-55. [PMID: 25971848 DOI: 10.1007/s40620-015-0194-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/26/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients; the increased risk of cardiovascular disease is due to accelerated atherosclerosis, inflammation and impaired lipoprotein metabolism. We aimed to evaluate lipoprotein-associated phospholipase A2 (Lp-PLA2) and some pro-inflammatory aspects of the lipoprotein profile in dialyzed patients in order to evaluate the relationship with the accelerated atherosclerosis and vascular accidents. METHODS In 102 dialysis patients and 40 non-uremic controls, we investigated the lipoprotein plasma profile, high sensitivity C-reactive protein (CRP), ceruloplasmin and serum amyloid A protein (SAA), and followed patients for 1 year to analyze the risk of acute cardiovascular events. RESULTS Total cholesterol, low-density lipoprotein and high-density lipoprotein plasma levels were significantly lower in uremic patients than controls, whereas CRP, SAA, ceruloplasmin, Lp-PLA2 and their ratio with apolipoprotein A1 were significantly higher. Patients with Lp-PLA2 levels >194 nmol/min/ml had more acute cardiovascular events than patients with lower values. CONCLUSION Our results show that in dialysis subjects: (1) low-density lipoproteins show a more atherogenic phenotype than in the general population; (2) high-density lipoproteins are less anti-inflammatory; (3) Lp-PLA2 could potentially be used to evaluate cardiovascular risk.
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Affiliation(s)
- Roberta Rolla
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Andreana De Mauri
- Nephrology and Dialysis Unit, University Hospital 'Maggiore della Carità', Corso Mazzini, 18, 28100, Novara, Italy.
| | - Ambra Valsesia
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Matteo Vidali
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Doriana Chiarinotti
- Nephrology and Dialysis Unit, University Hospital 'Maggiore della Carità', Corso Mazzini, 18, 28100, Novara, Italy
| | - Giorgio Bellomo
- Clinical Chemistry Laboratory, Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
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Malluche HH, Blomquist G, Monier-Faugere MC, Cantor TL, Davenport DL. High Parathyroid Hormone Level and Osteoporosis Predict Progression of Coronary Artery Calcification in Patients on Dialysis. J Am Soc Nephrol 2015; 26:2534-44. [PMID: 25838468 DOI: 10.1681/asn.2014070686] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/25/2014] [Indexed: 12/17/2022] Open
Abstract
Coronary artery calcifications (CACs) are observed in most patients with CKD on dialysis (CKD-5D). CACs frequently progress and are associated with increased risk for cardiovascular events, the major cause of death in these patients. A link between bone and vascular calcification has been shown. This prospective study was designed to identify noninvasive tests for predicting CAC progression, including measurements of bone mineral density (BMD) and novel bone markers in adult patients with CKD-5D. At baseline and after 1 year, patients underwent routine blood tests and measurement of CAC, BMD, and novel serum bone markers. A total of 213 patients received baseline measurements, of whom about 80% had measurable CAC and almost 50% had CAC Agatston scores>400, conferring high risk for cardiovascular events. Independent positive predictors of baseline CAC included coronary artery disease, diabetes, dialysis vintage, fibroblast growth factor-23 concentration, and age, whereas BMD of the spine measured by quantitative computed tomography was an inverse predictor. Hypertension, HDL level, and smoking were not baseline predictors in these patients. Three quarters of 122 patients completing the study had CAC increases at 1 year. Independent risk factors for CAC progression were age, baseline total or whole parathyroid hormone level greater than nine times the normal value, and osteoporosis by t scores. Our results confirm a role for bone in CKD-associated CAC prevalence and progression.
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39
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Aortic root calcification and cardiac risk factors in patients with coronary calcium score greater than zero using multidetector computed tomography. Artery Res 2015. [DOI: 10.1016/j.artres.2015.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kobayashi N, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Takimura H, Sakamoto Y. Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation. Heart Vessels 2014; 31:330-40. [PMID: 25523891 DOI: 10.1007/s00380-014-0615-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
| | - Toshiya Muramatsu
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Reiko Tsukahara
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Hiroshi Ishimori
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Masatsugu Nakano
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Hideyuki Takimura
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Yasunari Sakamoto
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
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Stompór T. Coronary artery calcification in chronic kidney disease: An update. World J Cardiol 2014; 6:115-129. [PMID: 24772252 PMCID: PMC3999332 DOI: 10.4330/wjc.v6.i4.115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/10/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Arterial calcification is a well-recognized complication of advanced atherosclerosis. Chronic kidney disease (CKD) is characterized by significantly more pronounced, disseminated and fast-progressing calcification of the vascular system, including the coronary arteries. New computed tomography-based imaging techniques allow for the noninvasive assessment and monitoring of calcification in different vascular sites. Coronary artery calcification (CAC) develops early in the course of CKD and is tightly associated with mineral and bone disorders, which include but are not limited to secondary hyperparathyroidism. In this review, recent data on the pathogenesis of CAC development and progression are discussed, with a special emphasis on fibroblast growth factor 23 and its co-receptor, klotho. The prevalence, progression and prognostic significance of CAC are reviewed separately for patients with end-stage renal disease treated with dialysis, kidney transplant recipients and patients with earlier stages of CKD. In the last section, therapeutic considerations are discussed, with special attention paid to the importance of treatment that addresses mineral and bone disorders of CKD.
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Abstract
Vascular calcification in chronic kidney disease (CKD) patients is associated to increased mortality. Osteoprotegerin (OPG) is a soluble tumor necrosis factor (TNF) superfamily receptor that inhibits the actions of the cytokines receptor activator of nuclear factor kappa-B ligand (RANKL) and TNF-related apoptosis-inducing ligand (TRAIL) by preventing their binding to signaling receptors in the cell membrane. OPG-deficient mice display vascular calcification while OPG prevented calcification of cultured vascular smooth muscle cells and protected kidney cells from TRAIL-induced death. OPG may be a biomarker in patients with kidney disease. Circulating OPG is increased in predialysis, dialysis and transplant CKD patients and may predict vascular calcification progression and patient survival. By contrast, circulating OPG is decreased in nephrotic syndrome. In addition, free and exosome-bound urinary OPG is increased in human kidney disease. Increased urinary OPG has been associated with lupus nephritis activity. Despite the association of high OPG levels with disease, experimental functional information available suggests that OPG might be protective in kidney disease and in vascular injury in the context of uremia. Thus, tissue injury results in increased OPG, while OPG may protect from tissue injury. Recombinant OPG was safe in phase I randomized controlled trials. Further research is needed to fully define the therapeutic and biomarker potential of OPG in patients with kidney disease.
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Wang M, Li H, You L, Yu X, Zhang M, Zhu R, Hao C, Zhang Z, Chen J. Association of serum phosphorus variability with coronary artery calcification among hemodialysis patients. PLoS One 2014; 9:e93360. [PMID: 24747427 PMCID: PMC3991577 DOI: 10.1371/journal.pone.0093360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/04/2014] [Indexed: 01/11/2023] Open
Abstract
Coronary artery calcification (CAC) is associated with increased mortality in patients on maintenance hemodialysis (MHD), but the pathogenesis of this condition is not well understood. We evaluated the relationship of CAC score (CACs) and variability in serum phosphorus in MHD patients. Seventy-seven adults on MHD at Huashan Hospital (Shanghai) were enrolled in July, 2010. CAC of all the patients were measured by computed tomography and CACs was calculated by the Agatston method at the entry of enrollment. Patients were divided into three categories according to their CACs (0∼10, 11∼400, and >400). Blood chemistry was recorded every 3 months from January 2008 to July 2010. Phosphorus variation was defined by the standard deviation (SD) or coefficient of variation (CV) and it was calculated from the past records. The ordinal multivariate logistic regression analysis was used to analyze the predictors of CAC. The mean patient age (± SD) was 61.7 years (±11.3) and 51% of patients were men. The mean CACs was 609.6 (±1062.9), the median CACs was 168.5, and 78% of patients had CACs more than 0. Multivariate analysis indicated that female gender (OR = 0.20, 95% CI = 0.07–0.55), age (OR = 2.31, 95% CI = 1.32–4.04), serum fibroblast growth factor 23 (OR = 2.25, 95% CI = 1.31–3.85), SD-phosphorus calculated from the most recent 6 measurements (OR = 2.12; 95% CI = 1.23–3.63), and CV-phosphorus calculated from the most recent 6 measurements (OR = 1.90, 95% CI = 1.16–3.11) were significantly and independently associated with CACs. These associations persisted for phosphorus variation calculated from past 7, 8, 9, 10, and 11 follow-up values. Variability of serum phosphorus may contribute significantly to CAC and keeping serum phosphorus stable may decrease coronary calcification and associated morbidity and mortality in MHD patients.
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Affiliation(s)
- Mengjing Wang
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiming Li
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li You
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoling Yu
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruijiang Zhu
- Division of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhijie Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Biomedical statistical Center, Fudan University, Shanghai, China
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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Zhang DL, Wang LY, Sun F, Zhou YL, Duan XF, Liu S, Sun Y, Cui TG, Liu WH. Is the dialysate calcium concentration of 1.75 mmol/L suitable for Chinese patients on maintenance hemodialysis? Calcif Tissue Int 2014; 94:301-10. [PMID: 24193439 DOI: 10.1007/s00223-013-9811-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/16/2013] [Indexed: 12/11/2022]
Abstract
We studied the effects of increasing the dialysate calcium concentration (DCa) to 1.75 mmol/L on controlling chronic kidney disease-mineral and bone disorder in Chinese patients on maintenance hemodialysis (MHD). We reviewed the data of MHD patients in one center (cohort 1) during prior 10 years and analyzed the risk factors of mortality and transference calcification (TC) in120 MHD patients surviving in 2003 (cohort 2). A multicenter, prospective, parallel-group, controlled trial (cohort 3) was also conducted from January 2011 to December 2012. The DCa at one center was increased from 1.5 to 1.75 mmol/L but was not changed at the other two centers. The clinical outcomes, biochemical parameters, medicine treatments, and TC markers [aortic arch calcification score (AoACS)] were compared between groups. In cohort 1, the annual mean serum iPTH increased significantly over 10 years. In cohort 1, 72 patients survived for 10 years, whose doses of calcium salts and active vitamin D3 and AoACs increased progressively. In cohort 2, the main cause of death was cardiocerebrovascular disease (CCVD) (n = 18, 48.6 %). Male sex and lower serum calcium concentrations were independent risk factors for CCVD mortality. In cohort 3, serum phosphorus, iPTH, and 25(OH)D decreased and serum calcium increased significantly; also, the doses of calcium and vitamin D3 decreased from 2011 to 2012 in the DCa 1.75 group. There were no significant differences in clinical outcomes either between groups or between the two calendar years. Our results indicate that increasing DCa to 1.75 mmol/L can decrease the elevated levels of serum iPTH and phosphorus, reduce the doses of calcium and vitamin D3, and be safe for short periods of time.
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Affiliation(s)
- Dong-liang Zhang
- Nephrology Faculty, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Street, Xi-Cheng District, Beijing, 100050, China
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Pateinakis P, Papagianni A, Douma S, Efstratiadis G, Memmos D. Associations of fetuin-A and osteoprotegerin with arterial stiffness and early atherosclerosis in chronic hemodialysis patients. BMC Nephrol 2013; 14:122. [PMID: 23758931 PMCID: PMC3700830 DOI: 10.1186/1471-2369-14-122] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular morbidity and mortality remains excessive in patients with chronic kidney disease. The association of vascular changes with regulators of extraosseous calcification in this patient population is still under investigation. The aim of the present study was to investigate the associations of the calcification inhibitor fetuin-A, and the anti-osteoclastic factor osteoprotegerin (OPG) with vascular pathology in chronic hemodialysis patients. METHODS In this cross-sectional study including 81 stable chronic hemodialysis patients, we measured carotid-to-femoral pulse wave velocity (cfPWV) with applanation tonometry, reflecting arterial stiffness, and common carotid intima-media thickness (ccIMT), a surrogate of early atherosclerosis, as well as serum levels of fetuin-A and OPG. Co-morbidities, traditional cardiovascular risk factors, inflammatory markers and mineral-bone disease serology parameters were also recorded. RESULTS cfPWV correlated inversely with fetuin-A (r=-0.355, p=0.001) and positively with OPG (r=0.584, p<0.001). In multilinear regression analysis including age, gender, diabetes, cardiovascular disease, hypertension, pulse pressure, LDL, logCRP, both fetuin-A and OPG were independently associated with cfPWV (p=0.024 and p=0.041 respectively). ccIMT was negatively associated with fetuin-A (r=-0.312, p=0.005) and positively with OPG (r=0.521, p<0.0001); however these associations lost statistical significance after adjustment for age. CONCLUSION In chronic hemodialysis patients both fetuin-A and OPG levels are independently associated with arterial stiffness but not with early atherosclerotic vascular changes.
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Affiliation(s)
- Panagiotis Pateinakis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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