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Kane J, Vos WG, Bosmans LA, van Os BW, den Toom M, Hoeksema‐Hackmann S, Moen‐de Wit D, Gijbels MJ, Beckers L, Grefhorst A, Levels JHM, Jakulj L, Vervloet MG, Lutgens E, Eringa EC. Peritoneal Dialysis Aggravates and Accelerates Atherosclerosis in Uremic ApoE-/- Mice. J Am Heart Assoc 2024; 13:e034066. [PMID: 38979792 PMCID: PMC11292770 DOI: 10.1161/jaha.123.034066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/29/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Atherosclerosis is highly prevalent in people with chronic kidney disease (CKD), including those receiving peritoneal dialysis (PD). Although it is lifesaving, PD induces profound systemic inflammation, which may aggravate atherosclerosis. Therefore, the hypothesis is that this PD-induced inflammation aggravates atherosclerosis via immune cell activation. METHODS AND RESULTS ApoE-/- mice were subjected to a 5/6 nephrectomy to induce CKD. Three weeks later, mice were fed a high-cholesterol diet. Half of the nephrectomized mice then received daily peritoneal infusions of 3.86% Physioneal for 67 further days (CKD+PD) until the end of the experiment, and were compared with mice without CKD. Sham operated and PD-only mice were additional controls. CKD+PD mice displayed more severe atherosclerotic disease than control mice. Plaque area increased, and plaques were more advanced with a vulnerable phenotype typified by decreased collagen content and decreased fibrous cap thickness. Increased CD3+ T-cell numbers were present in plaques and perivascular adipose tissue of CKD and CKD+PD mice. Plaques of CKD+PD mice contained more iNOS+ immune cells. Spleens of CKD+PD mice showed more CD4+ central memory, terminally differentiated type 1 T-helper (Th1), Th17, and CX3C motif chemokine receptor 1+ (CX3CR1) CD4+ T-cells with less regulatory and effector T-cells. CONCLUSIONS PD-fluid exposure in uremic mice potentiates systemic and vascular T-cell-driven inflammation and aggravates atherosclerosis. PD polarized CD4+ T-cells toward an inflammatory Th1/Th17 phenotype, and increased CX3CR1+ CD4+ T-cells, which are associated with vascular homing in CKD-associated atherosclerosis. Targeting CD4+ T-cell activation and CX3CR1+ polarization has the potential to attenuate atherosclerosis in PD patients.
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Affiliation(s)
- Jamie Kane
- Department of Nephrology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Winnie G. Vos
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Laura A. Bosmans
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
- Department of Experimental Vascular Medicine, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Bram W. van Os
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Myrthe den Toom
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
| | | | - Denise Moen‐de Wit
- Animal Research Institute AMCAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Marion J. Gijbels
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CentreMaastrichtthe Netherlands
| | - Linda Beckers
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam Immunity and InfectionAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Aldo Grefhorst
- Department of Experimental Vascular Medicine, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Johannes H. M. Levels
- Department of Experimental Vascular Medicine, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
| | - Lily Jakulj
- Department of Nephrology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
- Dianet Dialysis Centre AmsterdamAmsterdamthe Netherlands
| | - Marc G. Vervloet
- Department of Nephrology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
- Department of NephrologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Esther Lutgens
- Department of Cardiovascular Medicine and ImmunologyMayo ClinicRochesterMN
| | - Etto C. Eringa
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentreAmsterdamthe Netherlands
- Department of PhysiologyMaastricht UniversityMaastrichtthe Netherlands
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Dolade N, Rayego-Mateos S, Garcia-Carrasco A, Guerin M, Martín-Ventura JL, Ruiz-Ortega M, Tharaux PL, Valdivielso JM. B- and T-lymphocyte attenuator could be a new player in accelerated atherosclerosis associated with chronic kidney disease. Clin Sci (Lond) 2023; 137:1409-1429. [PMID: 37655751 DOI: 10.1042/cs20230399] [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: 04/21/2023] [Revised: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND In chronic kidney disease (CKD), cardiovascular morbi-mortality is higher than in general population. Atherosclerotic cardiovascular disease is accelerated in CKD, but specific CKD-related risk factors for atherosclerosis are unknown. METHODS CKD patients from the NEFRONA study were used. We performed mRNA array from blood of patients free from atheroma plaque at baseline, with (n=10) and without (n=10) de novo atherosclerotic plaque development 2 years later. Selected mRNA candidates were validated in a bigger sample (n=148). Validated candidates were investigated in vivo in an experimental model of CKD-accelerated atherosclerosis, and in vitro in murine macrophages. RESULTS mRNA array analysis showed 92 up-regulated and 67 down-regulated mRNAs in samples from CKD patients with de novo plaque development. The functional analysis pointed to a paramount role of the immune response. The validation in a bigger sample confirmed that B- and T-lymphocyte co-inhibitory molecule (BTLA) down-regulation was associated with de novo plaque presence after 2 years. However, BTLA down-regulation was not found to be associated with atherosclerotic progression in patients with plaque already present at baseline. In a model of CKD-accelerated atherosclerosis, mRNA and protein expression levels of BTLA were significantly decreased in blood samples and atheroma plaques. Plaques from animals with CKD were bigger, had more infiltration of inflammatory cells, higher expression of IL6 and IL17 and less presence of collagen than plaques from control animals. Incubation of macrophages with rat uremic serum decreased BTLA expression. CONCLUSIONS BTLA could be a potential biomarker or therapeutic target for atherosclerosis incidence in CKD patients.
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Affiliation(s)
- Nuria Dolade
- Red de Investigación Renal (REDinREN), Ricords2040, Spain
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida IRBLleida, Lleida 25198, Spain
| | - Sandra Rayego-Mateos
- Red de Investigación Renal (REDinREN), Ricords2040, Spain
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida IRBLleida, Lleida 25198, Spain
| | - Alicia Garcia-Carrasco
- Red de Investigación Renal (REDinREN), Ricords2040, Spain
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida IRBLleida, Lleida 25198, Spain
| | - Maryse Guerin
- INSERM UMR_S 1166 - ICAN. Faculté de Médecine Pitié-Salpêtrière: 75013 Paris, France
| | - Jose-Luis Martín-Ventura
- Vascular Research Laboratory, IIS-Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Catolicos 2, 28040 Madrid, Spain and CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Ruiz-Ortega
- Cellular and Molecular Biology in Renal and Vascular Pathology Laboratory, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
| | - Pierre-Louis Tharaux
- Paris Cardiovascular research Centre (PARCC), Institut National de la Santé et de la Recherche Médicale, INSERM, Université Paris Cité, Paris, France
| | - Jose Manuel Valdivielso
- Red de Investigación Renal (REDinREN), Ricords2040, Spain
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida IRBLleida, Lleida 25198, Spain
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Wangueu LT, de Fréminville JB, Gatault P, Buchler M, Longuet H, Bejan-Angoulvant T, Sautenet B, Halimi JM. Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period. J Nephrol 2023; 36:1931-1943. [PMID: 37548826 DOI: 10.1007/s40620-023-01706-9] [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: 03/08/2023] [Accepted: 06/09/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Hypertension is a burden for most kidney transplant recipients. Whether respect of hypertension guidelines results in better outcomes is unknown. METHODS In this multicenter study, office blood pressure at 12 months following transplantation (i.e., after > 20 outpatient visits), and survival were assessed over 35 years among 2004 consecutive kidney transplant recipients who received a first kidney graft from 1985 to 2019 (follow-up: 26,232 patient-years). RESULTS Antihypertensive medications were used in 1763/2004 (88.0%) patients. Renin-angiotensin-system blockers were used in 35.6% (47.1% when proteinuria was > 0.5 g/day) and calcium-channel blockers were used in 6.0% of patients. Combined treatment including renin-angiotensin-system-blockers, calcium-channel blockers and diuretics was used in 15.4% of patients receiving ≥ 3 antihypertensive drugs. Blood pressure was controlled in 8.3%, 18.8% and 43.1%, respectively, depending on definition (BP < 120/80, < 130/80, < 140/90 mmHg, respectively) and has not improved since the year 2001. Two-thirds of patients with uncontrolled blood pressure received < 3 antihypertensive classes. Low sodium intake < 2 g/day (vs ≥ 2) was not associated with better blood pressure control. Uncontrolled blood pressure was associated with lower patient survival (in multivariable analyses) and graft survival (in univariate analyses) vs controlled hypertension or normotension. Low sodium intake and major antihypertensive classes had no influence on patient and graft survival. CONCLUSIONS Pharmacological recommendations and sodium intake reduction are poorly respected, but even when respected, do not result in better blood pressure control, or patient or graft survival. Uncontrolled blood pressure, not the use of specific antihypertensive classes, is associated with reduced patient, and to a lesser extent, reduced graft survival, even using the 120/80 mmHg cut-off.
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Affiliation(s)
| | | | - Philippe Gatault
- Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France
- EA4245, University of Tours, Tours, France
| | - Matthias Buchler
- Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France
- EA4245, University of Tours, Tours, France
| | - Hélène Longuet
- Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France
| | - Theodora Bejan-Angoulvant
- Centre Hospitalier Universitaire Et Faculté de Médecine, Pharmacologie Médicale, EA4245, Université de Tours, Tours, France
| | - Benedicte Sautenet
- Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France
- INI-CRCT, vandoeuvre-Lès-Nancy, France
- INSERM U1246 SPHERE, Université de Tours-Université de Nantes, Tours, France
| | - Jean-Michel Halimi
- Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France.
- EA4245, University of Tours, Tours, France.
- INI-CRCT, vandoeuvre-Lès-Nancy, France.
- Service de Néphrologie, Hôpital Bretonneau, CHU Tours, 2 Boulevard Tonnellé, 37000, Tours, France.
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Duignan N, Ridge P, Leonard S, McDonnell M, Cusack R, Harrison M, Rutherford R, O'Malley N, Dolan C. Expanded central role of the respiratory physiotherapists in the community setting. Ir J Med Sci 2023; 192:1581-1588. [PMID: 36380190 PMCID: PMC9666941 DOI: 10.1007/s11845-022-03213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
The development of community hubs through the Slaintecare initiative will rely on respiratory physiotherapists and clinical nurse specialists for the management of chronic respiratory diseases. The role of the respiratory physiotherapist has evolved dramatically over the last decade. We review the increasing scope of practice of the physiotherapist and the evidence base for same. We pay particular attention to the role of the physiotherapist in areas such as pulmonary rehabilitation, sputum clearance, neuromuscular disease, chronic respiratory failure, ambulatory oxygen assessments and dysfunctional breathing. We give an in depth review of sputum clearance techniques. We also address areas of potential future expansion for the role of the physiotherapist such as prescription and initiation of non-invasive ventilation.
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Affiliation(s)
- Niamh Duignan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Padraic Ridge
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland.
| | - Sinead Leonard
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ruth Cusack
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Michael Harrison
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Robert Rutherford
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Niamh O'Malley
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ciara Dolan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
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Achim A, Péter OÁ, Cocoi M, Serban A, Mot S, Dadarlat-Pop A, Nemes A, Ruzsa Z. Correlation between Coronary Artery Disease with Other Arterial Systems: Similar, Albeit Separate, Underlying Pathophysiologic Mechanisms. J Cardiovasc Dev Dis 2023; 10:jcdd10050210. [PMID: 37233177 DOI: 10.3390/jcdd10050210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Atherosclerosis is a multifactorial systemic disease that affects the entire arterial tree, although some areas are more prone to lipid deposits than others. Moreover, the histopathological composition of the plaques differs, and the clinical manifestations are also different, depending on the location and structure of the atherosclerotic plaque. Some arterial systems are correlated with each other more than in that they simply share a common atherosclerotic risk. The aim of this perspective review is to discuss this heterogeneity of atherosclerotic impairment in different arterial districts and to investigate the current evidence that resulted from studies of the topographical interrelations of atherosclerosis.
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Affiliation(s)
- Alexandru Achim
- Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
| | | | - Mihai Cocoi
- Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Adela Serban
- Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Stefan Mot
- Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Alexandra Dadarlat-Pop
- Department of Cardiology, "Niculae Stancioiu" Heart Institute, University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Attila Nemes
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
| | - Zoltan Ruzsa
- Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
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Ruff C, Artzner C, Nikoalou K, Grözinger G. Atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease patients: a narrative review. Cardiovasc Diagn Ther 2023; 13:133-146. [PMID: 36864951 PMCID: PMC9971292 DOI: 10.21037/cdt-22-53] [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: 01/28/2022] [Accepted: 05/13/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Vascular calcification (VC) and resulting vascular disease is one of the major causes of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). CKD itself is increasingly recognized as a risk factor for cardiac and peripheral arterial disease (PAD). This paper examines the atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease (ESRD) patients. The literature was reviewed regarding the current status of medical and interventional management arteriosclerotic disease in patients with CKD. Lastly, three representative cases displaying typical endovascular treatment options are provided. Methods A literature search was performed in PubMed covering publications up to September 2021 as well as discussion with experts in the field. Key Content and Findings The high prevalence of atherosclerotic lesions in patients with chronic renal failure and high (re-)stenosis cause problems in the medium and long term as vascular calcium load represents one of the most widely encountered predictors of failure of endovascular treatment of PAD and future cardiovascular events (e.g., coronary calcium score). Patients with CKD also suffer from a greater risk for major vascular adverse events in general and worse revascularization outcomes following peripheral vascular intervention. A correlation between calcium burden and drug-coated balloon (DCB) performance has been established for PAD necessitating the need for different tools to cope with vascular calcium such as endoprosthesis or braided stents. Patients with CKD are at a higher risk of developing contrast-induced nephropathy (CIN). In addition to recommendations such as the administration of intravenous fluids, carbon dioxide (CO2) angiography is one option to potentially provide an effective and safe alternative both to iodine-based contrast media allergy and to the use of iodine-based contrast media in patients with CKD. Conclusions Management and endovascular procedures of patients with ESRD are complex. In the course of time, new endovascular therapy methods have been developed such as directional atherectomy (DA) and the so-called "pave-and-crack" technique to deal with high vascular calcium burden. Besides interventional therapy, vascular patients with CKD benefit from aggressive medical management.
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Affiliation(s)
- Christer Ruff
- Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany;,Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Artzner
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Gerd Grözinger
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
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González LM, Robles NR, Mota-Zamorano S, Valdivielso JM, González-Rodríguez L, López-Gómez J, Gervasini G. Influence of variability in the cyclooxygenase pathway on cardiovascular outcomes of nephrosclerosis patients. Sci Rep 2023; 13:1253. [PMID: 36690661 PMCID: PMC9870986 DOI: 10.1038/s41598-022-27343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023] Open
Abstract
Nephrosclerosis patients are at an exceptionally high cardiovascular (CV) risk. We aimed to determine whether genetic variability represented by 38 tag-SNPs in genes of the cyclooxygenase pathway (PTGS1, PTGS2, PTGES, PTGES2 and PTGES3) leading to prostaglandin E2 (PGE2) synthesis, modified CV traits and events in 493 nephrosclerosis patients. Additionally, we genotyped 716 controls to identify nephrosclerosis risk associations. The addition of three variants, namely PTGS2 rs4648268, PTGES3 rs2958155 and PTGES3 rs11300958, to a predictive model for CV events containing classic risk factors in nephrosclerosis patients, significantly enhanced its statistical power (AUC value increased from 78.6 to 87.4%, p = 0.0003). Such increase remained significant after correcting for multiple testing. In addition, two tag-SNPs (rs11790782 and rs2241270) in PTGES were linked to higher systolic and diastolic pressure [carriers vs. non-carriers = 5.23 (1.87-9.93), p = 0.03 and 5.9 (1.87-9.93), p = 0.004]. PTGS1(COX1) rs10306194 was associated with higher common carotid intima media thickness (ccIMT) progression [OR 1.90 (1.07-3.36), p = 0.029], presence of carotid plaque [OR 1.79 (1.06-3.01), p = 0.026] and atherosclerosis severity (p = 0.041). These associations, however, did not survive Bonferroni correction of the data. Our findings highlight the importance of the route leading to PGE2 synthesis in the CV risk experienced by nephrosclerosis patients and add to the growing body of evidence pointing out the PGE2 synthesis/activity axis as a promising therapeutic target in this field.
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Affiliation(s)
- Luz M González
- Department of Medical and Surgical Therapeutics, Medical School, University of Extremadura, Av. Elvas S/N 06071, Badajoz, Spain
| | - Nicolás R Robles
- Service of Nephrology, Badajoz University Hospital, Badajoz, Spain
- ISCIII RICORS2040, Madrid, Spain
| | - Sonia Mota-Zamorano
- Department of Medical and Surgical Therapeutics, Medical School, University of Extremadura, Av. Elvas S/N 06071, Badajoz, Spain
- ISCIII RICORS2040, Madrid, Spain
| | - José M Valdivielso
- ISCIII RICORS2040, Madrid, Spain
- Vascular and Renal Translational Research Group, UDETMA, IRBLleida, Lleida, Spain
| | - Laura González-Rodríguez
- Department of Medical and Surgical Therapeutics, Medical School, University of Extremadura, Av. Elvas S/N 06071, Badajoz, Spain
- ISCIII RICORS2040, Madrid, Spain
| | - Juan López-Gómez
- Service of Clinical Analyses, Badajoz University Hospital, Badajoz, Spain
| | - Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Medical School, University of Extremadura, Av. Elvas S/N 06071, Badajoz, Spain.
- ISCIII RICORS2040, Madrid, Spain.
- Institute of Molecular Pathology Biomarkers, University of Extremadura, Badajoz, Spain.
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8
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Shaik A, Kosiborod M, de Lemos JA, Gao Q, Mues KE, Alam S, Bhatt DL, Cannon CP, Ballantyne CM, Rosenson RS. Use of lipid-lowering therapies in patients with chronic kidney disease and atherosclerotic cardiovascular disease: 2-year results from Getting to an imprOved Understanding of Low-Density lipoprotein cholesterol and dyslipidemia management (GOULD). Clin Cardiol 2022; 45:1303-1310. [PMID: 36124341 DOI: 10.1002/clc.23923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/19/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a known risk factor of atherosclerotic cardiovascular disease (ASCVD). Per the 2018 American Heart Association/American College of Cardiology cholesterol guidelines, high-risk ASCVD patients with CKD and low-density lipoprotein cholesterol (LDL-C) levels ≥ $\ge $ 70 mg/dL should take a high-intensity statin with ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). OBJECTIVE/METHODS We examined the changes in use of lipid lowering therapies (LLT) over two years in 3304 patients with ASCVD and CKD in the Getting to an imprOved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) observational cohort study. RESULTS Of those with eGFR <60 ml/min/1.73 m2 , 21.6% (171/791) had intensification of LLT while 10.4% (82/791) had de-escalation of LLT. Notably, 61.6% (487/791) had no change in LLT regimen over 2 years. Statin use was 83.2% (785/944) at baseline and 80.1% (634/791) at 2 years. Statin/ezetimibe use increased from 2.9% (27/944) to 4.9% (39/791). Statin discontinuation at 2 years was greater with lower eGFR levels across all cohorts. CONCLUSION Despite the recommendations of multiscociety guidelines, statin use, while high, is not ubiquitous and rates of high-intensity statin and ezetimibe use remain low in patients with CKD. There remains a significant opportunity to optimize LLT and achieve atheroprotective cholesterol levels in the CKD population.
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Affiliation(s)
- Aleesha Shaik
- The Cardiometabolic Disorders Unit, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Qi Gao
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Cannon
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA.,Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | - Robert S Rosenson
- The Cardiometabolic Disorders Unit, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Mota-Zamorano S, González LM, Robles NR, Valdivielso JM, Arévalo-Lorido JC, López-Gómez J, Gervasini G. Polymorphisms in glucose homeostasis genes are associated with cardiovascular and renal parameters in patients with diabetic nephropathy. Ann Med 2022; 54:3039-3051. [PMID: 36314849 PMCID: PMC9635471 DOI: 10.1080/07853890.2022.2138531] [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] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) has become the major cause of end-stage kidney disease and is associated to an extremely high cardiovascular (CV) risk. METHODS We screened 318 DN patients for 23 SNPs in four glucose transporters (SLC2A1, SLC2A2, SLC5A1 and SLC5A2) and in KCNJ11 and ABCC8, which participate in insulin secretion. Regression models were utilised to identify associations with renal parameters, atherosclerosis measurements and CV events. In addition, 506 individuals with normal renal function were also genotyped as a control group. RESULTS In the patient's cohort, common carotid intima media thickness values were higher in carriers of ABCC8 rs3758953 and rs2188966 vs. non-carriers [0.78(0.25) vs. 0.72(0.22) mm, p < 0.05 and 0.79(0.26) vs. 0.72(0.22) mm, p < 0.05], respectively. Furthermore, ABCC8 rs1799859 was linked to presence of plaque in these patients [1.89(1.03-3.46), p < 0.05]. Two variants, SLC2A2 rs8192675 and SLC5A2 rs9924771, were associated with better [OR = 0.49 (0.30-0.81), p < 0.01] and worse [OR = 1.92 (1.15-3.21), p < 0.05] CV event-free survival, respectively. With regard to renal variables, rs841848 and rs710218 in SLC2A1, as well as rs3813008 in SLC5A2, significantly altered estimated glomerular filtration rate values [carriers vs. non-carriers: 30.41(22.57) vs. 28.25(20.10), p < 0.05; 28.95(21.11) vs. 29.52(21.66), p < 0.05 and 32.03(18.06) vs. 28.14(23.06) ml/min/1.73 m2, p < 0.05]. In addition, ABCC8 rs3758947 was associated with higher albumin-to-creatinine ratios [193.5(1139.91) vs. 160(652.90) mg/g, p < 0.05]. The epistasis analysis of SNP-pairs interactions showed that ABCC8 rs3758947 interacted with several SNPs in SLC2A2 to significantly affect CV events (p < 0.01). No SNPs were associated with DN risk. CONCLUSIONS Polymorphisms in genes determining glucose homeostasis may play a relevant role in renal parameters and CV-related outcomes of DN patients.
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Affiliation(s)
- Sonia Mota-Zamorano
- Department of Medical and Surgical Therapeutics, Medical School, Universidad de Extremadura, Badajoz, Spain.,RICORS2040 Renal Research Network, Madrid, Spain
| | - Luz M González
- Department of Medical and Surgical Therapeutics, Medical School, Universidad de Extremadura, Badajoz, Spain
| | - Nicolás R Robles
- RICORS2040 Renal Research Network, Madrid, Spain.,Service of Nephrology, Badajoz University Hospital, Badajoz, Spain
| | - José M Valdivielso
- RICORS2040 Renal Research Network, Madrid, Spain.,Vascular and Renal Translational Research Group, UDETMA, IRBLleida, Lleida, Spain
| | | | - Juan López-Gómez
- Service of Clinical Analyses, Badajoz University Hospital, Badajoz, Spain
| | - Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Medical School, Universidad de Extremadura, Badajoz, Spain.,RICORS2040 Renal Research Network, Madrid, Spain.,Institute of Biomarkers of Molecular and Metabolic Pathologies, Universidad de Extremadura, Badajoz, Spain
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10
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Serum Phosphate Levels Modify the Impact of FGF23 Levels on Hemoglobin in Chronic Kidney Disease. Nutrients 2022; 14:nu14224842. [PMID: 36432528 PMCID: PMC9698012 DOI: 10.3390/nu14224842] [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: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
Anemia is a complication of chronic kidney disease (CKD). Phosphate and fibroblast growth factor-23 (FGF23) have a close relationship, as both are related to the pathogenesis of anemia. However, the possible interplay between them regarding their effect on anemia has not been evaluated. This was a cross-sectional study of 896 participants from the NEFRONA study (273 CKD3, 246 CKD4-5, 282 dialysis and 95 controls). The levels of 25(OH) and 1,25(OH)2 vitamin D, intact FGF23 (iFGF23) and soluble Klotho were measured, together with standard blood biochemistries. Anemia was defined as hemoglobin levels < 13 g/dL in men and <12 g/dL in women. Patients with anemia (407, 45.4%) were younger, mostly men and diabetic; were in advanced CKD stages; had lower calcium, 1,25(OH)2 vitamin D and albumin levels; and had higher ferritin, phosphate, intact PTH, and iFGF23. An inverse correlation was observed between hemoglobin and both iFGF23 and phosphate. The multivariate logistic regression analyses showed that the adjusted risk of anemia was independently associated with higher serum phosphate and LogiFGF23 levels (ORs (95% CIs) of 4.33 (2.11−8.90) and 8.75 (3.17−24.2), respectively (p < 0.001)). A significant interaction between phosphate and iFGF23 (OR of 0.66 (0.53−0.83), p < 0.001) showed that the rise in the adjusted predicted risk of anemia with the increase in iFGF23 was steeper when phosphate levels were low. Phosphate levels acted as modifiers of the effect of iFGF23 concentration on anemia. Thus, the effect of the increase in iFGF23 levels was stronger when phosphate levels were low.
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11
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Lidgard B, Zelnickv L, Anderson AH, Feldman H, Go A, He J, Kansal M, Mohanty MJ, Mehta R, Shlipak MG, Soliman E, Weir MR, Bansal N. Cardiac Biomarkers and Risk of Atherosclerotic Cardiovascular Disease in Patients with CKD. KIDNEY360 2022; 3:859-871. [PMID: 36128494 PMCID: PMC9438429 DOI: 10.34067/kid.0006222021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/01/2022] [Indexed: 01/12/2023]
Abstract
Background Several cardiac biomarkers of cardiac stress, inflammation, and fibrosis (N-terminal pro brain-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T [hsTnT], growth differentiation factor 15 [GDF-15], and soluble ST2 [sST2]) have been associated with atherosclerotic disease in the general population. We hypothesized that these cardiac biomarkers may also be associated with the atherosclerotic cardiovascular disease in patients with CKD. Methods We analyzed levels of NT-proBNP, hsTnT, GDF-15, and sST2 in a cohort of 2732 participants with mild to moderate CKD from the Chronic Renal Insufficiency Cohort (CRIC) study. Outcomes included incident atherosclerotic disease, defined as the first instance of myocardial infarction, stroke, or peripheral vascular disease. We used Cox proportional hazard models to the test the association of each cardiac biomarker with risk of incident atherosclerotic disease, adjusting for multiple possible confounders. Results When modeled continuously (per SD increase in the log-transformed biomarker), NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic disease after adjustment for multiple potential confounders: (NT-proBNP HR, 1.51; 95% CI, 1.27 to 1.81; hsTnT HR, 1.61; 95% CI, 1.38 to 1.89; GDF-15 HR, 1.44; 95% CI, 1.19 to 1.73; and sST2 HR, 1.19; 95% CI, 1.04 to 1.36). Conclusions NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic cardiovascular disease in patients with CKD. These associations may highlight important mechanisms for the development of atherosclerotic disease in CKD.
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Affiliation(s)
- Benjamin Lidgard
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Leila Zelnickv
- Division of Nephrology, University of Washington, Seattle, Washington
| | | | - Harold Feldman
- CRIC Scientific and Data Coordinating Center, University of PennsylvaniaPhiladelphia, Pennsylvania
| | - Alan Go
- Kaiser Permanente Division of Research, Northern California, Oakland, California
| | - Jiang He
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | - Mayank Kansal
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Michael G. Shlipak
- Division of Nephrology, University of California, San Francisco, San Francisco, California
| | - Elsayed Soliman
- Department of Medicine, Wake Health, Winston-Salem, North Carolina
| | - Matt R. Weir
- Division of Nephrology, University of Maryland, College Park, Maryland
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle, Washington
| | - the CRIC Study Investigators*
- Division of Nephrology, University of Washington, Seattle, Washington
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
- CRIC Scientific and Data Coordinating Center, University of PennsylvaniaPhiladelphia, Pennsylvania
- Kaiser Permanente Division of Research, Northern California, Oakland, California
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Division of Nephrology, Wayne State University, Detroit, Michigan
- Division of Nephrology, Northwestern University, Chicago, Illinois
- Division of Nephrology, University of California, San Francisco, San Francisco, California
- Department of Medicine, Wake Health, Winston-Salem, North Carolina
- Division of Nephrology, University of Maryland, College Park, Maryland
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12
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González LM, Robles NR, Mota-Zamorano S, Arévalo-Lorido JC, Valdivielso JM, López-Gómez J, Gervasini G. Tag-SNPs in Phospholipase-Related Genes Modify the Susceptibility to Nephrosclerosis and its Associated Cardiovascular Risk. Front Pharmacol 2022; 13:817020. [PMID: 35586043 PMCID: PMC9108153 DOI: 10.3389/fphar.2022.817020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Nephrosclerosis patients have a high cardiovascular (CV) risk that is very often of more concern than the renal disease itself. We aimed to determine whether variants in phospholipase-related genes, associated with atherosclerosis and CV outcomes in the general population, could constitute biomarkers of nephrosclerosis and/or its associated CV risk. We screened 1,209 nephrosclerosis patients and controls for 86 tag-SNPs that were identified in the SCARB1, PLA2G4A, and PLA2G7 gene loci. Regression models were utilized to evaluate their effect on several clinical parameters. Most notably, rs10846744 and rs838880 in SCARB1 showed significant odds ratios (OR) of 0.66 (0.51–0.87), p = 0.003 and 1.48 (1.11–1.96), p = 0.007 for nephrosclerosis risk. PLA2G4A and PLA2G7 harboured several SNPs associated with atherosclerosis measurements in the patients, namely common carotid intima media thickness (ccIMT), presence of plaques, number of plaques detected and 2-years ccIMT progression (significant p-values ranging from 0.0004 to 0.047). Eight SNPs in PLA2G4A were independent risk factors for CV events in nephrosclerosis patients. Their addition to a ROC model containing classic risk factors significantly improved its predictive power from AUC = 69.1% (61.4–76.9) to AUC = 79.1% (73.1–85.1%), p = 0.047. Finally, PLA2G4A rs932476AA and rs6683619AA genotypes were associated with lower CV event-free survival after controlling for confounding variables [49.59 (47.97–51.21) vs. 51.81 (49.93–51.78) months, p = 0.041 and 46.46 (41.00–51.92) vs. 51.17 (50.25–52.08) months, p = 0.022, respectively]. Variability in phospholipase-related genes play a relevant role in nephrosclerosis and associated atherosclerosis measurements and CV events.
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Affiliation(s)
- Luz M. González
- Department of Medical and Surgical Therapeutics, Medical School, Institute of Molecular Pathology Biomarkers, University of Extremadura, Badajoz, Spain
| | - Nicolás R. Robles
- Service of Nephrology, Badajoz University Hospital, Badajoz, Spain
- RICORS2040 Renal Research Network, Madrid, Spain
| | - Sonia Mota-Zamorano
- Department of Medical and Surgical Therapeutics, Medical School, Institute of Molecular Pathology Biomarkers, University of Extremadura, Badajoz, Spain
- RICORS2040 Renal Research Network, Madrid, Spain
| | | | - José Manuel Valdivielso
- RICORS2040 Renal Research Network, Madrid, Spain
- Vascular and Renal Translational Research Group, UDETMA, IRBLleida, Lleida, Spain
| | - Juan López-Gómez
- Service of Clinical Analyses, Badajoz University Hospital, Badajoz, Spain
| | - Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Medical School, Institute of Molecular Pathology Biomarkers, University of Extremadura, Badajoz, Spain
- RICORS2040 Renal Research Network, Madrid, Spain
- *Correspondence: Guillermo Gervasini,
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13
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Galarza Tapia A, Velescu A, Collado Nieto S, Cao Baduell H, Ruiz-Carmona C, Mateos Torres E, Redondo Pachon MD, Clara Velasco A. Kidney transplantation reduces the risk of chronic limb threatening ischemia and amputation among patients with end-stage renal disease on hemodialysis. Vascular 2022:17085381221078176. [PMID: 35451345 DOI: 10.1177/17085381221078176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to analyze the risk of chronic limb threatening ischemia (CLTI) or amputation among patients with end-stage renal disease (ESRD) entering a hemodialysis (HD) program and to evaluate the protective effect associated with kidney transplantation (KT). DESIGN, MATERIAL AND METHODS Retrospective cohort of all consecutive ESRD patients entering into a HD program at our institution between 2000 and 2010. Collected variables included baseline characteristics (pre-entry in hemodialysis), time on HD program, KT and the composite outcome of chronic limb threatening ischemia or need for any amputation (CLTI/AMP). Patients with previous symptomatic peripheral arterial disease or amputation were excluded. RESULTS The study group included 336 patients (mean age 63 years, 66% male). The mean follow up was 6.7 years with an average time on HD of 4.2 years. Ninety two patients (27.4 %) underwent transplantation. CLTI free survival rates were 90.3 % and 82.6 % at 5 and 10 years, respectively. The episodes of CLT involved 28 revascularization procedures (17 endovascular and 11 open surgeries), 18 minor amputations and 20 major amputations. KT was associated with a protective effect over the development of CLTI (HR: 0.065; CI 95% 0.02-0.21) after adjustment for confounding factors. The long-term survival of non-transplanted patients was 45 % and 15 % at 5 and 10 years, respectively and the long-term survival in transplanted patients was 89% and 80% at 5 and 10 years, respectively; but decreased to 47 % at 1 year and 18.2 % at 5 years once CLTI occurred. CONCLUSION Patients on HD program show a notorious risk of chronic limb threatening ischemia or amputation over time. Once this complication occurs, patient's survival is markedly reduced. Transplantation confers an independent protective effect over the development of chronic limb threatening ischemia or amputation.
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Affiliation(s)
- Andres Galarza Tapia
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain
| | - Alina Velescu
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.,CIBER Enfermedades Cardiovasculares, Barcelona, Spain
| | | | | | - Carlos Ruiz-Carmona
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain
| | | | | | - Albert Clara Velasco
- Angiology and Vascular Surgery Department, 16546Hospital del Mar, Barcelona, Spain.,Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain.,CIBER Enfermedades Cardiovasculares, Barcelona, Spain.,Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
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14
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Quiroga B, Ramos PM, Horrillo AS, Ortiz A, Valdivieso JM, Carrero JJ. Triglycerides-glucose index and the risk of cardiovascular events in persons with non-diabetic chronic kidney disease. Clin Kidney J 2022; 15:1705-1712. [PMID: 36003671 PMCID: PMC9394724 DOI: 10.1093/ckj/sfac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/12/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with high rates of cardiovascular events. We
here explored whether the recently described triglycerides–glucose index (TyG) predicted
the incidence of major adverse cardiovascular events (MACE) in these patients. Methods This observationa study was undertaken of 1142 persons with CKD and free from diabetes
and 460 controls from the prospective NEFRONA study. The study exposure was the TyG
index at cohort inclusion. The study outcome was MACE (cardiovascular death, nonfatal
myocardial infarction, nonfatal stroke and hospitalization for unstable angina).
Covariates included demographics, comorbidities, lipid profile, renal function and
glycaemic control. Cox regression models evaluated the association between TyG index and
4-point MACE in patients with CKD. Results TyG was higher [median 8.63 (interquartile range 8.32–8.95)] in patients with CKD
compared with controls (P < 0.001). TyG increased across albuminuria categories but
was similar for glomerular filtration rate categories among patients with CKD stages
3–5. During 46 ± 13 months of follow-up, 49 (4.3%) MACE were registered. TyG predicted
the occurrence of MACE {hazard ratio (HR) 1.95 [95% confidence interval (CI) 1.11–3.40]
per TyG unit increase; and HR 2.29 (95% CI 1.24–4.20] for TyG values above the median of
8.63 units}. Sensitivity analysis for subgroups of participants according to age, kidney
function, body mass index and imaging evidence of atherosclerosis yielded similar
results, as did adjusted analysis. Neither triglycerides nor glucose alone was
associated with MACE. Conclusions The TyG index is associated with the occurrence of major cardiovascular events in
persons free from diabetes with non-dialysis dependent CKD.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - José Manuel Valdivieso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Juan Jesús Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Kumar V, Yadav AK, Sethi J, Ghosh A, Sahay M, Prasad N, Varughese S, Parameswaran S, Gopalakrishnan N, Kaur P, Modi GK, Kamboj K, Kundu M, Sood V, Inamdar N, Jaryal A, Vikrant S, Nayak S, Singh S, Gang S, Baid-Agrawal S, Jha V. The Indian Chronic Kidney Disease (ICKD) study: baseline characteristics. Clin Kidney J 2022; 15:60-69. [PMID: 35035937 PMCID: PMC8757418 DOI: 10.1093/ckj/sfab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on epidemiology and progression of CKD in low–middle income countries. The Indian Chronic Kidney Disease (ICKD) study aims to identify factors that associate with CKD progression, and development of kidney failure and cardiovascular disease (CVD) in Indian patients with CKD. Methods ICKD study is prospective, multicentric cohort study enrolling patients with estimated glomerular filtration rate (eGFR) 15–60 mL/min/1.73 m2, or >60 mL/min/1.73 m2 with proteinuria. Clinical details and biological samples are collected at annual visits. We analysed the baseline characteristics including socio-demographic details, risk factors, disease characteristics and laboratory measurements. In addition, we compared characteristics between urban and rural participants. Results A total of 4056 patients have been enrolled up to 31 March 2020. The mean ± SD age was 50.3 ± 11.8 years, 67.2% were males, two-thirds of patients lived in rural areas and the median eGFR was 40 mL/min/1.73 m2. About 87% were hypertensive, 37% had diabetes, 22% had CVD, 6.7% had past history of acute kidney injury and 23% reported prior use of alternative drugs. Diabetic kidney disease, chronic interstitial nephritis (CIN) and CKD-cause unknown (CKDu) were the leading causes. Rural participants had more occupational exposure and tobacco use but lower educational status and income. CIN and unknown categories were leading causes in rural participants. Conclusions The ICKD study is the only large cohort study of patients with mild-to-moderate CKD in a lower middle income country. Baseline characteristics of study population reveal differences as compared with other cohorts from high-income countries.
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Affiliation(s)
- Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmine Sethi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpita Ghosh
- George Institute for Global Health India, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Osmania General Hospital, Hyderabad, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
| | | | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | | | - Prabhjot Kaur
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gopesh K Modi
- Samarpan Kidney Institute and Research Center, Bhopal, India
| | - Kajal Kamboj
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Monica Kundu
- George Institute for Global Health India, New Delhi, India
| | - Vivek Sood
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeraj Inamdar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Jaryal
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Saurabh Nayak
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivendra Singh
- Department of Nephrology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
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16
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Bermudez-Lopez M, Perpiñan H, Amigo N, Castro E, Alonso N, Mauricio D, Fernandez E, Valdivielso JM. Advanced lipoprotein parameters could better explain atheromatosis in non-diabetic chronic kidney disease patients. Clin Kidney J 2021; 14:2591-2599. [PMID: 34950470 PMCID: PMC8690051 DOI: 10.1093/ckj/sfab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Chronic kidney disease (CKD) patients have a high burden of atheromatous cardiovascular disease (ASCVD) not fully explained by traditional lipid parameters. Lipoprotein composition and subclass particle number information could improve ASCVD risk assessment. The objective of this study is to investigate the association of advanced lipoprotein parameters with the risk of atheromatosis in a subpopulation of the NEFRONA study. Methods This was a cross-sectional study in 395 non-diabetic individuals (209 CKD and 186 non-diabetic and non-CKD) without statin therapy. Vascular ultrasound examination assessing 10 territories was combined with advanced lipoprotein testing performed by nuclear magnetic resonance spectroscopy. Logistic regression was used to estimate adjusted odds ratios (ORs) per 1 standard deviation increment. Results Atheromatosis was more prevalent in CKD patients (33.9% versus 64.6%). After adjusting for age, gender, smoking habit and CKD stage, the amount of triglycerides (TGs) within low-density lipoprotein (LDL) lipoproteins was independently and positively associated with atheromatosis [OR 1.33; 95% confidence interval (CI) 1.03–1.74; P = 0.03]. Similarly, total and medium LDL particles (LDL-Ps) showed a positive association (OR 1.29; 95% CI 1.00–1.68; P = 0.05 and OR 1.34; 95% CI 1.04–1.75; P = 0.03, respectively). TG-loaded medium LDL-Ps were higher in CKD patients compared with controls and showed an adjusted OR of 1.40 (95% CI 1.09–1.82; P = 0.01) in non-diabetic patients (CKD and non-CKD individuals). In contrast, non-diabetic CKD patients showed a similar coefficient but the significance was lost (OR 1.2; 95% CI 0.8–1.7; P = 0.359). Conclusions Non-diabetic CKD patients showed a higher amount of TG-loaded medium LDL-Ps compared with controls. These particles were independently associated with atheromatosis in non-diabetic patients.
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Affiliation(s)
- Marcelino Bermudez-Lopez
- Vascular and Renal Translational Research Group, Spanish Research Network for Renal Diseases (REDINREN del ISCIII), IRBLleida, Lleida, Spain
| | - Hector Perpiñan
- Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia, Spain
| | | | - Eva Castro
- Vascular and Renal Translational Research Group, Spanish Research Network for Renal Diseases (REDINREN del ISCIII), IRBLleida, Lleida, Spain
| | - Nuria Alonso
- Endocrinology and Nutrition Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Elvira Fernandez
- Vascular and Renal Translational Research Group, Spanish Research Network for Renal Diseases (REDINREN del ISCIII), IRBLleida, Lleida, Spain
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, Spanish Research Network for Renal Diseases (REDINREN del ISCIII), IRBLleida, Lleida, Spain
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17
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Bermúdez-López M, Martínez-Alonso M, Castro-Boqué E, Betriu À, Cambray S, Farràs C, Barbé F, Pamplona R, Lecube A, Mauricio D, Purroy F, Valdivielso JM, Fernández E. Localización y carga de ateromatosis subclínica en población con un riesgo cardiovascular bajo-moderado: estudio ILERVAS. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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18
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Bjergfelt SS, Sørensen IMH, Hjortkjær HØ, Landler N, Ballegaard ELF, Biering-Sørensen T, Kofoed KF, Lange T, Feldt-Rasmussen B, Sillesen H, Christoffersen C, Bro S. Carotid plaque thickness is increased in chronic kidney disease and associated with carotid and coronary calcification. PLoS One 2021; 16:e0260417. [PMID: 34813630 PMCID: PMC8610240 DOI: 10.1371/journal.pone.0260417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease accelerates both atherosclerosis and arterial calcification. The aim of the present study was to explore whether maximal carotid plaque thickness (cPTmax) was increased in patients with chronic kidney disease compared to controls and associated with cardiovascular disease and severity of calcification in the carotid and coronary arteries. METHODS The study group consisted of 200 patients with chronic kidney disease stage 3 from the Copenhagen Chronic Kidney Disease Cohort and 121 age- and sex-matched controls. cPTmax was assessed by ultrasound and arterial calcification by computed tomography scanning. RESULTS Carotid plaques were present in 58% of patients (n = 115) compared with 40% of controls (n = 48), p = 0.002. Among participants with plaques, cPTmax (median, interquartile range) was significantly higher in patients compared with controls (1.9 (1.4-2.3) versus 1.5 (1.2-1.8) mm), p = 0.001. Cardiovascular disease was present in 9% of patients without plaques (n = 85), 23% of patients with cPTmax 1.0-1.9 mm (n = 69) and 35% of patients with cPTmax >1.9 mm (n = 46), p = 0.001. Carotid and coronary calcium scores >400 were present in 0% and 4%, respectively, of patients with no carotid plaques, in 19% and 24% of patients with cPTmax 1.0-1.9 mm, and in 48% and 53% of patients with cPTmax >1.9 mm, p<0.001. CONCLUSIONS This is the first study showing that cPTmax is increased in patients with chronic kidney disease stage 3 compared to controls and closely associated with prevalent cardiovascular disease and severity of calcification in both the carotid and coronary arteries.
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Affiliation(s)
- Sasha S. Bjergfelt
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ida M. H. Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Ø. Hjortkjær
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nino Landler
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F. Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health (Biostatistics), University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Bro
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Saeseow S, Vantanasiri K, Suvikapakornkul R, Sukarayothin T, Apirakkittikul N, Disthabanchong S. Parathyroidectomy is associated with slow progression of vascular calcification in maintenance haemodialysis patients: A propensity score-matched case-control study. Nephrology (Carlton) 2021; 27:355-362. [PMID: 34651396 DOI: 10.1111/nep.13986] [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: 07/11/2021] [Revised: 08/18/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Parathyroidectomy has been the mainstay of treatment of severe hyperparathyroidism in patients with kidney failure until the introduction of calcimimetic. Several large observational studies demonstrated the improvement in patient outcomes after parathyroidectomy. The benefit of parathyroidectomy on vascular calcification remains largely unexplored. AIM To examine the association between parathyroidectomy and the progression of vascular calcification as well as overall survival in maintenance haemodialysis patients. METHOD This is a matched case-control study undertaken between 2012 and 2020. Patients who underwent parathyroidectomy were identified and matched 1:1 to non-parathyroidectomized (non-PTX) haemodialysis patients using propensity score matching method resulting in 120 patients in each arm. Aortic arch calcification (AoAC) score was determined annually in the posteroanterior chest x-ray. The average follow-up period was 38 months. RESULTS Baseline demographic, laboratory data and AoAC score were comparable among the two groups of patients. The prevalence of AoAC was 59% in the PTX group and 54% in the non-PTX group (p = .43). Progression of AoAC occurred in 33% in the PTX group and 47% in the non-PTX group (p = .04). Multivariate generalized linear model revealed parathyroidectomy as an independent protective factor [β (95% CI) -1.04 (-1.68, -0.41)] and increased serum calcium as a potentiating factor [β (95% CI) 0.62 (0.25, 0.1)] for progression of AoAC. Linear mixed models revealed an increase in AoAC score in both groups but between group comparisons indicated substantially slower progression in the PTX group. Rapid progression of AoAC was also observed more frequently among non-PTX patients. Death occurred in 7 and 16% in the PTX and non-PTX groups, respectively. Kaplan-Meier survival curve revealed better survival associated with parathyroidectomy (p = .01). More rapid progression of AoAC also correlated with worse survival. CONCLUSION Parathyroidectomy was associated with slow progression of vascular calcification in maintenance haemodialysis patients.
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Affiliation(s)
- Sarunya Saeseow
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Ronnarat Suvikapakornkul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thongchai Sukarayothin
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Navarat Apirakkittikul
- Department of Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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20
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San Norberto EM, Revilla Á, Fernández-Urbón A, Gómez-Giralda B, Taylor JH, Vaquero C. Vascular calcification progression in patients with end-stage chronic kidney disease. INT ANGIOL 2021; 40:528-536. [PMID: 34515450 DOI: 10.23736/s0392-9590.21.04698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intima media thickness (IMT), vascular calcifications and ankle-brachial pressure index (ABPI) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. METHODS Between January 2018 and March 2019, a physician-initiated, nonrandomized, prospective study was conducted. Carotid IMT, vascular calcifications analysis values and measurements of the ABPI, were made at baseline and after 1-year of follow-up. RESULTS A total of 284 patients, 152 patients with dialysis (100 hemodialysis (HD) and 52 CAPD (continuous ambulatory peritoneal dialysis)) and 132 patients with stage 4 chronic kidney disease (control group), were included (55% male, 67 [29-88] years). The values of carotid IMT at baseline were higher in the HD group than in the CAPD group (1.10±0.08 mm vs. 0.08±0.04 mm, P=0.004). Adragao and Kauppila scores were higher in the HD group than in the CAPD group (2.56±2.10 vs. 1.08±2.02, P=0.009; and 7.40±6.86 vs. 4.44±5.26, P<0.001; respectively). These differences remained after 1-year of follow-up. Pathological ABPI after 1-year follow-up was more prevalent in the HD group than in the CAPD or control groups (32.0% vs. 19.4% vs. 7.7%, respectively, P=0.042). Multivariate regression analysis revealed that age, gender, dialysis type and LDLc were independent predictors for carotid IMT increase; age, dialysis type and smoking for vascular calcifications increase on Adragao Score; and dialysis type on Kauppila Score. Only the dialysis type was the independent predictor for all vascular calcifications markers. CONCLUSIONS Dialysis, particularly HD, is an independent risk factor for cardiovascular calcification increase in ESRD patients.
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Affiliation(s)
| | - Álvaro Revilla
- Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - Ana Fernández-Urbón
- Department of Anesthesiology, Valladolid University Hospital, Valladolid, Spain
| | | | - James H Taylor
- Department of Cardiac Surgery, Valencia General University Hospital, Valencia, Spain
| | - Carlos Vaquero
- Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
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Genetics Variants in the Epoxygenase Pathway of Arachidonic Metabolism Are Associated with Eicosanoids Levels and the Risk of Diabetic Nephropathy. J Clin Med 2021; 10:jcm10173980. [PMID: 34501433 PMCID: PMC8432556 DOI: 10.3390/jcm10173980] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 02/08/2023] Open
Abstract
Genes in the epoxygenase pathway of arachidonic acid metabolism leading to vasoactive eicosanoids, mainly 20-hydroxyeicosatetraenoic (20-HETE) and epoxyeicosatrienoic (EETs) acids, have been related to glucose-induced renal damage in preclinical reports. We genotyped 1088 diabetic kidney disease (DKD) patients and controls for seven polymorphisms in five genes (CYP2C8, CYP2J2, CYP4F2, CYP4A11, and EPHX2) along this metabolic route and evaluated their effect on DKD risk, clinical outcomes, and the plasma/urine levels of eicosanoids measured by LC/MS/MS and immunoenzymatic assays. The CYP4F2 433M variant allele was associated with lower incidence of DKD (OR = 0.65 (0.48-0.90), p = 0.008), whilst the CYP2C8*3/*3 genotype was related to increased risk (OR = 3.21 (1.05-9.87), p = 0.036). Patients carrying the 433M allele also showed lower eGFR [median and interquartile range vs. wildtype carriers: 30.8 (19.8) and 33.0 (23.2) mL/min/1.73 m2, p = 0.037). Finally, the 433VM/MM variant genotypes were associated with lower urinary levels of 20-HETE compared with 433VV (3.14 (0.86) vs. 8.45 (3.69) ng/mg Creatinine, p = 0.024). Our results indicate that the CYP4F2 V433M polymorphism, by decreasing 20-HETE levels, may play an important role in DKD.
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González LM, Robles NR, Mota-Zamorano S, Valdivielso JM, López-Gómez J, Gervasini G. Genetic Variants in PGE2 Receptors Modulate the Risk of Nephrosclerosis and Clinical Outcomes in These Patients. J Pers Med 2021; 11:jpm11080772. [PMID: 34442416 PMCID: PMC8400263 DOI: 10.3390/jpm11080772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/16/2022] Open
Abstract
Prostaglandin E2 (PGE2) is a major actor mediating renal injury. We aimed to determine genetic variability in the genes coding for its receptors (PTGER1-4) and study associations with nephrosclerosis risk and clinical outcomes. We identified 96 tag-SNPs capturing global variability in PTGER1-4 and screened 1209 nephrosclerosis patients and controls. The effect of these variants was evaluated by multivariate regression analyses. Two PTGER3 SNPs, rs11209730 and rs10399704, remained significant in a backward elimination regression model with other non-genetic variables (OR = 1.45 (1.07-1.95), p = 0.016 and OR = 0.71 (0.51-0.99), p = 0.041, respectively). In the nephrosclerosis patients, a proximal region of PTGER3 was tagged as relevant for eGFR (p values for identified SNPs ranged from 0.0003 to 0.038). Two consecutive PTGER3 SNPs, rs2284362 and rs2284363, significantly decreased systolic (p = 0.005 and p = 0.0005), diastolic (p = 0.039 and p = 0.005), and pulse pressure values (p = 0.038 and 0.014). Patients were followed for a median of 47 months (7-54) to evaluate cardiovascular (CV) risk. Cox regression analysis showed that carriers of the PTGER1rs2241360 T variant had better CV event-free survival than wild-type individuals (p = 0.029). In addition, PTGER3rs7533733 GG carriers had lower event-free survival than AA/AG patients (p = 0.011). Our results indicate that genetic variability in PGE2 receptors, particularly EP3, may be clinically relevant for nephrosclerosis and its associated CV risk.
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Affiliation(s)
- Luz María González
- Department of Medical and Surgical Therapeutics, Division of Pharmacology, Medical School, University of Extremadura, 06006 Badajoz, Spain; (L.M.G.); (S.M.-Z.)
| | | | - Sonia Mota-Zamorano
- Department of Medical and Surgical Therapeutics, Division of Pharmacology, Medical School, University of Extremadura, 06006 Badajoz, Spain; (L.M.G.); (S.M.-Z.)
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, UDETMA, ISCIII REDinREN, IRBLleida, 25198 Lleida, Spain;
| | - Juan López-Gómez
- Service of Clinical Analyses, Badajoz University Hospital, 06080 Badajoz, Spain;
| | - Guillermo Gervasini
- Department of Medical and Surgical Therapeutics, Division of Pharmacology, Medical School, University of Extremadura, 06006 Badajoz, Spain; (L.M.G.); (S.M.-Z.)
- Correspondence: ; Tel.: +34-927-257-120
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Association between chronic kidney disease and new-onset dyslipidemia: The Japan Specific Health Checkups (J-SHC) study. Atherosclerosis 2021; 332:24-32. [PMID: 34375910 DOI: 10.1016/j.atherosclerosis.2021.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/02/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Dyslipidemias are common among patients with chronic kidney disease (CKD) and are a major risk factor for cardiovascular disease. This study aimed to investigate the association between early-stage CKD and new-onset dyslipidemia for each lipid profile. METHODS This nationwide longitudinal study included data from the Japan Specific Health Checkups (J-SHC) Study. New-onset dyslipidemia was indicated by hypertriglyceridemia (High-TG; ≥150 mg/dL), hyper-LDL cholesterolemia (High-LDL-C; ≥140 mg/dL), or hypo-HDL chelesterolemia (Low-HDL-C; <40 mg/dL) levels according to the guideline of Japan Atherosclerosis Society, or High-TG/HDL-C ratio (≥3.5) which was a good predictor of atherosclerosis. The incidence of new-onset dyslipidemia was compared between participants with and without CKD. Survival curves were used to analyze the incidence of each dyslipidemia. RESULTS Of 289,462 participants with a median follow-up period of 3 years, the incidence of High-TG, High-LDL-C, Low-HDL-C, and High-TG/HDL-C ratios were 64.4/1000 person-years, 83.1/1000 person-years, 14.5/1000 person-years, and 39.6/1000 person-years, respectively. The adjusted hazard ratios (95% confidence intervals) for High-TG, High-LDL-C, Low-HDL-C, and High-TG/HDL-C ratio were 1.09 (1.05-1.13), 0.99 (0.95-1.04), 1.12 (1.05-1.18), and 1.14 (1.09-1.18), respectively, in CKD participants as compared to non-CKD participants. Decreased eGFR and presence of proteinuria were independently associated with higher risks for new-onset of High-TG, Low-HDL-C, and High-TG/HDL-C ratios. CONCLUSIONS CKD was associated with a higher risk of new-onset High-TG, Low-HDL-C, and High-TG/HDL-C ratios, but not High-LDL-C, in the general population. These CKD-specific lipid abnormalities may explain the residual risk for CKD-related cardiovascular disease.
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Xiong J, Yu Z, Zhang D, Huang Y, Yang K, Zhao J. A Nomogram for Identifying Subclinical Atherosclerosis in Chronic Kidney Disease. Clin Interv Aging 2021; 16:1303-1313. [PMID: 34267510 PMCID: PMC8275156 DOI: 10.2147/cia.s312129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Atherosclerosis contributes substantially to cardiovascular mortality in patients with chronic kidney disease (CKD). But precise risk model for subclinical atherosclerosis in the CKD population is still lacking. The study aimed to develop and validate a nomogram for screening subclinical atherosclerosis among CKD patients without dialysis. Patients and Methods A total of 1452 CKD stage 1‒5 has been recruited in this cross-sectional study. Subclinical atherosclerosis was diagnosed with carotid ultrasonography. Patients were divided into the training set and validation set. The risk factors of atherosclerosis were identified by the training set and confirmed by the validation set. The receiver operating characteristic (ROC) curves and decision curve analyses (DCA) were executed to evaluate the accuracy of fitted logistic models in training and validation sets. Finally, a nomogram based on constructed logistic regression model in all participants was plotted. Results A total of 669 (46.1%) patients were diagnosed with subclinical carotid atherosclerosis. Binary logistic regression analysis showed that males, age, hypertension, diabetes, CKD stages, calcium, platelet, and albumin were risk factors for atherosclerosis. The accuracy of fitted logistic models was evaluated by the area under the ROC curve (AUC), which showed good predictive accuracy in the training set (AUC=0.764 (95% Confidence interval (CI): 0.733–0.794) and validation set (AUC=0.808 (95% CI: 0.765–0.852). A high net benefit was also proven by the DCA. Finally, these predictors were all included to generate the nomogram. Conclusion This proposed nomogram shows excellent predictive ability and might have a significant clinical implication for detecting subclinical atherosclerosis in patients with CKD.
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Affiliation(s)
- Jiachuan Xiong
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Zhikai Yu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Daohai Zhang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Yinghui Huang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Ke Yang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Jinghong Zhao
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
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25
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Gorriz JL, Arroyo D, D'Marco L, Torra R, Tomás P, Puchades MJ, Panizo N, Pantoja J, Montomoli M, Llisterri JL, Pallares-Carratalá V, Valdivielso JM. Cardiovascular risk factors and the impact on prognosis in patients with chronic kidney disease secondary to autosomal dominant polycystic kidney disease. BMC Nephrol 2021; 22:110. [PMID: 33765945 PMCID: PMC7995703 DOI: 10.1186/s12882-021-02313-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent hereditary renal disease. There is an increased rate of cardiovascular disease (CVD) in ADPKD. In this study, we evaluate the prevalence of cardiovascular risk factors, the achievement rates for treatment goals and cardiovascular events (CVE) in ADPKD and their relations with asymptomatic CVD in CKD from other etiologies (CKDoe) and controls. METHODS We evaluated 2445 CKD patients (2010-2012). The information collected was: clinical, anthropometric and analytical parameters, treatments and CVD evaluation (intima-media thickness (IMT), atheromatous plaque presence and ankle-brachial index (ABI)). Laboratory, vital status, CVE and hospitalizations were collected for 4 years. RESULTS ADPKD patients had a worse renal function and worst achievement of blood pressure, higher parathormone levels but lower proteinuria compared to CKDoe. ADPKD patients presented lower IMT values than other groups, however, an intermediate rate of pathologic ABI and atheromatous plaque was present. More than half of the patients received statins, achieving LDL-c levels < 100 only in 50 and 39.8% of them (ADPKD and CKDoe respectively). The number of CVE during the follow-up period was low. In adjusted Cox regression model, ADPDK had the lowest occurrence of CVE of all three groups (HR:0.422, 95%CI 0.221-0.808, p = 0.009). CONCLUSION ADPKD patients show intermediate control rates of CVD. A better control of CVD risk seems to be related with a lower load of CVD compared to other groups, which may lead in the long term to a better prognosis. Further investigation is necessary to determine cardiovascular prognosis in ADPKD.
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Affiliation(s)
- José Luis Gorriz
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain.
| | - David Arroyo
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Luis D'Marco
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Medicine Department-Universitat Autónoma de Barcelona, REDinREN, nstituto de Investigación Carlos III, Barcelona, Spain
| | - Patricia Tomás
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - María Jesús Puchades
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - Nayara Panizo
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | - Jonay Pantoja
- Department of Nephrology, University Dr Peset Hospital, Valencia, Spain
| | - Marco Montomoli
- Department of Nephrology, University Clinic Hospital, INCLIVA, University of Valencia, Av Blasco Ibañez 17, 46010, Valencia, Spain
| | | | - Vicente Pallares-Carratalá
- Health Surveillance Unit, Castellon Mutual Insurance Union, Castellon, Spain. Department of Medicine, Jaume I University, Castellon, Spain.
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain, 2 Statistics Department, University of Lleida, Lleida, Spain
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Association of Glomerular Filtration Rate and Carotid Intima-Media Thickness in Non-Diabetic Chronic Kidney Disease Patients over a 4-Year Follow-Up. Life (Basel) 2021; 11:life11030204. [PMID: 33807694 PMCID: PMC7998356 DOI: 10.3390/life11030204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have increased risk of cardiovascular events. However, the association of glomerular filtration rate (GFR) and carotid intima-media thickness (CIMT) in non-diabetic CKD patients is under-investigated. This prospective study was conducted at University Clinical Hospital Mostar over a 4-year period and enrolled a total of 100 patients with stage 2 and 4 CKD (50 patients per group). Stage 4 CKD group had significantly higher baseline CIMT values (1.13 ± 0.25 vs. 0.74 ± 0.03 mm, P < 0.001), and more atherosclerotic plaques at the study onset (13 (26%) vs. 0 (0%), P < 0.001) compared to stage 2 CKD. A statistically significant 4-year increase in GFR (coefficient of 2.51, 3.25, 2.71 and 1.50 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.05) with non-significant CIMT alterations has been observed in stage 2 CKD. Furthermore, linear mixed effects analysis revealed significant decrease in GFR (coefficient of −6.69, −5.12, −3.18 and −1.77 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.001) with increase in CIMT (coefficient of 0.20, 0.14, 0.07 and 0.03 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.001) in stage 4 CKD. GFR and CIMT showed significant negative correlation in both CKD groups during all follow-up phases (P < 0.001). Furthermore, multiple linear regression analysis revealed significant independent prediction of CIMT by baseline GFR (B = −0.85, P < 0.001), while there was no significant prediction of CIMT with other covariates. In conclusion, this study demonstrates significant association of GFR and CIMT in non-diabetic stage 2 and stage 4 CKD during the 4-year follow-up.
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Schrauben SJ, Hsu JY, Amaral S, Anderson AH, Feldman HI, Dember LM. Effect of Kidney Function on Relationships between Lifestyle Behaviors and Mortality or Cardiovascular Outcomes: A Pooled Cohort Analysis. J Am Soc Nephrol 2021; 32:663-675. [PMID: 33547215 PMCID: PMC7920187 DOI: 10.1681/asn.2020040394] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Adherence to healthy behaviors reduces risks of cardiovascular disease and death in the general population. However, among people with kidney disease, a group at higher risk for cardiovascular disease, such benefits have not been established. METHODS We pooled data from three cohort studies with a total of 27,271 participants. Kidney function was categorized on the basis of eGFR (≥60, 45 to <60, and <45 ml/min per 1.73 m2). We used proportional hazard frailty models to estimate associations between healthy behaviors (not smoking, at recommended body mass index [BMI], physical activity, healthy diet, and moderate to no alcohol intake) and outcomes (all-cause death, major coronary events, ischemic stroke, and heart failure events). RESULTS All recommended lifestyle behaviors were significantly associated with lower risks of death, regardless of eGFR. Not smoking (versus current) and any moderate to vigorous physical activity (versus none) was significantly associated with reduced risks of major coronary and heart failure events, regardless of eGFR. Any (versus no) moderate or vigorous physical activity significantly associated with decreased risk of ischemic stroke events only among those with eGFR ≥60. Moderate to no daily alcohol intake (versus excessive) was significantly associated with an increased risk of major coronary events, regardless of eGFR. For heart failure events, a BMI of 18.5 to 30 associated with decreased risk, regardless of eGFR. Across all eGFR categories, the magnitude of risk reduction for death and all cardiovascular outcomes increased with greater numbers of recommended lifestyle behaviors. CONCLUSIONS Recommended lifestyle behaviors are associated with lower risk of death and cardiovascular disease events among individuals with or without reduced kidney function, supporting lifestyle behaviors as potentially modifiable risk factors for people with kidney disease.
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Affiliation(s)
- Sarah J. Schrauben
- Renal, Electrolyte-Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Y. Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandra Amaral
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda H. Anderson
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Harold I. Feldman
- Renal, Electrolyte-Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura M. Dember
- Renal, Electrolyte-Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Cambray S, Bermudez-Lopez M, Bozic M, Valdivielso JM. Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease. Clin Kidney J 2021; 13:1017-1024. [PMID: 33391745 PMCID: PMC7769551 DOI: 10.1093/ckj/sfaa014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with non-cardiovascular death in CKD populations are lacking. Methods The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n = 2185 CKD patients). Results After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG + rs2283368 CC/CT + rs2320762 GG). Among the patients with the three SNPs genotyped (n = 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA + rs2283368 TT + rs2320762 GT/TT). All the other combinations [n = 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher {hazard ratio [HR] 3.28 [confidence interval (CI) 1.51–7.12]} and lower [HR 6 × 10−6 (95% CI 3.3 × 10−7–1.1 × 10−5)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Conclusions Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD.
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Affiliation(s)
- Serafi Cambray
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida and RedinRen RETIC, ISCIII, Lleida, Spain
| | - Marcelino Bermudez-Lopez
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida and RedinRen RETIC, ISCIII, Lleida, Spain
| | - Milica Bozic
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida and RedinRen RETIC, ISCIII, Lleida, Spain
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida and RedinRen RETIC, ISCIII, Lleida, Spain
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29
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Bermúdez-López M, Martínez-Alonso M, Castro-Boqué E, Betriu À, Cambray S, Farràs C, Barbé F, Pamplona R, Lecube A, Mauricio D, Purroy F, Valdivielso JM, Fernández E. Subclinical atheromatosis localization and burden in a low-to-moderate cardiovascular risk population: the ILERVAS study. ACTA ACUST UNITED AC 2020; 74:1042-1053. [PMID: 33162389 DOI: 10.1016/j.rec.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is a discrepancy between risk assessment based on cardiovascular risk factors (CVRF) and atheromatosis burden. The objective was to identify the prevalence of subclinical diseases with common risk factors, such as atheromatosis, occult kidney disease, prediabetes, and diabetes in a middle-aged population with low-to-moderate cardiovascular risk; to assess the vascular distribution, and severity of subclinical atheromatosis. METHODS Randomized, interventional, longitudinal clinical trial. The intervention consisted of vascular ultrasound examination in the carotid and femoral arteries assessing 12 territories, combined with clinical, anthropometric, lifestyle, and biochemical parameters. Inclusion criteria consisted of women (aged 50-70 years) and men (aged 45-65 years) with at least 1 CVRF. Exclusion criteria consisted of a clinical history of diabetes, chronic kidney disease, or a prior CV event. Here, baseline characteristics of the ILERVAS cohort are shown. RESULTS A total of 8330 middle-aged asymptomatic participants, 50.7% women, were enrolled. The presence of 1-2 CVRF was found in 74.8% and adherence to the Mediterranean diet was low in 52.8%. Several previously unknown chronic diseases were diagnosed, such as dyslipidemia (21.1%), hypertension (15.3%), kidney disease (15.4%), obesity (10.6%), and diabetes (2.3%). Subclinical atheromatosis was found in 71.4% of participants, localized in common femoral (54.5%), carotid bifurcation (41.1%) and internal carotid (22%). Intermediate atheromatosis (2-3 territories with atheroma plaque) was found in 32.6%, and generalized atheromatosis (>3 territories) in 19.7. Total plaque area was higher in men (0.97 cm2 vs 0.58 cm2, P<.001). Total plaque area was also higher in the femoral artery, and increased with the number of CVRF. CONCLUSIONS Subclinical atheromatosis was highly prevalent in a middle-aged population with low-to moderate cardiovascular risk, with 1 in 5 participants having generalized atheromatosis. ClinicalTrials.gov Identifier: NCT03228459.
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Affiliation(s)
- Marcelino Bermúdez-López
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain.
| | - Montse Martínez-Alonso
- Unitat de Bioestadística, IRBLleida, Departament de Ciències Mèdiques Bàsiques, Universitat de Lleida, Lleida, Spain
| | - Eva Castro-Boqué
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Àngels Betriu
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Serafí Cambray
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Cristina Farràs
- Centre d'Atenció Primària Cappont, Gerència Territorial de Lleida; Institut Català de la Salut, Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ferran Barbé
- Departament de Medicina Respiratòria, Hospital Universitari Arnau de Vilanova, Grup Recerca Translacional Medicina Respiratòria, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Reinald Pamplona
- Departament de Medicina Experimental, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Grup de Recerca Obesitat i Metabolisme (ODIM), IRBLleida, Universitat de Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Departament d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Francisco Purroy
- Unitat Ictus, Hospital Universitari Arnau de Vilanova, Grup Neurosciències Clíniques, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - José Manuel Valdivielso
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain.
| | - Elvira Fernández
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
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Cambray S, Ibarz M, Bermudez-Lopez M, Marti-Antonio M, Bozic M, Fernandez E, Valdivielso JM. Magnesium Levels Modify the Effect of Lipid Parameters on Carotid Intima Media Thickness. Nutrients 2020; 12:nu12092631. [PMID: 32872319 PMCID: PMC7551902 DOI: 10.3390/nu12092631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
Classical risk factors of atherosclerosis in the general population show paradoxical effects in chronic kidney disease (CKD) patients. Thus, low low-density lipoprotein (LDL) cholesterol levels have been associated with worse cardiovascular outcomes. Magnesium (Mg) is a divalent cation whose homeostasis is altered in CKD. Furthermore, Mg levels have been associated with cardiovascular health. The present study aims to understand the relationships of Mg and lipid parameters with atherosclerosis in CKD. In this analysis, 1754 participants from the Observatorio Nacional de Atherosclerosis en Nefrologia (NEFRONA) cohort were included. Carotid intima media thickness (cIMT) was determined in six arterial territories, and associated factors were investigated by linear regression. cIMT correlated positively with being male, Caucasian, a smoker, diabetic, hypertensive, dyslipidemic and with increased age, BMI, and triglyceride levels, and negatively with levels of HDL cholesterol. First-order interactions in linear regression analysis showed that Mg was an effect modifier on the influence of lipidic parameters. Thus, cIMT predicted values were higher when triglycerides or LDL levels were high and Mg levels were low. On the contrary, when Mg levels were high, this effect disappeared. In conclusion, Mg acts as an effect modifier between lipidic parameters and atherosclerotic cardiovascular disease. Therefore, Mg levels, together with lipidic parameters, should be taken into account when assessing atherosclerotic risk.
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Affiliation(s)
- Serafi Cambray
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida Av. Rovira Roure 80, 25198 Lleida, Spain; (M.B.-L.); (M.M.-A.); (M.B.); (E.F.)
- Correspondence: (S.C.); (J.M.V.)
| | - Merce Ibarz
- Indicators and Specifications of the Quality in the Clinical Laboratory Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida, 25198 Lleida, Spain;
| | - Marcelino Bermudez-Lopez
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida Av. Rovira Roure 80, 25198 Lleida, Spain; (M.B.-L.); (M.M.-A.); (M.B.); (E.F.)
| | - Manuel Marti-Antonio
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida Av. Rovira Roure 80, 25198 Lleida, Spain; (M.B.-L.); (M.M.-A.); (M.B.); (E.F.)
| | - Milica Bozic
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida Av. Rovira Roure 80, 25198 Lleida, Spain; (M.B.-L.); (M.M.-A.); (M.B.); (E.F.)
| | - Elvira Fernandez
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida Av. Rovira Roure 80, 25198 Lleida, Spain; (M.B.-L.); (M.M.-A.); (M.B.); (E.F.)
| | - Jose M. Valdivielso
- Vascular and Renal Translational Research Group, Institute for Biomedical Research Pifarré Foundation, IRBLleida Av. Rovira Roure 80, 25198 Lleida, Spain; (M.B.-L.); (M.M.-A.); (M.B.); (E.F.)
- Correspondence: (S.C.); (J.M.V.)
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Disthabanchong S, Srisuwarn P. Mechanisms of Vascular Calcification in Kidney Disease. Adv Chronic Kidney Dis 2019; 26:417-426. [PMID: 31831120 DOI: 10.1053/j.ackd.2019.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023]
Abstract
The increase in prevalence and severity of vascular calcification in chronic kidney disease is a result of complex interactions between changes in the vascular bed, mineral metabolites, and other uremic factors. Vascular calcification can occur in the intima and the media of arterial wall. Under permissive conditions, vascular smooth muscle cells (VSMCs) can transform to osteoblast-like phenotype. The membrane-bound vesicles released from transformed VSMCs and the apoptotic bodies derived from dying VSMCs serve as nucleating structures for calcium crystal formation. Alterations in the quality and the quantity of endogenous calcification inhibitors also give rise to an environment that potentiates calcification.
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Affiliation(s)
- Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Praopilad Srisuwarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Valdivielso JM, Rodríguez-Puyol D, Pascual J, Barrios C, Bermúdez-López M, Sánchez-Niño MD, Pérez-Fernández M, Ortiz A. Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different? Arterioscler Thromb Vasc Biol 2019; 39:1938-1966. [PMID: 31412740 DOI: 10.1161/atvbaha.119.312705] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of premature mortality, mainly from cardiovascular causes. The association between CKD on hemodialysis and accelerated atherosclerosis was described >40 years ago. However, more recently, it has been suggested that the increase in atherosclerosis risk is actually observed in early CKD stages, remaining stable thereafter. In this regard, interventions targeting the pathogenesis of atherosclerosis, such as statins, successful in the general population, have failed to benefit patients with very advanced CKD. This raises the issue of the relative contribution of atherosclerosis versus other forms of cardiovascular injury such as arteriosclerosis or myocardial injury to the increased cardiovascular risk in CKD. In this review, the pathophysiogical contributors to atherosclerosis in CKD that are shared with the general population, or specific to CKD, are discussed. The NEFRONA study (Observatorio Nacional de Atherosclerosis en NEFrologia) prospectively assessed the prevalence and progression of subclinical atherosclerosis (plaque in vascular ultrasound), confirming an increased prevalence of atherosclerosis in patients with moderate CKD. However, the adjusted odds ratio for subclinical atherosclerosis increased with CKD stage, suggesting a contribution of CKD itself to subclinical atherosclerosis. Progression of atherosclerosis was closely related to CKD progression as well as to the baseline presence of atheroma plaque, and to higher phosphate, uric acid, and ferritin and lower 25(OH) vitamin D levels. These insights may help design future clinical trials of stratified personalized medicine targeting atherosclerosis in patients with CKD. Future primary prevention trials should enroll patients with evidence of subclinical atherosclerosis and should provide a comprehensive control of all known risk factors in addition to testing any additional intervention or placebo.
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Affiliation(s)
- José M Valdivielso
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Diego Rodríguez-Puyol
- Nephrology Unit, Fundación para la investigación del Hospital Universitario Príncipe de Asturias, RedInRen, Alcalá de Henares, Madrid, Spain (D.R.-P.)
| | - Julio Pascual
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Clara Barrios
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Marcelino Bermúdez-López
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Maria Dolores Sánchez-Niño
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
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Abstract
PURPOSE OF REVIEW The majority of end-stage renal disease including dialysis and kidney transplant patients are men. In contrast, the incidence of chronic kidney disease (CKD) is higher in women compared with men. In this review, we dissect the sex hormone levels and its effects on experimental models and patients with CKD. RECENT FINDINGS Sex hormones are clearly involved in CKD progression to end-stage renal disease (ESRD). A significant reduction in lipid peroxidation as a mechanism of renoprotection has been observed in kidneys of streptozotocin (STZ)-diabetic ovariectomized rats after estradiol administration. Furthermore, a G-protein-coupled estrogen receptor inhibits podocyte oxidative stress maintaining the integrity of the mitochondrial membrane. Sex hormone depletion has been shown to modulate RAS system and protect against kidney injury in the male STZ-diabetic model. In human primary proximal tubular epithelial cells, a proteomic study showed that dihydrotestosterone dysregulated metabolic, suggesting that the deleterious effect of androgens within the kidney maybe related to altered energy metabolism in renal tubules. SUMMARY Male gender is associated with worse CKD progression and this fact may be ascribed to sex hormone. Although male hormones exert a deleterious effect in terms of increasing oxidative stress, activating RAS system, and worsening fibrosis within the damaged kidney, female hormones exert a renoprotective effect.
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Bermudez-Lopez M, Forne C, Amigo N, Bozic M, Arroyo D, Bretones T, Alonso N, Cambray S, Del Pino MD, Mauricio D, Gorriz JL, Fernandez E, Valdivielso JM. An in-depth analysis shows a hidden atherogenic lipoprotein profile in non-diabetic chronic kidney disease patients. Expert Opin Ther Targets 2019; 23:619-630. [PMID: 31100024 DOI: 10.1080/14728222.2019.1620206] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Chronic kidney disease (CKD) is an independent risk factor for atherosclerotic disease. We hypothesized that CKD promotes a proatherogenic lipid profile modifying lipoprotein composition and particle number. Methods: Cross-sectional study in 395 non-diabetic individuals (209 CKD patients and 186 controls) without statin therapy. Conventional lipid determinations were combined with advanced lipoprotein profiling by nuclear magnetic resonance, and their discrimination ability was assessed by machine learning. Results: CKD patients showed an increase of very-low-density (VLDL) particles and a reduction of LDL particle size. Cholesterol and triglyceride content of VLDLs and intermediate-density (IDL) particles increased. However, low-density (LDL) and high-density (HDL) lipoproteins gained triglycerides and lost cholesterol. Total-Cholesterol, HDL-Cholesterol, LDL-Cholesterol, non-HDL-Cholesterol and Proprotein convertase subtilisin-kexin type (PCSK9) were negatively associated with CKD stages, whereas triglycerides, lipoprotein(a), remnant cholesterol, and the PCSK9/LDL-Cholesterol ratio were positively associated. PCSK9 was positively associated with total-Cholesterol, LDL-Cholesterol, LDL-triglycerides, LDL particle number, IDL-Cholesterol, and remnant cholesterol. Machine learning analysis by random forest revealed that new parameters have a higher discrimination ability to classify patients into the CKD group, compared to traditional parameters alone: area under the ROC curve (95% CI), .789 (.711, .853) vs .687 (.611, .755). Conclusions: non-diabetic CKD patients have a hidden proatherogenic lipoprotein profile.
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Affiliation(s)
- Marcelino Bermudez-Lopez
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - Carles Forne
- b Biostatistics Unit , IRBLleida , Lleida , Spain.,c Department of Basic Medical Sciences , University of Lleida , Lleida , Spain
| | | | - Milica Bozic
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - David Arroyo
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain.,e Servicio de nefrología , Hospital Universitario Severo Ochoa , Leganés , Spain
| | - Teresa Bretones
- f Department of Cardiology , Hospital Universitario Puerta del Mar , Cádiz , Spain
| | - Nuria Alonso
- g Endocrinology and Nutrition Department , Hospital Universitari Germans Trias i Pujol , Badalona , Spain.,h Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , Barcelona , Spain
| | - Serafi Cambray
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | | | - Didac Mauricio
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain.,h Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM) , Barcelona , Spain.,j Endocrinology and Nutrition Department , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Jose Luis Gorriz
- k Hospital Clínico Universitario Valencia , Universitat de Valencia, INCLIVA , Lleida , Spain
| | - Elvira Fernandez
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - Jose Manuel Valdivielso
- a Vascular & Renal Translational Research Group , IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
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Palanca A, Castelblanco E, Perpiñán H, Betriu À, Soldevila B, Valdivielso JM, Bermúdez M, Duran X, Fernández E, Puig-Domingo M, Groop PH, Alonso N, Mauricio D. Prevalence and progression of subclinical atherosclerosis in patients with chronic kidney disease and diabetes. Atherosclerosis 2018; 276:50-57. [PMID: 30032025 DOI: 10.1016/j.atherosclerosis.2018.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and diabetes. Traditional cardiovascular risk factors fail to fully account for the increase in cardiovascular risk in these patients. This study aims to analyse the prevalence and progression of subclinical atherosclerosis in CKD patients with and without diabetes. METHODS We included data from CKD patients with and without diabetes free from previous cardiovascular events from the NEFRONA cohort. Patients underwent baseline and 24-month follow-up carotid and femoral ultrasound examinations. Multivariable models were used to assess the contribution of diabetes to the presence and plaque progression. RESULTS A total of 419 patients with diabetes and 1129 without diabetes were included. Diabetic patients were older, had higher BMIs, more hypertension and dyslipidaemia. At baseline, the proportion of patients with plaque was higher among diabetic patients (81.4% vs. 64.1%, p < 0.001). Diabetic patients more frequently had more than two vascular territories with plaque (64.4% vs. 48.4%, p < 0.001). Multivariable analysis indicated that plaque at baseline was significantly associated with age, gender, smoking and renal replacement therapy (RRT) in the non-diabetic patients, but only with age and male gender in diabetic patients. Plaque progression was significantly associated with age, number of territories with basal plaque, smoking and RRT in both groups. CONCLUSIONS Subclinical atherosclerosis is more prevalent, carries a higher plaque burden and is more rapidly progressive in renal patients with diabetes. In these patients, diabetes outweighs other described risk factors associated with the presence of subclinical atherosclerosis.
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Affiliation(s)
- Ana Palanca
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain
| | - Hèctor Perpiñán
- Biostatistics Unit, Institut de Recerca Biomèdica de Lleida, Spain
| | - Àngels Betriu
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Berta Soldevila
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Marcelino Bermúdez
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Xavier Duran
- Methodological and Biostatistical Advisory Service, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group. Institut de Recerca Biomèdica de Lleida, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland; Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain.
| | - Dídac Mauricio
- Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain; Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Spain; Department of Endocrinology and Nutrition, University Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain.
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Nezami N, Ghabili K, Shokouhi-Gogani B, Mirchi M, Ghojazadeh M, Safa J, Zomorrodi A, Gharadaghi A, Mojadidi MK, Tarzamni MK, Khajir G, Ghorashi S, Revzin M. The Relationship between Carotid and Femoral Artery Intima-Media Thickness and Histopathologic Grade of Atherosclerosis in Patients with Chronic Kidney Disease. Nephron Clin Pract 2018. [PMID: 29514148 DOI: 10.1159/000487491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Variability in the grade of atherosclerosis among patients with chronic kidney disease (CKD) could affect the ultrasound measurements of intima media thickness (IMT). We sought to investigate IMTs of carotid (cIMT) and femoral (fIMT) arteries in CKD patients and assess the degree of their correlation with histopathological atherosclerosis. METHODS Eighty-nine out of 99 enrolled subjects completed this study. The subjects were divided into 3 groups: 34 patients with CKD (Case group), 31 with coronary artery disease undergoing coronary artery bypass graft (CABG, positive control group), and 24 healthy kidney donors (negative control group). For histopathological assessment of atherosclerosis, arterial tissue samples were obtained from the patients in each study group. The cIMT and fIMTs were measured by ultrasonography. RESULTS Histopathological atherosclerosis was present in 82.3, 100, and 20.8% of CKD, CABG, and donor groups respectively (p < 0.001). CKD patients had higher values of cIMT and fIMT than the donor group (p = 0.01 and 0.004, respectively). cIMT was positively correlated with the grade of atherosclerosis in the CKD group only (p < 0.001), while fIMT was correlated with the grade of atherosclerosis in both CKD and donor groups (p < 0.001 and p = 0.009 respectively). In CKD patients, cIMT >0.65 mm and femoral values >0.57 mm predicted the presence of histopathological atherosclerosis with sensitivities of 96 and 92% respectively. CONCLUSION Higher values of cIMT and fIMT in CKD patients are associated with higher rates and degrees of histopathological atherosclerosis. Additionally, when compared to fIMT, cIMT has a higher sensitivity for detecting atherosclerosis in CKD patients.
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Affiliation(s)
- Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamyar Ghabili
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Mohammad Mirchi
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Safa
- Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshar Zomorrodi
- Department of Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abasad Gharadaghi
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Kazem Tarzamni
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghazal Khajir
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sona Ghorashi
- Southern Connecticut State University, New Haven, Connecticut, USA
| | - Margarita Revzin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Bermúdez-López M, Betriu À, Valdivielso JM, Bretones Del Pino T, Arroyo D, Fernández E. Beyond the traditional lipid parameters in chronic kidney disease. Nefrologia 2017; 38:109-113. [PMID: 29137894 DOI: 10.1016/j.nefro.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marcelino Bermúdez-López
- Grupo de Investigación Translacional Vascular y Renal, Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, España.
| | - Àngels Betriu
- Grupo de Investigación Translacional Vascular y Renal, Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, España
| | - Jose M Valdivielso
- Grupo de Investigación Translacional Vascular y Renal, Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, España
| | | | - David Arroyo
- Grupo de Investigación Translacional Vascular y Renal, Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, España
| | - Elvira Fernández
- Grupo de Investigación Translacional Vascular y Renal, Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, España
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Borràs Sans M, Pérez-Fontán M, Martinez-Alonso M, Bajo A, Betriu À, Valdivielso JM, Fernández E. The modality of dialysis does not influence atheromatous vascular disease progression or cardiovascular outcomes in dialysis patients without previous cardiovascular disease. PLoS One 2017; 12:e0186921. [PMID: 29095847 PMCID: PMC5667854 DOI: 10.1371/journal.pone.0186921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/10/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is limited and inconclusive information regarding the influence of the modality of renal replacement therapy on the atherosclerotic burden of patients on dialysis. The aim of this study was to compare the prevalence of asymptomatic atheromatous carotid disease, as also its rate of progression and cardiovascular outcomes, in two matched populations of patients treated with hemodialysis (HD) and peritoneal dialysis (PD). METHODS Following a prospective, observational and multicenter design, we compared 237 PD and 237 HD patients without previous cardiovascular disease, included in the NEFRONA study, and matched for age, sex, diabetes and time on dialysis. Carotid ultrasound study was performed at baseline and after two years of follow-up in 6 carotid territories. Atheromatous vascular disease (AVD) progression was defined as any increase in the number of territories with plaques after 2 years. Fatal and non fatal cardiovascular events were also recorded during 36-month of follow-up. MAIN RESULTS At baseline, PD patients presented a worse general cardiovascular risk profile than HD patients. On the contrary, some markers of prevalent atherosclerotic disease (common carotid intima-media thickness and ankle-brachial index) were more favorable in PD patients. During follow-up, we observed no differences either in the rate of progression of atheromatous vascular disease (OR 1.78, 95% CI 0.80-4.06, p = 0.161) or in the incidence of cardiovascular events (OR 1.51, 95% CI 0.85-2.66, p = 0.159), according to the modality of dialysis. CONCLUSION Dialysis modality did not impact on atherosclerotic carotid disease progression or cardiovascular outcomes, in two groups of patients treated with PD or HD.
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Affiliation(s)
- Mercè Borràs Sans
- Department of Nephrology, University Hospital Arnau de Vilanova de Lleida, Lleida,Spain
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | | | - Montserrat Martinez-Alonso
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Auxiliadora Bajo
- Department of Nephrology, University Hospital La Paz, REDinREN del ISCIII, Madrid, Spain
| | - Àngels Betriu
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - José M. Valdivielso
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Elvira Fernández
- Department of Nephrology, University Hospital Arnau de Vilanova de Lleida, Lleida,Spain
- UDETMA Unitat de Detecció de Malalties Aterotrombòtiques, Lleida, Spain
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
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Abajo M, Betriu À, Arroyo D, Gracia M, Del Pino MD, Martínez I, Valdivielso JM, Fernández E. Mineral metabolism factors predict accelerated progression of common carotid intima-media thickness in chronic kidney disease: the NEFRONA study. Nephrol Dial Transplant 2017; 32:1882-1891. [PMID: 27566835 DOI: 10.1093/ndt/gfw306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/14/2016] [Indexed: 11/14/2022] Open
Abstract
Background The leading cause of premature death in chronic kidney disease (CKD) is cardiovascular disease (CVD), but risk assessment in renal patients is challenging. The aim of the study was to analyse the factors that predict accelerated progression of common carotid intima-media thickness (CCIMT) in a CKD cohort after 2 years of follow-up (2010-12). Methods The study included 1152 patients from the NEFRONA cohort with CKD stages 3-5D and without a clinical history of CVD. CCIMT was measured at the far wall on both common carotids. CCIMT progression was defined as the change between CCIMT at baseline and at 24 months for each side, averaged and normalized as change per year. Accelerated progressors were defined as those with a CCIMT change ≥75th percentile. Results The median CCIMT progression rate was 0.0125 mm/year, without significant differences between CKD stages. The cut-off value for defining accelerated progression was 0.0425 mm/year. After adjustment, age was a common factor among all CKD stages. Traditional cardiovascular risk factors, such as diabetes and systolic blood pressure, were predictors of progression in CKD stages 4-5, whereas high-density lipoprotein and low-density lipoprotein cholesterol predicted progression in women in stage 3. Mineral metabolism factors predicting accelerated progression were serum phosphorus in stages 3 and 5D; low 25-hydroxyvitamin D and parathyroid hormone levels >110 pg/mL in stages 4-5 and intact parathyroid hormone levels out of the recommended range in stage 5D. Conclusions Mineral metabolism parameters might predict accelerated CCIMT progression from early CKD stages.
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Affiliation(s)
- Maria Abajo
- Nephrology Research Department, Biomedical Research Institute of Lleida (IRBLleida) and REDINREN, Edificio Biomedicina 1. Lab B1-10, Rovira Roure 80, Lleida 25198, Spain
| | - Àngels Betriu
- Nephrology Research Department, Biomedical Research Institute of Lleida (IRBLleida) and REDINREN, Edificio Biomedicina 1. Lab B1-10, Rovira Roure 80, Lleida 25198, Spain
| | - David Arroyo
- Department of Nephrology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Marta Gracia
- Nephrology Research Department, Biomedical Research Institute of Lleida (IRBLleida) and REDINREN, Edificio Biomedicina 1. Lab B1-10, Rovira Roure 80, Lleida 25198, Spain
| | | | - Isabel Martínez
- Department of Nephrology, Hospital de Galdakao, Bilbao, Spain
| | - Jose M Valdivielso
- Nephrology Research Department, Biomedical Research Institute of Lleida (IRBLleida) and REDINREN, Edificio Biomedicina 1. Lab B1-10, Rovira Roure 80, Lleida 25198, Spain
| | - Elvira Fernández
- Nephrology Research Department, Biomedical Research Institute of Lleida (IRBLleida) and REDINREN, Edificio Biomedicina 1. Lab B1-10, Rovira Roure 80, Lleida 25198, Spain.,Department of Nephrology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
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Arroyo D, Betriu A, Valls J, Gorriz JL, Pallares V, Abajo M, Gracia M, Valdivielso JM, Fernandez E. Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study. Nephrol Dial Transplant 2017; 32:513-520. [PMID: 27190385 DOI: 10.1093/ndt/gfw039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/03/2016] [Indexed: 11/14/2022] Open
Abstract
Background The ankle-brachial index (ABI) is widely used to diagnose subclinical peripheral artery disease (PAD) in the general population, but data assessing its prevalence and related factors in different chronic kidney disease (CKD) stages are scarce. The aim of this study is to evaluate the prevalence and associated factors of pathological ABI values in CKD patients. Methods NEFRONA is a multicentre prospective project that included 2445 CKD patients from 81 centres and 559 non-CKD subjects from 9 primary care centres across Spain. A trained team collected clinical and laboratory data, performed vascular ultrasounds and measured the ABI. Results PAD prevalence was higher in CKD than in controls (28.0 versus 12.3%, P < 0.001). Prevalence increased in more advanced CKD stages, due to more patients with an ABI ≥1.4, rather than ≤0.9. Diabetes was the only factor predicting both pathological values in all CKD stages. Age, female sex, carotid plaques, higher carotid intima-media thickness, higher high-sensitivity C-reactive protein (hsCRP) and triglycerides, and lower 25-hydroxi-vitamin D were independently associated with an ABI ≤0.9. Higher phosphate and hsCRP, lower low-density lipoprotein (LDL)-cholesterol and dialysis were associated with an ABI ≥1.4. A stratified analysis showed different associated factors in each CKD stage, with phosphate being especially important in earlier CKD, and LDL-cholesterol being an independent predictor only in Sage 5D CKD. Conclusions Asymptomatic PAD is very prevalent in all CKD stages, but factors related to a low or high pathological ABI differ, revealing different pathogenic pathways. Diabetes, dyslipidaemia, inflammation and mineral-bone disorders play a role in the appearance of PAD in CKD.
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Affiliation(s)
- David Arroyo
- Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Unit for Detection and Treatment of Atherotrombotic Disease (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Experimental Nephrology Laboratory, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Angels Betriu
- Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Unit for Detection and Treatment of Atherotrombotic Disease (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Joan Valls
- Biostatistics Unit, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jose L Gorriz
- Nephrology Department, Hospital Universitario Doctor Peset, Valencia, Spain and
| | - Vicente Pallares
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Medicine Department, Universitat Jaume I, Castellón, Spain
| | - Maria Abajo
- Experimental Nephrology Laboratory, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Marta Gracia
- Experimental Nephrology Laboratory, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jose Manuel Valdivielso
- Experimental Nephrology Laboratory, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Elvira Fernandez
- Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Unit for Detection and Treatment of Atherotrombotic Disease (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Experimental Nephrology Laboratory, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Valdivielso JM, Betriu A, Martinez-Alonso M, Arroyo D, Bermudez-Lopez M, Fernandez E. Factors predicting cardiovascular events in chronic kidney disease patients. Role of subclinical atheromatosis extent assessed by vascular ultrasound. PLoS One 2017; 12:e0186665. [PMID: 29045466 PMCID: PMC5646852 DOI: 10.1371/journal.pone.0186665] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/05/2017] [Indexed: 01/12/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased incidence of cardiovascular events (CVE). The contribution of subclinical atheromatosis extent, including femoral arteries, to CVE in CKD patients has not been investigated. In this paper, we examine the prognostic value of subclinical atheromatosis extent, assessed as the number of arterial territories with plaque, in predicting the incidence of major and minor CVE. The NEFRONA is a multicenter, prospective cohorts study that recruited 2445 CKD subjects and 559 controls, free from previous cardiovascular disease, in 81 medical centers across Spain. The presence of atheroma plaque was assessed by arterial ultrasound in ten arterial territories (carotid and femoral). The predictive power of the presence or absence of atheroma plaque in any territory was compared with the quantification of atheroma extent as the number of territories with plaque. During the median follow up of 48 months, 216 CVE were reported. Factors predicting the incidence of CVE in the whole cohort were being male, CKD patient, lower levels of 25(OH) vitamin D, higher levels of cholesterol and the extent of subclinical atheromatosis, yielding a higher concordance (C) index than the presence or absence of plaque. In stratified analysis including specific factors of CKD patients not on dialysis, the variables predicting CVE were the same as in the whole cohort, plus higher levels of potassium. Again, the inclusion of the information about atheromatosis as number of territories with plaque, presented a higher C index than the presence or absence of plaque. In the dialysis population, significant variables were older age, diabetes, dialysis vintage and higher levels of cholesterol and phosphate. In this case the higher C index was obtained with the information about plaque presence. Subclinical atheromatosis extent, including femoral arteries, influences CVE in CKD and its detection could improve the prediction of cardiovascular events.
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Affiliation(s)
- José M. Valdivielso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
- * E-mail: (JMV); (EF)
| | - Angels Betriu
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | | | - David Arroyo
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Marcelino Bermudez-Lopez
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
| | - Elvira Fernandez
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, Lleida, Spain
- * E-mail: (JMV); (EF)
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Bermúdez-López M, Arroyo D, Betriu À, Masana L, Fernández E, Valdivielso JM. New perspectives on CKD-induced dyslipidemia. Expert Opin Ther Targets 2017; 21:967-976. [PMID: 28829206 DOI: 10.1080/14728222.2017.1369961] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a world-wide health concern associated with a significantly higher cardiovascular morbidity and mortality. One of the principal cardiovascular risk factors is the lipid profile. CKD patients have a more frequent and progressive atheromatous disease that cannot be explained by the classical lipid parameters used in the daily clinical practice. Areas covered: The current review summarizes prevailing knowledge on the role of lipids in atheromathosis in CKD patients, including an overview of lipoprotein metabolism highlighting the CKD-induced alterations. Moreover, to obtain information beyond traditional lipid parameters, new state-of-the-art technologies such as lipoprotein subfraction profiling and lipidomics are also reviewed. Finally, we analyse the potential of new lipoprotein subclasses as therapeutic targets in CKD. Expert opinion: The CKD-induced lipid profile has specific features distinct from the general population. Besides quantitative alterations, renal patients have a plethora of qualitative lipid alterations that cannot be detected by routine determinations and are responsible for the excess of cardiovascular risk. New parameters, such as lipoprotein particle number and size, together with new biomarkers obtained by lipidomics will personalize the management of these patients. Therefore, nephrologists need to be aware of new insights into lipoprotein metabolism to improve cardiovascular risk assessment.
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Affiliation(s)
- Marcelino Bermúdez-López
- a Vascular and Renal Translational Research Group , Institute for Biomedical Research of Lleida (IRBLleida), REDinREN del ISCIII , Lleida , Spain
| | - David Arroyo
- a Vascular and Renal Translational Research Group , Institute for Biomedical Research of Lleida (IRBLleida), REDinREN del ISCIII , Lleida , Spain
| | - Àngels Betriu
- a Vascular and Renal Translational Research Group , Institute for Biomedical Research of Lleida (IRBLleida), REDinREN del ISCIII , Lleida , Spain
| | - Luis Masana
- b Unitat de Medicina Vascular i Metabolisme , Sant Joan University Hospital, IISPV, CIBERDEM, Universitat Rovira I Virgili , Reus , Spain
| | - Elvira Fernández
- a Vascular and Renal Translational Research Group , Institute for Biomedical Research of Lleida (IRBLleida), REDinREN del ISCIII , Lleida , Spain
| | - Jose M Valdivielso
- a Vascular and Renal Translational Research Group , Institute for Biomedical Research of Lleida (IRBLleida), REDinREN del ISCIII , Lleida , Spain
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Soluble TWEAK and atheromatosis progression in patients with chronic kidney disease. Atherosclerosis 2017; 260:130-137. [DOI: 10.1016/j.atherosclerosis.2017.03.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 12/18/2022]
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Anguiano L, Riera M, Pascual J, Valdivielso JM, Barrios C, Betriu A, Clotet S, Mojal S, Fernández E, Soler MJ. Circulating angiotensin converting enzyme 2 activity as a biomarker of silent atherosclerosis in patients with chronic kidney disease. Atherosclerosis 2016; 253:135-143. [PMID: 27615597 DOI: 10.1016/j.atherosclerosis.2016.08.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/21/2016] [Accepted: 08/23/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Circulating Angiotensin Converting Enzyme 2 (ACE2) activity in chronic kidney disease (CKD) patients without previous history of cardiovascular disease (CVD) has been associated with classical risk factors (older age, diabetes and male gender). Furthermore, silent atherosclerosis has been described as a pathological link between CKD and CVD. We analyzed baseline ACE2 activity in non-dialysis CKD stages 3-5 (CKD3-5) patients as a biomarker of renal progression, silent atherosclerosis and CV events after 2 years of follow-up. METHODS Prospective study of 1458 CKD3-5 subjects without any previous CV event included in the Spanish multicenter NEFRONA study. Association between baseline circulating ACE2 activity and renal parameters, carotid/femoral echography, atheromatous disease, ankle-brachial index, intima-media thickness, need of renal replacement therapy, cardiovascular events and mortality at 24 months of follow-up were analyzed. RESULTS Patients with an increase in the number of territories with plaques at 24 months showed significantly higher levels of baseline ACE2 activity as compared to stable patients (29.6 (20.6-47.6)RFU/μL/h versus 35.7 (24.5-56), p < 0.001). Multivariate linear regression analysis showed that male gender, pathological ankle-brachial index and progressive silent atherosclerosis defined as an increased number of territories with plaques at 24 months were associated with increased baseline ACE2 activity. Male gender, older age, diabetes, smoking and increased baseline circulating ACE2 were independent predictors of atherosclerosis at 24 months of follow-up. CONCLUSIONS In CKD3-5 patients, higher circulating ACE2 activity at baseline is associated with higher risk for silent atherosclerosis, suggesting that ACE2 may serve as a biomarker to predict CV risk before CVD is established.
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Affiliation(s)
- Lidia Anguiano
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Marta Riera
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Clara Barrios
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Angels Betriu
- Nephrology Research Laboratory, Institute for Biomedical Research, IRB, Lleida, Spain; Department of Nephrology and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Sergi Clotet
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Sergi Mojal
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Elvira Fernández
- Nephrology Research Laboratory, Institute for Biomedical Research, IRB, Lleida, Spain; Department of Nephrology and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - María José Soler
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain.
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Montes A, Corrales A, Calaza M, Lopez-Mejias R, Parra JA, González-Gay MA, González A. Brief report: lack of replication of an association between anti-citrullinated fibrinogen and subclinical atherosclerosis in patients with rheumatoid arthritis. Arthritis Rheumatol 2016; 67:2861-5. [PMID: 26246227 DOI: 10.1002/art.39302] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/23/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Results of a recent study suggested that the excess cardiovascular (CV) risk observed in patients with rheumatoid arthritis (RA) could be partially explained by the presence of immune complexes of antibodies against citrullinated proteins that locally promote and perpetuate inflammation and progression of atherosclerotic plaques. The present study was undertaken to attempt to replicate one of the observations supporting this hypothesis, i.e., association between anti-citrullinated fibrinogen (anti-Cit-fibrinogen) positivity and subclinical atherosclerosis. METHODS Three surrogate markers of atherosclerosis were assessed in 124 RA patients with no previous history of CV events: carotid intima-media thickness (CIMT) assessed by carotid ultrasonography, carotid plaques assessed by carotid ultrasonography, and Coronary Artery Calcification Score (CACS) determined by multidetector computed tomography (CT) scanning. We analyzed the relationship of these 3 subclinical atherosclerosis markers to the presence and levels of autoantibodies, including anti-Cit-fibrinogen, anti-cyclic citrullinated peptide 2 (anti-CCP-2), and rheumatoid factor (RF). RESULTS Carotid plaques and CIMT >0.90 mm were present in 69.4% and 15.3%, of the patients, respectively, and the CACS was moderate or high in 21.0%. None of these surrogate markers of atherosclerosis showed a significant association with positivity for or the level of anti-Cit-fibrinogen antibodies (either against the whole protein [present in 33.9% of the patients] or against an immunodominant peptide [present in 23.4%]), anti-CCP-2 (present in 60.7%), or RF (present in 58.1%) in this series of patients with RA. CONCLUSION Our results do not support the notion that there is a relationship between anti-Cit-fibrinogen antibodies and subclinical atherosclerosis in RA, thus calling into question the claim that these antibodies have a role in the increased risk of CV disease observed in patients with RA.
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Affiliation(s)
- Ariana Montes
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Alfonso Corrales
- Hospital Universitario Marqués de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Manuel Calaza
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Raquel Lopez-Mejias
- Hospital Universitario Marqués de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Jose A Parra
- Hospital Universitario Marqués de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Miguel A González-Gay
- Hospital Universitario Marqués de Valdecilla and Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Antonio González
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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Gracia M, Betriu À, Martínez-Alonso M, Arroyo D, Abajo M, Fernández E, Valdivielso JM. Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD. Clin J Am Soc Nephrol 2015; 11:287-96. [PMID: 26668022 DOI: 10.2215/cjn.01240215] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 11/02/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Ultrasonographic detection of subclinical atheromatosis is a noninvasive method predicting cardiovascular events. Risk factors predicting atheromatosis progression in CKD are unknown. Predictors of atheromatosis progression were evaluated in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our multicenter, prospective, observational study included 1553 patients with CKD (2009-2011). Carotid and femoral ultrasounds were performed at baseline and after 24 months. A subgroup of 476 patients with CKD was also randomized to undergo ultrasound examination at 12 months. Progression of atheromatosis was defined as an increase in the number of plaque territories analyzed by multivariate logistic regression. RESULTS Prevalence of atheromatosis was 68.7% and progressed in 59.8% of patients after 24 months. CKD progression was associated with atheromatosis progression, suggesting a close association between pathologies. Variables significantly predicting atheromatosis progression, independent from CKD stages, were diabetes and two interactions of age with ferritin and plaque at baseline. Given that multiple interactions were found between CKD stage and age, phosphate, smoking, dyslipidemia, body mass index, systolic BP (SBP), carotid intima-media thickness, plaque at baseline, uric acid, cholesterol, 25-hydroxy vitamin D (25OH vitamin D), and antiplatelet and phosphate binders use, the analysis was stratified by CKD stages. In stage 3, two interactions (age with phosphate and plaque at baseline) were found, and smoking, diabetes, SBP, low levels of 25OH vitamin D, and no treatment with phosphate binders were positively associated with atheromatosis progression. In stages 4 and 5, three interactions (age with ferritin and plaque and plaque with smoking) were found, and SBP was positively associated with atheromatosis progression. In dialysis, an interaction between body mass index and 25OH vitamin D was found, and age, dyslipidemia, carotid intima-media thickness, low cholesterol, ferritin, and uric acid were positively associated with atheromatosis progression. CONCLUSIONS Atheromatosis progression affects more than one half of patients with CKD, and predictive factors differ depending on CKD stage.
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Affiliation(s)
- Marta Gracia
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Àngels Betriu
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | | | - David Arroyo
- Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - María Abajo
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | | | - José M Valdivielso
- Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain;
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Diabetic nephropathy is an independent factor associated to severe subclinical atheromatous disease. Atherosclerosis 2015; 242:37-44. [DOI: 10.1016/j.atherosclerosis.2015.06.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/05/2015] [Accepted: 06/25/2015] [Indexed: 11/21/2022]
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Anguiano L, Riera M, Pascual J, Valdivielso JM, Barrios C, Betriu A, Mojal S, Fernández E, Soler MJ. Circulating angiotensin-converting enzyme 2 activity in patients with chronic kidney disease without previous history of cardiovascular disease. Nephrol Dial Transplant 2015; 30:1176-85. [PMID: 25813276 PMCID: PMC7107869 DOI: 10.1093/ndt/gfv025] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/10/2015] [Indexed: 01/01/2023] Open
Abstract
Background Patients with cardiovascular (CV) disease have an increased circulating angiotensin-converting enzyme 2 (ACE2) activity, but there is little information about changes in ACE2 in chronic kidney disease (CKD) patients without history of CV disease. We examined circulating ACE2 activity in CKD patients at stages 3–5 (CKD3-5) and in dialysis (CKD5D) without any history of CV disease. Methods Circulating ACE2 activity was measured in human ethylenediamine-tetraacetic acid (EDTA)-plasma samples from the NEFRONA study (n = 2572): control group (CONT) (n = 568), CKD3-5 (n = 1458) and CKD5D (n = 546). Different clinical and analytical variables such as gender; age; history of diabetes mellitus (DM), dyslipidemia and hypertension; glycaemic, renal, lipid and anaemia profiles; vitamin D analogues treatment and antihypertensive treatments (angiotensin-converting enzyme inhibitor and angiotensin receptor blockade) were analysed. Circulating ACE2 and ACE activities were measured using modified fluorimetric assay for EDTA-plasma samples, where zinc chloride was added to recover enzymatic activity. Results In CKD3-5 and CKD5D, significant decrease in circulating ACE2 activity was observed when compared with CONT, but no differences were found between CKD3-5 and CKD5 when performing paired case-control studies. By multivariate linear regression analysis, male gender and advanced age were identified as independent predictors of ACE2 activity in all groups. Diabetes was identified as independent predictor of ACE2 activity in CKD3-5. Significant increase in the activity of circulating ACE was found in CKD3-5 and CKD5D when compared with CONT and in CKD5D when compared with CKD3-5. By multiple regression analysis, female gender and younger age were identified as independent predictors of ACE activity in CONT and CKD3-5. Diabetes was also identified as an independent predictor of ACE activity in CKD3-5 patients. Conclusions Circulating ACE2 and ACE activities can be measured in human EDTA-plasma samples with zinc added to recover enzymatic activity. In a CKD population without previous history of CV disease, ACE2 activity from human EDTA-plasma samples directly correlated with the classical CV risk factors namely older age, diabetes and male gender. Our data suggest that circulating ACE2 is altered in CKD patients at risk for CV event.
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Affiliation(s)
- Lidia Anguiano
- Department of Nephrology, Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marta Riera
- Department of Nephrology, Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Clara Barrios
- Department of Nephrology, Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Angels Betriu
- Nephrology Research Laboratory, Institute for Biomedical Research, IRB Lleida, Spain Department of Nephrology and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Elvira Fernández
- Nephrology Research Laboratory, Institute for Biomedical Research, IRB Lleida, Spain Department of Nephrology and UDETMA, University Hospital Arnau de Vilanova, Lleida, Spain
| | - María José Soler
- Department of Nephrology, Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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