Cardiovascular Biomarkers in Chronic Kidney Disease

Hyperphosphatemia - The Risk Factor for Adverse Outcome in Maintenance Hemodialysis Patients

Hyperphosphatemia is a potent stimulator of vascular and valvular calcifications in hemodialysis patients. To determine the prevalence of hyperphosphatemia and assess its effect on the outcome of hemodialysis patients, a total of 115 chronic hemodialysis patients were studied. Laboratory parameters were determined at baseline, and after 12 and 24 months of follow-up. Valvular calcification was assessed with echocardiography. Laboratory parameters were statistically analyzed with ANOVA. Survival analysis was performed with the Kaplan-Meier test and Log-Rank test. Hyperphosphatemia was present in 31.30% of the patients, high calcium-phosphate (Ca × P) product in 36.52% and valvular calcifications in 48.70%. Patients with serum phosphate >2.10 mmol/L and Ca × P product >5.65 mmol2/L2at baseline were at high risk for all-cause and cardiovascular mortality. Hyperphosphatemia is a risk factor for adverse outcome in patients on regular hemodialysis.

Cardiovascular Mortality in Hemodialysis Patients: Clinical and Epidemiological Analysis

Cardiovascular diseases are the leading cause of death in hemodialysis (HD) patients. The annual cardiovascular mortality rate in these patients is 9%, with left ventricular (LV) hypertrophy, ischemic heart disease and heart failure being the most prevalent causes of death. The aim of this study was to determine the cardiovascular mortality rate and estimate the influence of risk factors on cardiovascular mortality in HD patients. A total of 115 patients undergoing HD for at least 6 months were investigated. Initially a cross-sectional study was performed, followed by a two-year follow-up study. Beside the standard biochemical parameters, C-reactive protein (CRP), homocysteine, cardiac troponins (cTn) and the echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction) were determined. Results were analyzed using Cox regression analysis, Kaplan-Meier and Log-Rank tests. The average one-year cardiovascular mortality rate was 8.51%. Multivariate Cox regression analysis identified increased CRP, cTn T and I, and LV mass index as independent risk factors for cardiovascular mortality. Patients with cTnT > 0.10 ng/mL and CRP > 10 mg/L had significantly higher cardiovascular mortality risk (p < 0.01) than patients with cTnT > 0.10 ng/mL and CRP ≤ 10 mg/L and those with cTnT ≤ 0.10 ng/mL and CRP ≤ 10 mg/L (p < 0.01). HD patients with high cTnT and CRP have a higher cardiovascular mortality risk.

Lipoprotein Metabolism Abnormalities in Patients with Chronic Renal Insufficiency

Patients with chronic renal insufficiency (CRI) on hemodialysis develop lipoprotein abnormalities that may contribute to increased risk for atherosclerosis. The objective of this study was to assess the atherogenic risk of chronic renal insufficiency patients and dialysis treated patients (DTP) by measuring total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and calculating the risk factor ratio: TC/HDL-C and LDL-C/HDL-C. The examined group consisted of 18 chronic renal insufficiency patients and 60 patients on hemodialysis. The results were compared to a control group of 85 voluntary blood donors. Serum lipid parameters were examined by standard methods. All lipid parameters in hemodialysis patients were statistically different as compared to the control group (p<0.05) while chronic renal insufficiency patients showed significant difference only in triglycerides and HDL-cholesterol. Hypertriglyceridemia was present in both examined groups of patients and HDL-cholesterol was lower within both groups. All calculated atherogenic ratios were higher for patients than the control group. Lipid parameters were compared between chronic renal insufficiency and hemodialysis patients, but statistically significant difference was obtained only for HDL-cholesterol (p<0.05). The increased values of triglycerides and lower HDL-cholesterol in chronic renal insufficiency patients contribute to high incidence of cardiovascular disease. Chronic renal insufficiency patients have impaired reverse cholesterol transport from peripheral cells to lipoproteins, decreased levels of HDL-cholesterol, hypertriglyceridemia prevalence of small, dense LDL and increased levels of potentially atherogenic remnant particles.