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Chiu KJ, Chen SC, Su WY, Chang YY, Chang KC, Li CH, Wu YJ, Wu DW, Kuo CH. The association of peritoneal dialysis and hemodialysis on mitral and aortic valve calcification associated mortality: a meta-analysis. Sci Rep 2024; 14:4748. [PMID: 38413701 PMCID: PMC10899208 DOI: 10.1038/s41598-024-55326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
Cardiac valve calcification (CVC), characterized by the accumulation of calcium in the heart valves, is highly prevalent among patients undergoing dialysis. This meta-analysis aimed to provide an updated summary of recent studies on the prognostic value of CVC in patients undergoing dialysis. We conducted a search of PubMed, Embase, and Web of Science to identify observational studies investigating cardiovascular or all-cause mortality associated with CVC in dialysis patients until March 2023. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated for the meta-analysis, and the strength and significance of the associations between CVC and mortality outcomes in dialysis patients were assessed. From 6218 initially identified studies, we included 10 critical studies with a total of 3376 dialysis patients in a further meta-analysis. Pooled analyses demonstrated a significant association between CVC and an elevated risk of all-cause and cardiovascular mortality in dialysis patients. In our study, we discovered HRs of 1.592 (95% CI 1.410-1.797) for all-cause mortality and 2.444 (95% CI 1.632-3.659) for cardiovascular mortality. Furthermore, subgroup analysis revealed elevated all-cause mortality among patients with mitral valve calcification (HR 1.572; 95% CI 1.200-2.060) compared to those with aortic valve calcification (HR 1.456; 95% CI 1.105-1.917). Similarly, patients undergoing peritoneal dialysis faced a greater risk for all-cause mortality (HR 2.094; 95% CI 1.374-3.191) than those on hemodialysis (HR 1.553; 95% CI 1.369-1.763). This highlights the possibility of CVC being an independent risk factor for dialysis patients, particularly in relation to mitral valve calcification or peritoneal dialysis.
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Affiliation(s)
- Kuan-Jung Chiu
- School of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan
- Teaching and Research Center of Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 812, Taiwan
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Wei-Yu Su
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Yong-Yuan Chang
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Kai-Chao Chang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Chiu Hui Li
- Doctoral Degree Program, Department of International Business, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
- Health Management and Occupational Safety and Health Center of Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 812, Taiwan
| | - Ying-Jhen Wu
- Teaching and Research Center of Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 812, Taiwan
| | - Da-Wei Wu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan.
- Teaching and Research Center of Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 812, Taiwan.
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Doctoral Degree Program, Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
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Wei H, Liu S, Tian M, Shang W, Li H, Wu Y, Dong J. The number of valvular insufficiency is a strong predictor of cardiovascular and all-cause mortality in hemodialysis patients. Int Urol Nephrol 2023; 55:2915-2924. [PMID: 37010736 PMCID: PMC10560163 DOI: 10.1007/s11255-023-03576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES To investigate the relationship between the number of valvular insufficiency (VI) and emergency hospitalization or mortality in maintenance hemodialysis (HD) patients. METHODS The maintenance HD patients with cardiac ultrasonography were included. According to the number of VI ≥ 2 or not, the patients were divided into two groups. The difference of emergency hospitalized for acute heart failure, arrhythmia, acute coronary syndrome (ACS) or stroke, cardiovascular mortality, and all-cause mortality between the two groups were compared. RESULTS Among 217 maintenance HD patients, 81.57% had VI. 121 (55.76%) patients had two or more VI, and 96 (44.24%) with one VI or not. The study subjects were followed up for a median of 47 (3-107) months. At the end of the follow up, 95 patients died (43.78%), of whom 47 (21.66%) patients died because of cardiovascular disease. Age (HR 1.033, 95% CI 1.007-1.061, P = 0.013), number of VI ≥ 2 (HR 2.035, 95% CI 1.083-3.821, P = 0.027) and albumin (HR 0.935, 95% CI 0.881-0.992, P = 0.027) were independent risk factors for cardiovascular mortality. The three parameters were also independent risk factors for all-cause mortality. The patients with number of VI ≥ 2 were more likely to be emergency hospitalized for acute heart failure (56 [46.28%] vs 11 [11.46%], P = 0.001). On the contrary, the number of VI was not associated with emergency hospitalized for arrhythmia, ACS or stroke. Survival analysis results showed that probability of survival was statistically different in the two groups (P < 0.05), no matter based on cardiovascular mortality or all-cause mortality. Based on age, number of VI ≥ 2 and albumin, nomogram models for 5-year cardiovascular and all-cause mortality were built. CONCLUSIONS In maintenance HD patients, the prevalence of VI is prominently high. The number of VI ≥ 2 is associated with emergency hospitalized for acute heart failure, cardiovascular and all-cause mortality. Combining age, number of VI ≥ 2, and albumin can predict cardiovascular and all-cause mortality.
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Affiliation(s)
- Honglan Wei
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shufang Liu
- Department of Ophthalmology, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ming Tian
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Weifeng Shang
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Hua Li
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yang Wu
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Junwu Dong
- Department of Nephrology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Zhang J, Pang Q, Wang S, Wu L, Zhang A. Associated factors of cardiac valve calcification and its prognostic effects among patients with chronic kidney disease: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1120634. [PMID: 37180797 PMCID: PMC10169583 DOI: 10.3389/fcvm.2023.1120634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background Cardiac valve calcification (CVC) is highly prevalent and a risk factor for adverse outcomes in patients with chronic kidney disease (CKD). This meta-analysis aimed to investigate the risk factors for CVC and association between CVC and mortality in CKD patients. Method Three electronic databases including PubMed, Embase, and Web of Science were searched for relevant studies up to November 2022. Hazard ratios (HR), odds ratios (OR), and 95% confidence intervals (CI) were pooled using random-effect meta-analyses. Results 22 studies were included in the meta-analysis. Pooled analyses showed that CKD patients with CVC were relatively older, had a higher body mass index, left atrial dimension, C-reaction protein level, and a declined ejection fraction. Calcium and phosphate metabolism dysfunction, diabetes, coronary heart disease, and duration of dialysis were all predictors for CVC in CKD patients. The presence of CVC (both aortic valve and mitral valve) increased the risk of all-cause and cardiovascular mortality in CKD patients. However, the prognostic value of CVC for mortality was not significant anymore in patients with peritoneal dialysis. Conclusion CKD patients with CVC had a greater risk of all-cause and cardiovascular mortality. Multiple associated factors for development of CVC in CKD patients should be taken into consideration by healthcare professionals to improve prognosis. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42022364970].
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Affiliation(s)
- Jialing Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Pang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shiyuan Wang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Leiyun Wu
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
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Guo R, Fan C, Sun Z, Zhang H, Sun Y, Song L, Jiang Z, Liu L. Clinical efficacy and safety of Cox-maze IV procedure for atrial fibrillation in patients with aortic valve calcification. Front Cardiovasc Med 2023; 10:1092068. [PMID: 37077739 PMCID: PMC10106572 DOI: 10.3389/fcvm.2023.1092068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
ObjectiveAtrial fibrillation is associated with a high incidence of heart valve disease. There are few prospective clinical research comparing aortic valve replacement with and without surgical ablation for safety and effectiveness. The purpose of this study was to compare the results of aortic valve replacement with and without the Cox-maze IV procedure in patients with calcific aortic valvular disease and atrial fibrillation.MethodsWe analyzed one hundred and eight patients with calcific aortic valve disease and atrial fibrillation who underwent aortic valve replacement. Patients were divided into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox-maze operation (no Cox-maze group). After surgery, freedom from atrial fibrillation recurrence and all-cause mortality were evaluated.ResultsFreedom from all-cause mortality after aortic valve replacement at 1 year was 100% in the Cox-maze group and 89%, respectively, in the no Cox-maze group. No Cox-maze group had a lower rate of freedom from atrial fibrillation recurrence and arrhythmia control than those in the Cox-maze group (P = 0.003 and P = 0.012, respectively). Pre-operatively higher systolic blood pressure (hazard ratio, 1.096; 95% CI, 1.004–1.196; P = 0.04) and post-operatively increased right atrium diameters (hazard ratio, 1.755; 95% CI, 1.182–2.604; P = 0.005) were associated with atrial fibrillation recurrence.ConclusionThe Cox-maze IV surgery combined with aortic valve replacement increased mid-term survival and decreased mid-term atrial fibrillation recurrence in patients with calcific aortic valve disease and atrial fibrillation. Pre-operatively higher systolic blood pressure and post-operatively increased right atrium diameters are associated with the prediction of recurrence of atrial fibrillation.
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Liao MT, Chao CT, Wu CK. Association of aortic arch and aortic valve calcifications with cardiovascular risk in patients on maintenance hemodialysis. Front Cardiovasc Med 2022; 9:1053265. [PMID: 36561768 PMCID: PMC9763299 DOI: 10.3389/fcvm.2022.1053265] [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: 09/25/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction This study aimed to investigate the association of aortic arch calcification (AoAC) and aortic valve calcification (AVC) with major adverse cardiovascular events (MACE) and cardiovascular and all-cause mortality in patients on maintenance hemodialysis (MHD). Methods This study enrolled 297 adult patients with end-stage kidney disease who were on MHD. They were divided into those with an AoAC score <2 without AVC (n = 70, 23.6%), those with an AoAC score <2 with AVC (n = 96, 32.3%), and those with an AoAC score ≥2 regardless of AVC status (n = 131, 44.1%). We analyzed the risks of MACE, cardiovascular and overall mortality among the three groups using Cox proportional hazard analyses. Survival probabilities were estimated using the log-rank test via the Kaplan-Meier method. Results Kaplan-Meier analysis revealed that the MACE-free rate and the survival rates of cardiovascular and overall mortality were significantly higher in adult chronic hemodialysis patients with AoAC score <2 without AVC, followed by those with AoAC score <2 with AVC, and then those with AoAC score ≥2 (log-rank test; all p < 0.01). The grade of AoAC is a significant risk factor for MACE, cardiovascular mortality, and overall mortality after adjusting for age and gender Relative to AoAC score <2 without AVC, adult chronic hemodialysis patients with AoAC score ≥2 remained an independently significantly risk factor of MACE (adjusted hazard ratio, 2.17; 95% confidence interval 1.11-4.20; p = 0.023) after adjusting for age, sex, and all significant variables in baseline characteristics. Conclusion AoAC grade was positively correlated with a higher risk of MACE and cardiovascular and overall mortality. Furthermore, the presence of AVC modified the adverse cardiovascular risk associated with AoAC in patients on MHD.
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Affiliation(s)
- Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital Hsinchu Branch, Hsinchu, Taiwan,Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan,Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan,Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan,School of Medicine, Fu Jen Catholic University, New Taipei city, Taiwan,*Correspondence: Chung-Kuan Wu,
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Cardiac valve calcification as a predictor of cardiovascular outcomes in peritoneal dialysis patients: an inverse probability of treatment weighting analysis. Int Urol Nephrol 2022; 55:1271-1278. [PMID: 36454448 DOI: 10.1007/s11255-022-03430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cardiovascular events (CVE) are the leading cause of death in peritoneal dialysis (PD) patients. The predictive value of cardiac valve calcification (CVC) for CVE in dialysis patients remains controversial. In particular, such studies are limited in PD patients. We aimed to examine the predictive role of CVC for CVE and cardiovascular mortality in PD patients. METHODS A retrospective analysis was performed on patients who initiated PD in our hospital. According to the result of echocardiography, patients were divided into CVC group and non-CVC group. The differences in baseline demographic characteristics, biochemical variables, comorbidities, and clinical outcomes between the two groups were compared. Kaplan-Meier method was used to obtain survival curves. The Cox regression model was used to evaluate the influence of CVC for cardiovascular outcomes. The inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups. RESULTS 458 peritoneal dialysis patients were enrolled in this study. 77 patients were in CVC group and 381 patients in non-CVC group. The average follow-up time was (32 ± 21) months. At baseline, the absolute standardized difference (ASD) of age, BMI, history of CVE, diabetes, LVEF, LVMI, albumin, calcium, phosphorus, triglycerides, hsCRP, urine volume, Kt/V, statins and vitamin D intake rate were greater than 0.1 between the two groups. All of ASD dropped to less than 0.1 after IPTW, which meant that the balance had been reached between the two groups. Multivariable logistic analysis showed that advanced age, diabetes, and hyperphosphatemia were associated with CVC. The Kaplan-Meier survival curve showed the cumulative CVE-free survival rate and cardiovascular survival rate of CVC group were significantly lower than that of non-CVC group before and after IPTW (log-rank P < 0.05). After IPTW was used to eliminate the effect of confounders, multivariate Cox regression analysis still showed CVC was an independent risk factor for CVE (HR = 2.383, 95% CI 1.331~4.264, P = 0.003) and cardiovascular mortality (HR = 2.347, 95% CI 1.211~4.548, P = 0.012) in PD patients. CONCLUSION The prevalence of CVC is high in peritoneal dialysis patients. CVC is an independent risk factor for CVE and cardiovascular mortality in peritoneal dialysis patients.
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Shajahan S, Amin J, Phillips JK, Hildreth CM. Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis. PLoS One 2021; 16:e0254554. [PMID: 34252153 PMCID: PMC8274915 DOI: 10.1371/journal.pone.0254554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/28/2021] [Indexed: 01/29/2023] Open
Abstract
Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03-1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.
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Affiliation(s)
- Sultana Shajahan
- Department of Biomedical Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Janaki Amin
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jacqueline K. Phillips
- Department of Biomedical Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Cara M. Hildreth
- Department of Biomedical Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Martins MTS, Matos CM, Lopes MB, Kraychete AC, Lopes GB, Martins MTS, Fernandes JL, Amoedo MK, Neves CL, Lopes AA. Vascular calcification by conventional X-ray and mortality in a cohort of predominantly African descent hemodialysis patients. Int J Artif Organs 2020; 44:318-324. [PMID: 33063583 DOI: 10.1177/0391398820962805] [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
BACKGROUND/OBJECTIVE There is a lack of studies describing the prevalence of vascular calcification (VC) and its association with mortality in maintenance hemodialysis (MHD) patients of African descent. We investigated if a VC score based on the number of calcified vascular beds was associated with mortality in MHD patients. METHODS We analyzed data from 211 MHD patients enrolled from January 2010 to January 2011 in the prospective cohort study, "The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO)," developed in Salvador, BA, Brazil. VC was evaluated using radiographs of the hands, abdomen, hip, and chest; the score was calculated by the number of calcified sites as 0 (absence of calcification), 1 (one calcified site), 2 (two sites), 3 (⩾3 sites). We used Cox's regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of associations between VC and mortality with adjustments for age and comorbidities. RESULTS VC was detected in 114 (54.0%) patients; 37 (17.5%) with a VC score = 1; 21 (10%) with VC score = 2 and 56 (26.5%) with VC score = 3. Compared with VC score = 0, the adjusted hazard of death was 2.67 (95% CI: 1.12, 6.33) for patients with VC score = 1; HR = 2.89 (95% CI: 0.95, 7.63) for VC score = 2; and HR = 3.27 (95% CI: 1.47, 7.28) for VC score = 3. CONCLUSION The present study in an African descent MHD population provides support for the VC score based on conventional radiography as a prediction tool for the clinical practice. As shown, the VC score was monotonically and independently associated with mortality.
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Affiliation(s)
- Maria Tereza S Martins
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil
| | - Cácia M Matos
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil.,Institute of Nephrology and Dialysis (INED), Salvador, BA, Brazil
| | - Marcelo B Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil.,Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA, Brazil
| | - Angiolina C Kraychete
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil.,Institute of Nephrology and Dialysis (INED), Salvador, BA, Brazil
| | - Gildete B Lopes
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil.,Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA, Brazil
| | - Márcia Tereza S Martins
- Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil.,Kidney Disease and Hypertension Clinic (CLINIRIM), Salvador, BA, Brazil
| | | | | | - Carolina L Neves
- Department of Internal Medicine, Federal University of Bahia, Salvador, BA, Brazil
| | - Antonio A Lopes
- Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA, Brazil.,Department of Internal Medicine, Federal University of Bahia, Salvador, BA, Brazil
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Wang Z, Chen Z, Ma X, Yu H, Chen X. The predictive value of serum galectin 3 for abdominal aortic calcification in maintenance hemodialysis patients: A prospective cohort study. Hemodial Int 2020; 24:212-220. [PMID: 32048459 DOI: 10.1111/hdi.12825] [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: 12/01/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Heterotopic vascular calcification is a common complication of maintenance hemodialysis (MHD) patients. Galectin 3 (Gal-3) has been reported to be associated with cardiovascular calcification. The current study aims to explore the potential predictive value of serum Gal-3 for severe abdominal aortic calcification (AAC) and AAC progression in MHD patients. METHODS A prospective cohort who underwent hemodialysis during July 2014 at the Blood Purification Center of Ruijin Hospital were followed up for 3 years. Two AAC assessments were performed: one at baseline and one after the 3-year follow-up period. Serum Gal-3 was detected with quantitative ELISA kits. SPSS 23.0 and MedCalc 11.4.2.0 were used to analyze the data. FINDINGS One hundred and fifty-two patients were recruited. Approximately 59.9% were male, the median age was 60 (50-67) years. Logistic regression analysis indicated that serum Gal-3 was an independent risk factor for both follow-up severe AAC and AAC progression. Receiver operating characteristic (ROC) curve analysis revealed significant prognostic value of serum Gal-3 for predicting severe AAC and AAC progression within 3 years. DISCUSSION We found serum Gal-3 is correlated to vascular calcification in ESRD patients. Gal-3 may be a potential biomarker of vascular calcification for MHD patients.
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Affiliation(s)
- Zhiyu Wang
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijin Chen
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobo Ma
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijin Yu
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaonong Chen
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Zhang Y, Darssan D, Pascoe EM, Johnson DW, Pi H, Dong J. Vitamin D status and mortality risk among patients on dialysis: a systematic review and meta-analysis of observational studies. Nephrol Dial Transplant 2019; 33:1742-1751. [PMID: 29481620 DOI: 10.1093/ndt/gfy016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background Vitamin D deficiency is highly prevalent in patients on dialysis. Although vitamin D deficiency is closely associated with cardiovascular disease (CVD) and high mortality in the general population, the relationship between serum 25-hydroxyvitamin D [25(OH)D] and all-cause and cardiovascular mortality in dialysis patients is uncertain. We aim to explore the relationship between serum 25(OH)D levels and all-cause and cardiovascular mortality in dialysis patients. Methods This is a systematic review and meta-analysis of clinical studies among patients receiving maintenance dialysis. We did a systematic literature search in PubMed and Embase to identify studies reporting the relationship between serum 25(OH)D levels and all-cause and cardiovascular mortality in patients on dialysis. The search was last updated on 10 February 2017. Results The study included 18 moderate to high-quality cohort studies with an overall sample of 14 154 patients on dialysis. The relative risk of all-cause mortality per 10 ng/mL increase in serum 25(OH)D level was 0.78 [95% confidence interval (CI) 0.71-0.86], although there was marked heterogeneity (I2=96%, P < 0.01) that was partly explained by differences in CVD prevalence, baseline parathyroid hormone level and dialysis duration among included studies. The relative risk of cardiovascular mortality per 10 ng/mL increase in serum 25(OH)D level was 0.71 (95% CI 0.63-0.79), with substantial heterogeneity (I2=74%, P=0.004) that was largely explained by differences in study type and serum 25(OH)D measurement method. Conclusions In the present study, increased serum 25(OH)D level was significantly associated with lower all-cause mortality and lower cardiovascular mortality in dialysis patients.
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Affiliation(s)
- Yuhui Zhang
- Department of Medicine Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Darsy Darssan
- Australasian Kidney Trials Network, Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Department of Kidney Disease, Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Haichen Pi
- Department of Emergency Medicine, Peking University First Hospital, Beijing, China
| | - Jie Dong
- Department of Medicine Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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11
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Li J, Li A, Wang J, Zhang Y, Zhou Y. Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification. Cardiorenal Med 2018; 9:22-30. [DOI: 10.1159/000491679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/30/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose: Cardiac valve calcification (VC) is very common in patients on hemodialysis. However, the definite effect of VC on left ventricular (LV) geometry and function in this population is unknown, especially when LV ejection fraction (LVEF) is normal. The aim of this study was to determine the effect of VC on LV geometry and function in long-term hemodialysis patients by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). Methods: A total of 47 hemodialysis patients (2–3 times weekly for 5 years or more) were enrolled in this study. Cardiac VC was defined as bright echoes of more than 1 mm on one or more cusps of the aortic valve or mitral valve or mitral annulus using echocardiography as the screening method. LV longitudinal global strain (GLS) was assessed on the apical four-chamber view and calculated as the mean strain of 6 segments. LV global circumferential strain was acquired on the LV short axis view at the level of papillary muscles. Results: Twenty-five patients with VC had higher mean values of interventricular septum thickness, LV posterior wall thickness, LV mass index, relative wall thickness, and LV mass/end-diastolic volume than 22 patients without VC (p < 0.05, respectively), indicating more obvious LV hypertrophy (LVH). VC patients had higher mitral annular E/E′ values, especially at the septal side representing increased LV filling pressure compatible with diastolic dysfunction, while only the E/E′ ratio of the septal side was significantly different between the 2 groups (16.7 ± 4.1 vs. 12.3 ± 4.4, p < 0.01). When assessed by GLS, LV longitudinal systolic function was also lower in in patients with VC compared with those without VC (–0.18 ± 0.03 vs. –0.25 ± 0.04; p < 0.01). Conclusions: Cardiac VC diagnosed by echocardiography when it occurs in long-term hemodialysis patients may indicate more severe LVH, myocardial damage, and worse heart function in comparison to those without VC. Tissue Doppler imaging and 2D-STE can detect the subtle change of heart function in this population in the early stage of LV dysfunction when LVEF is normal.
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12
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Liu ZH, Yu XQ, Yang JW, Jiang AL, Liu BC, Xing CY, Lou JZ, Wang M, Cheng H, Liu J, Fu JZ, Zhang AH, Zhang M, Zhou QL, Yu C, Wang R, Wang L, Chen YQ, Guan TJ, Peng A, Chen N, Hao CM, Cheng XY. Prevalence and risk factors for vascular calcification in Chinese patients receiving dialysis: baseline results from a prospective cohort study. Curr Med Res Opin 2018; 34:1491-1500. [PMID: 29672176 DOI: 10.1080/03007995.2018.1467886] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE With limited data available on calcification prevalence in chronic kidney disease (CKD) patients on dialysis, the China Dialysis Calcification Study (CDCS) determined the prevalence of vascular/valvular calcification (VC) and association of risk factors in Chinese patients with prevalent hemodialysis (HD) or peritoneal dialysis (PD). METHODS CKD patients undergoing HD/PD for ≥6 months were enrolled. Prevalence data for calcification and medical history were documented at baseline. Coronary artery calcification (CAC) was assessed by electron beam or multi-slice computed tomography (EBCT/MSCT), abdominal aortic calcification (AAC) by lateral lumbar radiography, and cardiac valvular calcification (ValvC) by echocardiography. Serum phosphorus, calcium, intact parathyroid hormone (iPTH), and 25-hydroxyvitamin D and FGF-23 were evaluated. A logistic regression model was used to evaluate the association between risk factors and VC. RESULTS Of 1,497 patients, 1,493 (78.3% HD, 21.7% PD) had ≥1 baseline calcification image (final analysis cohort, FAC) and 1,423 (78.8% HD, 21.2% PD) had baseline calcification data complete (BCDC). Prevalence of VC was 77.4% in FAC (80.8% HD, 65.1% PD, p < .001) and 77.5% in BCDC (80.7% HD, 65.8% PD). The proportion of BCDC patients with single-site calcification were 20% for CAC, 4.3% for AAC, and 4.3% for cardiac valvular calcification (ValvC), respectively. Double site calcifications were 23.4% for CAC and AAC, 6.5% for CAC and ValvC, and 1.1% for AAC and ValvC, respectively. In total, 17.9% patients had calcification at all three sites. CONCLUSIONS High prevalence of total VC in Chinese CKD patients will supplement current knowledge, which is mostly limited, contributing in creating awareness and optimizing VC management.
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Affiliation(s)
- Zhi-Hong Liu
- a Department of Nephrology , National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine , Nanjing , PR China
| | - Xue-Qing Yu
- b Department of Nephrology , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou , PR China
| | - Jun-Wei Yang
- c Center of Kidney Disease , The Second Affiliated Hospital of Nanjing Medical University , Nanjing , PR China
| | - Ai-Li Jiang
- d Department of Kidney Disease and Blood Purification , The Second Hospital of Tianjin Medical University , Tianjin , PR China
| | - Bi-Cheng Liu
- e Institute of Nephrology , Zhongda Hospital of Southeast University , Nanjing , PR China
| | - Chang-Ying Xing
- f Department of Nephrology , First Affiliated Hospital of Nanjing Medical University , Nanjing , PR China
| | - Ji-Zhuang Lou
- g Department of Nephrology , Nanjing First Hospital , Nanjing , PR China
| | - Mei Wang
- h Department of Nephrology , Peking University People's Hospital , Beijing , PR China
| | - Hong Cheng
- i Department of Nephrology , Beijing Anzhen Hospital , Beijing , PR China
| | - Jun Liu
- j Department of Nephrology , Southern Medical University Nanfang Hospital , Guangzhou , PR China
| | - Jun-Zhou Fu
- k Department of Nephrology , Guangzhou First People's Hospital , Guangzhou , PR China
| | - Ai-Hua Zhang
- l Department of Nephrology , Third Hospital of Peking University , Beijing , PR China
| | - Miao Zhang
- m Department of Nephrology , Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital , Nanjing , PR China
| | - Qiao-Ling Zhou
- n Department of Nephrology , Xiangya Hospital of Central South University , Changsha , PR China
| | - Chen Yu
- o Department of Nephrology , Shanghai Tongji Hospital , Shanghai , PR China
| | - Rong Wang
- p Department of Nephrology , Shandong Provincial Hospital , Jinan , PR China
| | - Li Wang
- q Department of Nephrology , Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital , Chengdu , PR China
| | - Yu-Qing Chen
- r Renal Division, Department of Medicine , Peking University First Hospital , Beijing , PR China
| | - Tian-Jun Guan
- s Department of Nephrology , Zhongshan Hospital Xiamen University , Xiamen , PR China
| | - Ai Peng
- t Department of Nephrology , Shanghai Tenth People's Hospital , Shanghai , PR China
| | - Nan Chen
- u Department of Nephrology , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , PR China
| | - Chuan-Ming Hao
- v Department of Nephrology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Xu-Yang Cheng
- w Renal Division, Department of Medicine , Peking University First Hospital , Beijing , PR China
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13
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Pichler G, Haller MC, Kainz A, Wolf M, Redon J, Oberbauer R. Prognostic value of bone- and vascular-derived molecular biomarkers in hemodialysis and renal transplant patients: a systematic review and meta-analysis. Nephrol Dial Transplant 2018; 32:1566-1578. [PMID: 28025385 DOI: 10.1093/ndt/gfw387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/26/2016] [Indexed: 12/24/2022] Open
Abstract
Background Patients undergoing hemodialysis and kidney graft recipients are high-risk populations for cardiovascular and all-cause mortality. Fibroblast growth factor 23 (FGF23), osteoprotegerin (OPG), RANK ligand, osteopontin (OPN), Klotho protein and bone morphogenetic protein-7 (BMP-7) are bone- and vascular-derived molecular biomarkers that have been shown to be associated with cardiovascular surrogate end points; however, currently available data on the prognostic value of these biomarkers is inconsistent. The aim of the present study was to conduct a systematic review and meta-analysis in order to summarize the available evidence on the association of molecular biomarkers with mortality in individuals undergoing hemodialysis and renal transplant patients. Methods Two databases (MEDLINE and Embase) were systematically searched. Studies were eligible if the association of biomarker and mortality was reported as time-to-event data [hazard Ratio (HR)] or as effect size with a fixed time of follow-up [odds Ratio (OR)]. Abstracted HRs were converted onto a standard scale of effect and combined using a random effects model. Results From a total of 1170 studies identified in initial searches, 21 met the inclusion criteria. In hemodialysis patients, comparing the lower third with the upper third of baseline FGF23 distribution, pooled HRs (95% confidence intervals) were 1.94 (1.47, 2.56) for all-cause mortality and 2.4 (1.64, 3.51) for cardiovascular mortality. For the same comparison of baseline OPG distribution, pooled HRs were 1.8 (0.95, 3.39) for all-cause mortality and 2.53 (1.29, 4.94) for cardiovascular mortality. Reported risk estimates of RANK ligand, OPN, Klotho protein and BMP-7 were not suitable for pooling; however, only Klotho protein was significantly related to mortality. For kidney graft recipients, four studies that investigated the relationship of FGF23 and OPG with mortality were identified, all of which reported a significant association. Conclusions In hemodialysis patients, FGF23 is a predictor of all-cause and cardiovascular mortality, whereas the predictive value of OPG is restricted to cardiovascular mortality. Further studies are needed in order to gain insight into the prognostic value of these biomarkers in renal transplant recipients.
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Affiliation(s)
- Gernot Pichler
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain.,Hypertension Unit, Department of Internal Medicine, University Hospital Clínico of Valencia, Valencia, Spain.,Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Maria C Haller
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria.,Department of Nephrology and Hypertension Diseases, Transplantation Medicine and Rheumatology, Krankenhaus Elisabethinen, Linz, Austria.,Methods Support Team European Renal Best Practice, Ghent University Hospital, Ghent, Belgium
| | - Alexander Kainz
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Myles Wolf
- Division of Nephrology, Department of Medicine and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Josep Redon
- Area of Cardiometabolic and Renal Risk, Institute for Biomedical Research INCLIVA, Valencia, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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14
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Wang Z, Jiang A, Wei F, Chen H. Cardiac valve calcification and risk of cardiovascular or all-cause mortality in dialysis patients: a meta-analysis. BMC Cardiovasc Disord 2018; 18:12. [PMID: 29370754 PMCID: PMC5785897 DOI: 10.1186/s12872-018-0747-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular calcification is a risk factor for the pathogenesis of cardiovascular disease and mortality in dialysis patients. Nevertheless, the association between cardiac valve calcification (CVC) and the outcome of dialysis is still illusive. The purpose of this meta-analysis is to evaluate the association between theCVC and cardiovascular or all-cause mortality in dialysis patients. METHODS Literatures involving the baseline CVC and cardiovascular or all-cause mortality in dialysis patients were searchedfrom the PubMed, Embase, as well as two Chinese databases (i.e. Wanfang and CNKI databases). Articles published before November 2016were eligible to the study. RESULTS Ten studies involving 2686 participants were included. CVC was correlated with increased risk of cardiovascular mortality (hazard risk [HR]: 2.81; 95% confidence intervals [CI]: 1.92-4.10) and all-cause mortality (HR: 1.73; 95% CI: 1.42-2.11). Subgroup analysis showed an excess risk of all-cause mortality (HR: 1.35; 95% CI: 1.02-1.79) among patients with one CVC, and increased risk of all-cause mortality in patients with two CVCs (HR 2.15; 95% CI 1.57-2.94). CONCLUSIONS CVC is correlated with higher cardiovascular and all-cause mortality risk in dialysis patients. Regular follow-up monitoring of CVC may be helpful for risk stratification of patients underwent dialysis.
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Affiliation(s)
- Zhe Wang
- Department of Blood Purification, The Second Hospital of Tianjin Medical University, Hexi District, 23 Pingjiang Road, Tianjin, 300211, China
| | - Aili Jiang
- Department of Blood Purification, The Second Hospital of Tianjin Medical University, Hexi District, 23 Pingjiang Road, Tianjin, 300211, China.
| | - Fang Wei
- Department of Blood Purification, The Second Hospital of Tianjin Medical University, Hexi District, 23 Pingjiang Road, Tianjin, 300211, China
| | - Haiyan Chen
- Department of Blood Purification, The Second Hospital of Tianjin Medical University, Hexi District, 23 Pingjiang Road, Tianjin, 300211, China
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15
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Xu Z, Wu YT, Li X, Wu H, Chen HR, Shi YL, Arshad B, Li HY, Wu KN, Kong LQ. Thyrotoxicosis Occurring in Secondary Hyperparathyroidism Patients Undergoing Dialysis after Total Parathyroidectomy with Autotransplantation. Chin Med J (Engl) 2017; 130:1995-1996. [PMID: 28776554 PMCID: PMC5555136 DOI: 10.4103/0366-6999.211886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zhou Xu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu-Tuan Wu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin Li
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - He Wu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hao-Ran Chen
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan-Ling Shi
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bilal Arshad
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hong-Yuan Li
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Kai-Nan Wu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ling-Quan Kong
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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16
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Song KK, Zhao DL, Wang YD, Wang Y, Sun XF, Miao LN, Ni ZH, Lin HL, Liu FY, Li Y, He YN, Wang NS, Wang CL, Zhang AH, Chen MH, Yang XP, Deng YY, Shao FM, Fu SX, Fang JA, Cai GY, Chen XM. Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China. Chin Med J (Engl) 2017; 130:885-891. [PMID: 28397716 PMCID: PMC5407033 DOI: 10.4103/0366-6999.204103] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death. Methods: Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients’ data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality. Results: In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094–1.886), age (OR: 1.046, 95% CI: 1.036–1.057), and presence of DN (OR: 1.837, 95% CI: 1.322–2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346–0.989), hemoglobin (OR: 0.974, 95% CI: 0.967–0.981), albumin (OR: 0.939, 95% CI: 0.915–0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070–0.386) were protective factors based on a multivariate analysis. Conclusions: Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.
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Affiliation(s)
- Kang-Kang Song
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - De-Long Zhao
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Yuan-Da Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Yong Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xue-Feng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Li-Ning Miao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Zhao-Hui Ni
- Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center, Shanghai 200127, China
| | - Hong-Li Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Fu-You Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Ying Li
- Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, Hebei 050081, China
| | - Ya-Ni He
- Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Nian-Song Wang
- Department of Nephrology, Shanghai Jiao Tong University, Affiliated The Sixth People's Hospital, Shanghai 200233, China
| | - Cai-Li Wang
- Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014040, China
| | - Ai-Hua Zhang
- Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - Meng-Hua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Xiao-Ping Yang
- Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832008, China
| | - Yue-Yi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Feng-Min Shao
- Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
| | - Shu-Xia Fu
- Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Jing-Ai Fang
- Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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17
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Li XF, Wang Y, Zheng DD, Xu HX, Wang T, Pan M, Shi JH, Zhu JH. M1 macrophages promote aortic valve calcification mediated by microRNA-214/TWIST1 pathway in valvular interstitial cells. Am J Transl Res 2017; 8:5773-5783. [PMID: 28078049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 11/05/2016] [Indexed: 09/28/2022]
Abstract
OBJECTIVE The identification of the biological function of M1 macrophages and the mechanism underlying their role in valvular interstitial cell (VIC) calcification may provide therapeutic targets for the prevention of aortic valve calcification (AVC). This study investigated the mechanism by which M1 macrophages and macrophage-derived microvesicles (MVs) affected the calcification of VICs. An additional aim was to investigate the involvement of the miR-214 pathway in this process. METHODS The M1 or M2 macrophage phenotype in human calcific aortic valve was confirmed by gene expression analysis of M1 or M2 macrophage markers. Two macrophage cell lines (BMDMs and RAW 264.7 macrophages) were transformed into M1 macrophages by lipopolysaccharide (LPS) stimulation. To investigate the mechanism by which M1 macrophages promoted VIC calcification, the generated M1 macrophages and macrophage-derived MVs were co-cultured with VICs and VICs were then used for calcification or signals analysis. In addition, a hypercholesterolemic apoE-/- AVC murine model was used to evaluate the therapeutic efficacy of miR-214 specific-siRNA (miR-214 inhibitor). RESULTS Macrophages in calcific aortic valves showed M1-directed polarization. In the VICs co-cultured with LPS-stimulated M1 macrophages and macrophage-derived MVs, VIC calcification was enhanced, and the expression of TWIST1, a direct target of miR-214, was downregulated. We showed that knockdown of TWIST1 serves as a responding molecule for miR-214 and reversed the anti-calcification action of miR-214 inhibitor, mediating signal delivery by the M1 macrophage-derived MVs to VICs and promoting VIC calcification. When M1 macrophages co-cultured with VICs, TWIST1 overexpression in M1 macrophages had no effect on the expression of TWIST1 in VICs. As shown by intravenous therapy, knockdown of miR-214 in mice seemed to improve AVC in apoE-/- mice with high-cholesterol (HC)-diet induced AVC. CONCLUSIONS These findings suggested that M1 macrophages promoted AVC by the delivery of miR-214 to valvular interstitial cells via macrophage-derived MVs and subsequent downregulation of TWIST1 of valvular interstitial cells.
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Affiliation(s)
- Xiao-Fei Li
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Yan Wang
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Dong-Dong Zheng
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Hai-Xia Xu
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Teng Wang
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Min Pan
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Jia-Hai Shi
- Department of Cardio-Thoracic Surgery, Affiliated Hospital of Nantong University Nantong 226001, China
| | - Jian-Hua Zhu
- Department of Cardiology, Affiliated Hospital of Nantong University Nantong 226001, China
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