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Meer R, Romero Prats ML, Vervloet MG, van der Schouw YT, de Jong PA, Beulens JWJ. The effect of six-month oral vitamin K supplementation on calcification propensity time in individuals with type 2 diabetes mellitus: A post hoc analysis of a randomized, double-blind, placebo-controlled trial. Atherosclerosis 2023:117307. [PMID: 37852868 DOI: 10.1016/j.atherosclerosis.2023.117307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/26/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIMS Experimental studies suggested that vitamin K supplementation may retard arterial calcification. Recently, serum calcification propensity time (T50) has been suggested as a functional biomarker for arterial wall calcification propensity. In this post-hoc analysis of a clinical trial, we evaluated the effect of six-month oral vitamin K supplementation on T50 and assessed the correlation between T50 and imaging arterial calcification parameters in people with type 2 diabetes (T2DM). METHODS This double-blind, randomized, placebo-controlled trial included 68 participants (age = 69 ± 8 years, 76% male) with T2DM. Participants were assigned to menaquinone-7 (360 μg/day; n = 35) or placebo (n = 33). T50 was measured via nephelometry in serum collected at baseline, three and six months. Arterial calcification was measured at baseline and six months via 18F-Na PET-CT and conventional CT using Target-to-Background ratio (TBR) and Agatston score. Longitudinal analysis of covariance adjusted for baseline T50 was used to study the treatment effect. Spearman's correlation was used to assess the correlation between T50 and imaging calcification parameters. RESULTS Median baseline T50 was similar in the vitamin K (350 [321-394] minutes) and placebo groups (363 [320-398]). There was no significant difference in T50 between treatment arms over time (ẞ = 1.00, 95%C.I. = 0.94-1.07, p = 0.982). The correlation coefficient of T50 with TBR and Agatston score at baseline were -0.185 (p = 0.156) and -0.121 (p = 0.358), respectively. CONCLUSIONS No effect of vitamin K supplementation on T50 was observed in T2DM. Moreover, T50 did not correlate with TBR and Agatston score. Further research on vitamin K in arterial calcification and on the validity of T50 as arterial calcification marker is warranted.
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Affiliation(s)
- R Meer
- Department of Epidemiology & Data Science, Amsterdam UMC - Location Vrije Universiteit, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands.
| | - M L Romero Prats
- Department of Epidemiology & Data Science, Amsterdam UMC - Location Vrije Universiteit, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands
| | - M G Vervloet
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands; Department of Nephrology, Amsterdam UMC - Location VUmc, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Y T van der Schouw
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands
| | - P A de Jong
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - J W J Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - Location Vrije Universiteit, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Chen H, Lips P, Vervloet MG, van Schoor NM, de Jongh RT. Association of renal function with bone mineral density and fracture risk in the Longitudinal Aging Study Amsterdam. Osteoporos Int 2018; 29:2129-2138. [PMID: 29947873 PMCID: PMC6105137 DOI: 10.1007/s00198-018-4592-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
Early renal dysfunction is associated with a 38% increased fracture risk in individuals aged 65 years and older. In men but not women, early renal dysfunction is associated with decreased femoral neck bone mineral density (BMD) which can be partially explained by increased parathyroid hormone (PTH) concentrations. INTRODUCTION It is uncertain whether early renal dysfunction is associated with osteoporosis and increased fracture risk. The aim of this study was to determine the relationship of decreased renal function with BMD and fracture risk and the role of PTH therein. METHODS We analyzed data of participants aged 65 years and older from the Longitudinal Aging Study Amsterdam. A 6-year fracture follow-up was obtained in 1477 participants. BMD was measured by dual-energy x-ray absorptiometry (n = 535) and vertebral fractures by lateral spinal radiograph (n = 527) in a subsample at baseline. Glomerular filtration rate (eGFR) was estimated according to the modification of diet in renal disease equation and assessed by the five stages of chronic kidney disease (CKD). RESULTS In men and women, eGFR < 57 ml/min/1.73 m2 (lowest quartile) compared to eGFR > 74 ml/min/1.73 m2 (highest quartile) was associated with a 38% increase in fracture risk after adjustment for relevant confounders [hazard ratio (95%CI): 1.38 (1.17 to 1.61)]. Also, CKD stages 3a and 3b were associated to a 28 and 46% increase in fracture risk, respectively, as compared to CKD stages 1 and 2 together (eGFR > 60 ml/min/1.73 m2) after adjustment for confounders. Renal function was not associated with prevalent vertebral fractures. In men, but not women, lowest quartile of eGFR was related to lower femoral neck BMD as compared to the highest quartile eGFR [unstandardized B (95%CI) - 0.052 g/cm2 (- 0.098 to - 0.006)], after adjustment for relevant confounders. Further adjustment for PTH attenuated this relationship by 27%. CONCLUSIONS In men and women, early decreased renal function (eGFR < 60 ml/min/1.73 m2) was related to increased incident any fracture risk but not with increased prevalence of vertebral fractures. In men, but not women, early renal dysfunction was related to lower femoral neck BMD which could statistically be partially explained by increased PTH concentrations.
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Affiliation(s)
- H Chen
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
- Department of Internal Medicine, Endocrine section, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
| | - P Lips
- Department of Internal Medicine, Endocrine section, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
| | - M G Vervloet
- Department of Nephrology and Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - N M van Schoor
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - R T de Jongh
- Department of Internal Medicine, Endocrine section, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.
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Vlot MC, den Heijer M, de Jongh RT, Vervloet MG, Lems WF, de Jonge R, Obermayer-Pietsch B, Heijboer AC. Clinical utility of bone markers in various diseases. Bone 2018; 114:215-225. [PMID: 29920402 DOI: 10.1016/j.bone.2018.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022]
Abstract
Measurements of bone markers (BMs) in peripheral blood or urine are a pivotal part of bone research within modern clinical medicine. In recent years the use of BMs increased substantially as they can be useful either to diagnose bone (related) disease and to follow its natural history, but also to monitor the effects of interventions. However, the use of BMs is still complicated mainly due to (pre)analytical variability of these substances, limited accessibility of assays, variable cut-off values in different countries and laboratories and heterogeneous results with regard to clinical implications of measuring BMs in several studies. This review will provide the clinician with a practical guide, based on current evidence, in which circumstances to test which bone markers for optimal diagnostic purposes, in order to improve patient care in different areas of bone diseases including Paget's disease, primary osteoporosis, tumor induced osteomalacia, hypophosphatemic rickets, van Buchem disease, chronic kidney disease, rheumatoid arthritis, neoplasma/multiple myeloma, type 2 diabetes mellitus and primary hyperparathyroidism. The clinician should consider fasting state, recent fractures, aging, menopausal status, concomitant liver and kidney disease when ordering and interpreting BM measurements as these factors might result in misleading BM concentrations. We found that BMs are clearly useful in the current diagnosis of tumor induced osteomalacia, van Buchem disease, Paget's disease and hypophosphatemic rickets. In addition, BMs are useful to monitor disease activity in chronic kidney disease, Paget's disease and are useful to monitor treatment adherence in osteoporosis.
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Affiliation(s)
- M C Vlot
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Internal Medicine, Endocrinology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - M den Heijer
- Department of Internal Medicine, Endocrinology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - R T de Jongh
- Department of Internal Medicine, Endocrinology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - M G Vervloet
- Department Nephrology, Amsterdam Cardiovascular Sciences (ACS) VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - W F Lems
- Department of Rheumatology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - R de Jonge
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Endocrinology and Diabetology, Medical University of Graz, Graz 8036, Austria
| | - A C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Clinical Chemistry, Laboratory of Endocrinology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Neradova A, Schumacher SP, Hubeek I, Lux P, Schurgers LJ, Vervloet MG. Phosphate binders affect vitamin K concentration by undesired binding, an in vitro study. BMC Nephrol 2017; 18:149. [PMID: 28464802 PMCID: PMC5414218 DOI: 10.1186/s12882-017-0560-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 04/19/2017] [Indexed: 12/02/2022] Open
Abstract
Background Vascular calcification is a major contributing factor to mortality in end stage renal disease (ESRD). Despite the efficacy of phosphate binders to improve hyperphosphatemia, data on vascular calcification are less clear. There seems to be a difference in attenuation or delay in progression between different binders. In this in vitro experiment we tested whether phosphate binders could limit bioavailability of vitamin K2 by undesired binding. Vitamin K-deficiency limits activation of the vascular tissue mineralization inhibitor matrix γ-carboxyglutamate (Gla) protein (MGP) thereby exacerbating vascular calcification. Methods In this experiment vitamin K2 (menaquinone-7; MK-7) binding was assessed by adding 1 mg of vitamin K2 to a medium with pH 6 containing 67 mg phosphate binder with either 7 mg of phosphate or no phosphate. Five different phosphate binders were tested. After five and a half hours vitamin K was analyzed by HPLC. All experiments were performed in triplicate. Results Sucroferric-oxyhydroxide and sevelamer carbonate did not significantly bind vitamin K2, both in solution only containing vitamin K2 or in combination with phosphate. Calcium acetate/magnesium carbonate binds vitamin K2 strongly both in absence (p = 0.001) and presence of phosphate (p = 0.003). Lanthanum carbonate significantly binds vitamin K2 in solution containing only vitamin K2 (p = 0.005) whereas no significant binding of vitamin K2 was observed in the solution containing vitamin K2 and phosphate (p = 0.462). Calcium carbonate binds vitamin K2 significantly in a solution with vitamin K2 and phosphate (p = 0.009) whereas without phosphate no significant binding of vitamin K2 was observed (p = 0.123). Conclusions Sucroferric-oxyhydroxide and sevelamer carbonate were the only binders of the five binders studied that did not bind vitamin K2 in vitro. The presence or absence of phosphate significantly interferes with vitamin K2 binding so phosphate binders could potentially limit bioavailability vitamin K2.
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Affiliation(s)
- A Neradova
- Department of Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - S P Schumacher
- Department of cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I Hubeek
- Clinical chemistry laboratory, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P Lux
- Department of Biochemistry, Cardiovascular Research institute Maastricht, University Maastricht, Maastricht, The Netherlands
| | - L J Schurgers
- Department of Biochemistry, Cardiovascular Research institute Maastricht, University Maastricht, Maastricht, The Netherlands
| | - M G Vervloet
- Department of Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Institute for Cardiovascular Research VU, ICaR-VU, Amsterdam, The Netherlands.
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Vermeulen EA, Vervloet MG, Lubach CH, Nurmohamed SA, Penne EL. Feasibility of long-term continuous subcutaneous magnesium supplementation in a patient with irreversible magnesium wasting due to cisplatin. Neth J Med 2017; 75:35-38. [PMID: 28124669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 39-year-old woman presented with severe, uncontrolled and irreversible hypomagnesaemia, following cisplatin treatment in her childhood. Because high-dose oral magnesium supplementation therapy was insufficient and not tolerated, continuous subcutaneous magnesium supplementation was successfully instituted and continued in the outpatient setting. This case demonstrates that continuous subcutaneous magnesium supplementation is effective in maintaining magnesium levels within the normal range, is well tolerated and may provide a long-term solution for chronic hypomagnesaemia due to intractable renal losses.
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Affiliation(s)
- E A Vermeulen
- Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
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Bover J, Evenepoel P, Urena-Torres P, Vervloet MG, Brandenburg V, Mazzaferro S, Covic A, Goldsmith D, Massy ZA, Cozzolino M. Opponent's comments. Nephrol Dial Transplant 2015; 30:357. [DOI: 10.1093/ndt/gfv021a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baia LC, Van den Berg E, Vervloet MG, Heilberg IP, Navis G, Bakker SJL, Geleijnse JM, Kromhout D, Soedamah-Muthu SS, De Borst MH. Fish and omega-3 fatty acid intake in relation to circulating fibroblast growth factor 23 levels in renal transplant recipients. Nutr Metab Cardiovasc Dis 2014; 24:1310-1316. [PMID: 25063539 DOI: 10.1016/j.numecd.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/16/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS A high circulating fibroblast growth factor 23 (FGF23) level is an independent risk factor for cardiovascular mortality in renal transplant recipients and the general population. N-3 fatty acids eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) may contribute to cardiovascular risk reduction. We investigated whether fish and EPA-DHA intake are related to FGF23 levels in renal transplant recipients. METHODS AND RESULTS We performed a cross-sectional analysis in 619 stable renal transplant recipients (mean age 53 years, 57% male, estimated glomerular filtration rate [eGFR] 53 ± 20 mL/min/1.73 m(2)). Dietary intake was assessed by a 177-item food frequency questionnaire. Serum intact FGF23 was measured by ELISA. We examined differences in FGF23 levels across categories of fish and EPA-DHA intake using analysis of variance models adjusted for age, sex, dietary and lifestyle factors and key determinants of FGF23. Patients consumed on average 15 g of fish and 139 mg EPA-DHA/day. Median FGF23 was 62 pg/mL (IQR 43-98 pg/mL). Higher dietary EPA-DHA and fish intake were associated with lower serum FGF23 levels. Subgroup analyses revealed that particularly in patients with reduced renal function (eGFR <60 mL/min/1.73 m(2)), adjusted FGF23 levels (114, 79, 75 pg/mL, P = 0.0001) were inversely associated with tertiles of EPA-DHA intake. Similarly, we observed an inverse association between fish consumption and serum FGF23 levels in adjusted analyses. CONCLUSION A higher intake of fish and dietary n-3 fatty acids (EPA-DHA) is related to lower circulating FGF23 levels in renal transplant recipients. Further research is needed to assess the causality of this association and the clinical implications.
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Affiliation(s)
- L C Baia
- Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands; Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - E Van den Berg
- Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands
| | - M G Vervloet
- Department of Nephrology, VU University Medical Center Amsterdam, The Netherlands
| | - I P Heilberg
- Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - G Navis
- Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands
| | - S J L Bakker
- Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands
| | - J M Geleijnse
- Division of Human Nutrition, Wageningen University, The Netherlands
| | - D Kromhout
- Division of Human Nutrition, Wageningen University, The Netherlands
| | | | - M H De Borst
- Department of Nephrology, University Medical Center Groningen and University of Groningen, The Netherlands.
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Drechsler C, Evenepoel P, Vervloet MG, Wanner C, Ketteler M, Marx N, Floege J, Dekker FW, Brandenburg VM. High levels of circulating sclerostin are associated with better cardiovascular survival in incident dialysis patients: results from the NECOSAD study. Nephrol Dial Transplant 2014; 30:288-93. [DOI: 10.1093/ndt/gfu301] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Diaz-Tocados JM, Herencia C, Martinez-Moreno JM, Montes De Oca A, Rodriguez-Ortiz ME, Gundlach K, Buchel J, Steppan S, Passlick-Deetjen J, Rodriguez M, Almaden Y, Munoz-Castaneda JR, Nakano C, Hamano T, Fujii N, Matusi I, Mikami S, Tomida K, Mori D, Kusunoki Y, Shimomura A, Obi Y, Hayashi T, Rakugi H, Isaka Y, Tsubakihara Y, Jorgensen HS, Winther S, Hauge EM, Rejnmark L, Botker HE, Bottcher M, Svensson M, Ivarsen P, Sagliker Y, Demirhan O, Yildiz I, Paylar N, Inandiklioglu N, Akbal E, Tunc E, Tartaglione L, Rotondi S, Pasquali M, Muci ML, Mandanici G, Leonangeli C, Sotir N, Sales S, Mazzaferro S, Gigante M, Cafiero C, Brunetti G, Simone S, Grano M, Colucci S, Ranieri E, Pertosa G, Gesualdo L, Evenepoel P, Goffin E, Meijers B, Kanaan N, Bammens B, Coche E, Claes K, Jadoul M, Louvet L, Metzinger L, Buchel J, Steppan S, Massy ZA, Prasad B, St.Onge JR, Tentori F, Zepel L, Comment L, Akiba T, Bommer J, Fukagawa M, Goodkin DA, Jacobson SH, Robinson BM, Port FK, Evenepoel P, Viaene L, Poesen R, Bammens B, Meijers B, Naesens M, Sprangers B, Kuypers D, Claes K, Tominaga Y, Hiramitsu T, Yamamoto T, Tsujita M, Makowka A, G Yda M, Rutkowska-Majewska E, Nowicki MP, Takeshima A, Ogata H, Yamamoto M, Ito H, Kinugasa E, Kadokura Y, Dimkovic N, Dellanna F, Spasovski G, Wanner C, Locatelli F, Troib A, Assadi MH, Landau D, Rabkin R, Segev Y, Ciceri P, Elli F, Cappelletti L, Tosi D, Savi F, Bulfamante G, Cozzolino M, Barreto FC, De Oliveira RB, Benchitrit J, Louvet L, Rezg R, Poirot S, Jorgetti V, Drueke TB, Riser BL, Massy ZA, Pasquali M, Tartaglione L, Rotondi S, Muci ML, Mandanici G, Leonangeli C, Massimetti C, Utzeri G, Biondi B, Mazzaferro S, Verkaik M, Eringa EC, Musters RJ, Pulskens WP, Vervloet MG, Ter Wee PM, Schiller A, Onofriescu M, Apetrii M, Schiller O, Bob F, Timar R, Mihaescu A, Florea L, Mititiuc I, Veisa G, Covic A, Krause R, Kaase H, Stange R, Hopfenmuller W, Chen TC, Holick MF, Kawasaki T, Ando R, Maeda Y, Arai Y, Sato H, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, An WS, Jeong E, Son SH, Kim SE, Son YK, Baxmann AC, Menon VB, Moreira SR, Medina-Pestana J, Carvalho AB, Heilberg IP, Bergman A, Qureshi AR, Haarhaus MH, Lindholm B, Barany P, Heimburger O, Stenvinkel P, Anderstam B, Wilson RJ, Copley JB, Keith MS, Preston P, Santos RSS, Moyses RMA, Silva BC, Jorgetti V, Coelho FMS, Elias RM, Wanderley RA, Ferreira LQO, Sena TCM, Valerio TR, Gueiros JEB, Gueiros APS, Awata R, Goto S, Nakai K, Fujii H, Nishi S, Sagliker Y, Dingil M, Paylar N, Kapur S, Kim B, Lee DY, Yang S, Kim HW, Moon KH, Palmer S, Teixeira-Pinto A, Saglimbene V, Macaskill P, Craig J, Strippoli G, Marks A, Nguyen H, Fluck N, Prescott G, Robertson L, Black C. CKD BONE DISEASE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cozzolino M, Urena-Torres P, Vervloet MG, Brandenburg V, Bover J, Goldsmith D, Larsson TE, Massy ZA, Mazzaferro S. Is chronic kidney disease-mineral bone disorder (CKD-MBD) really a syndrome? Nephrol Dial Transplant 2014; 29:1815-20. [DOI: 10.1093/ndt/gft514] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Navis GJ, Blankestijn PJ, Deegens J, De Fijter JW, Homan van der Heide JJ, Rabelink T, Krediet RT, Kwakernaak AJ, Laverman GD, Leunissen KM, van Paassen P, Vervloet MG, Wee PMT, Wetzels JF, Zietse R, van Ittersum FJ. The Biobank of Nephrological Diseases in the Netherlands cohort: the String of Pearls Initiative collaboration on chronic kidney disease in the university medical centers in the Netherlands. Nephrol Dial Transplant 2013; 29:1145-50. [DOI: 10.1093/ndt/gft307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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de Bruin JL, Vervloet MG, Buimer MG, Baas AF, Prinssen M, Blankensteijn JD. Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial. Br J Surg 2013; 100:1465-70. [DOI: 10.1002/bjs.9280] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Deterioration of renal function after major vascular surgery is an important complication, and may vary between patients undergoing endovascular (EVAR) or open surgical (OR) repair of an abdominal aortic aneurysm (AAA). The objective was to determine the impact of OR and EVAR on renal function after 5 years.
Methods
This was a post hoc analysis of data collected prospectively from the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. Five years after surgery, creatinine levels were available for 189 patients (94 after OR and 95 after EVAR). The severity of renal disease was staged using the chronic kidney disease classification of the US National Kidney Foundation clinical guidelines.
Results
Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the estimated glomerular filtration rate (eGFR) for the entire group declined over time, with a mean(s.d.) preoperative value of 80·0(7·6) ml per min per 1·73 m2 compared with 75·7(9·7) ml per min per 1·73 m2 after 5 years (mean difference 4·2 (95 per cent confidence interval 3·2 to 5·3) ml per min per 1·73 m2; P < 0·001). Five years after surgery, the mean eGFR (CKD-EPI equation) was not significantly different between the OR and EVAR groups: 76·3(9·3) versus 75·1(10·0) ml per min per 1·73 m2 (mean difference 1·2 (−1·6 to 3·9) ml per min per 1·73 m2; P = 0·410).
Conclusion
Renal function 5 years after OR and EVAR for AAA was similar. Neither surgical procedure accelerated the loss of renal function. Registration number: NCT00421330 (http://www.clinicaltrials.gov).
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Affiliation(s)
| | - J L de Bruin
- Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
| | - M G Vervloet
- Department of Nephrology, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
| | - M G Buimer
- Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
| | - A F Baas
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Prinssen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J D Blankensteijn
- Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
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Vervloet MG, du Buf-Vereijken PWG, Potter van Loon BJ, Manamley N, Reichert LJM, Smak Gregoor PJH. Cinacalcet for secondary hyperparathyroidism: from improved mineral levels to improved mortality? Neth J Med 2013; 71:348-354. [PMID: 24038560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Secondary hyperparathyroidism is an almost inevitable complication of advanced kidney failure. The introduction of the calcimimetic cinacalcet for the treatment of secondary hyperparathyroidism in patients on dialysis was based on its ability to reduce elevated levels of parathyroid hormone (PTH). Subsequent clinical studies confirmed the beneficial effects of cinacalcet on biochemical parameters reflecting mineral disturbances and bone disease. In this review we summarise the impact of cinacalcet on biochemical, intermediate and clinical outcomes. We also present previously unpublished mineral metabolism data from 144 Dutch dialysis patients treated with cinacalcet who participated in the pan-European ECHO observational study. Although secondary hyperparathyroidism tended to be more severe in our Dutch cohort, compared with the entire ECHO cohort, cinacalcet was nevertheless effective in reducing PTH in these patients. Two recent clinical studies evaluated, respectively, the efficacy of cinacalcet in improving the intermediate endpoint of cardiovascular calcifications (ADVANCE trial), and its impact on clinical outcomes, including all-cause mortality and cardiovascular events (EVOLVE trial). The ADVANCE trial provided evidence that cinacalcet may indeed improve calcification in both large arteries and cardiac valves. The EVOLVE trial, however, did not meet its clinical primary endpoint (time to all-cause mortality, myocardial infarction, hospitalisation for unstable angina, heart failure or a peripheral vascular event), although secondary and sensitivity analysis suggested a beneficial effect. The clinical implications of these important studies are also addressed in this review.
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Affiliation(s)
- M G Vervloet
- Department of Nephrology, VU University Medical Centre, Amsterdam, the Netherlands
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14
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van den Broek JS, Hoekstra T, Drechsler C, Brandenburg VM, Dekker FW, Vervloet MG, Albrizio P, Sepe V, Gnecchi M, Cervio E, Mangione F, Fiorini F, Rampino T, Libetta C, Dal Canton A, Di Marco G, Reuter S, Kentrup D, Tiemann K, Fobker M, Engelbertz C, Breithardt G, Reinecke H, Brand E, Pavenstadt H, Brand M, De Mauri A, Conti N, Chiarinotti D, David P, Capurro F, De Leo M, Delanaye P, Krzesinski JM, Warling X, Smelten N, Cavalier E, Hayashi M, Kanno Y, Iwai M, Yoshida T, Abe T. Cardiovascular disease in CKD. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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van Tellingen A, Voskuyl AE, Vervloet MG, Bijl M, de Sévaux RGL, Berger SP, Derksen RHWM, Berden JHM. Dutch guidelines for diagnosis and therapy of proliferative lupus nephritis. Neth J Med 2012; 70:199-207. [PMID: 22641632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Proliferative lupus nephritis is a strong predictor of morbidity and mortality in patients with systemic lupus erythematosus. Despite improvements in the management of lupus nephritis, a significant number of the patients do not respond to immunosuppressive therapy and progress to end-stage renal failure. In order to optimise the diagnostic strategy and treatment of patients with proliferative lupus nephritis, guidelines are needed. In this review, the Dutch Working Party on Systemic Lupus Erythematosus provides recommendations regarding four important areas in patients with proliferative lupus nephritis: I) indications for a first renal biopsy, II ) definitions of treatment response, III ) selection of treatment options, and IV) indications for a repeat biopsy.
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Affiliation(s)
- A van Tellingen
- Department of Nephrology, VU University Medical Centre, Amsterdam, the Netherlands.
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16
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Nubé MJ, Vervloet MG. [Proatherogenic changes induced by hemodialysis; probably a result of bio-incompatibility]. Ned Tijdschr Geneeskd 2000; 144:2540-4. [PMID: 11191788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Chronic haemodialysis patients have a disproportionately high risk for developing cardiovascular disease, which can only in part be explained by known risk factors such as dyslipidaemia, hypertension, hyperhomocysteinemia, diabetes mellitus and chronic volume expansion. A possible cause is that the haemodialysis treatment itself contributes to the accelerated atherosclerosis, observed in these patients. Nowadays, atherosclerosis is considered an inflammatory process, mediated by a dysfunction of the vascular endothelium. As a result, blood cells adhere to the vascular surface and release a variety of vasoactive mediators, cytokines, growth factors and free radicals. Due to the contact between blood and dialyzer, humoral systems and cellular elements are stimulated, and this may be viewed as an inflammatory reaction. As a consequence of this, the vascular surface of haemodialysis patients is repeatedly exposed to the influences of cytokines, coagulation products, vasoactive mediators, stimulated leukocytes and thrombocytes, and oxidative stress. It is therefore conceivable that the haemodialysis treatment itself enhances the greatly increased cardiovascular risk in chronic haemodialysis patients.
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Affiliation(s)
- M J Nubé
- Medisch Centrum Alkmaar, afd. Nefrologie en Dialyse, Wilhelminalaan 12, 1815 JD Alkmaar.
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17
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Vervloet MG, Wester JP, Oudemans-Van Straaten HM, ter Wee PM, Girbes AR. Cross-contamination of infectious disease in CVVH: a potential hazard. Intensive Care Med 2000; 26:1403. [PMID: 11089778 DOI: 10.1007/s001340000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Abstract
In patients with sepsis and septic shock, both coagulation and fibrinolysis are activated frequently leading to the syndrome of diffuse intravascular coagulation (DIC). The different mechanisms leading to abnormalities in coagulation and fibrinolysis are discussed in detail. The coagulation and fibrinolytic system appear to be influenced by the septic process largely independently, leading to a procoagulant imbalance between these systems. Coagulation is initiated by mediator-induced expression of tissue factor and is associated with consumption of the natural coagulation inhibitors antithrombin III, protein C, and protein S. As a result, high plasma levels of thrombin-antithrombin complex (TAT) can be found. The effects on fibrinolysis are dominated by (highly) increased levels of plasminogen activator inhibitor type 1 (PAI-1), leading to inadequate fibrinolysis. Although levels of plasminogen activator antigen are increased, its activity is almost completely inhibited by PAI-1. The resulting effects predispose to a procoagulant state, with widespread fibrin deposition, which may be an important mechanism contributing to multiple organ failure. A thorough understanding of the pathophysiological mechanisms underlying the DIC-syndrome is a prerequisite for a rational approach and future therapy for this severe complication of sepsis.
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Affiliation(s)
- M G Vervloet
- Medical Intensive Care Unit of the University Hospital VU Amsterdam, The Netherlands
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