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Petrović M, Brković V, Baralić M, Marić I, Petković N, Stanković S, Lalić N, Stanisavljević D, Đukanović L, Ležaić V. Comparative Analysis of Vascular Calcification Risk Factors in Pre-Hemodialysis and Prevalent Hemodialysis Adult Patients: Insights into Calcification Biomarker Associations and Implications for Intervention Strategies in Chronic Kidney Disease. Diagnostics (Basel) 2024; 14:824. [PMID: 38667470 PMCID: PMC11049133 DOI: 10.3390/diagnostics14080824] [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] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
This retrospective study aimed to compare risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with calcification biomarkers. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF 23, fetuin-A, sclerostin, and VC scores (Adragao method). Prevalence of VC was similar in both groups, but HD patients had more frequent VC scores ≥ 6. Pre-HD patients were older, with higher prevalence of hypertension and less frequent use of calcium phosphate binders. Both groups showed similar patterns of hyperphosphatemia, low vitamin D, and iPTH. Fetuin-A and sclerostin levels were higher in pre-HD, while FGF 23 was elevated in HD patients. Higher VC risk in pre-HD patients was associated with male gender, older age, lower fetuin-A and higher sclerostin, lower ferritin, and no vitamin D treatment, while in HD patients with higher sclerostin, FGF 23 and urea, and lower iPTH. Conclusion: Biomarkers could be measurable indicators of biological processes underlying VC in CKD patients that may serve as a potential guide for considering personalized therapeutic approaches. Further studies are needed to elucidate the underlying pathways.
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Affiliation(s)
- Marko Petrović
- Department of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.P.); (M.B.)
| | - Voin Brković
- Department of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.P.); (M.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (L.Đ.)
| | - Marko Baralić
- Department of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.P.); (M.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (L.Đ.)
| | - Ivko Marić
- Special Hospital for Internal Diseases, 11550 Lazarevac, Serbia
| | - Nenad Petković
- Fresenius Medical Care Dialysis Center, 76230 Šamac, Bosnia and Herzegovina
| | - Sanja Stanković
- Centre for Medical Biochemistry, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Nataša Lalić
- Uromedica Polyclinic Belgrade, 11000 Belgrade, Serbia
| | | | - Ljubica Đukanović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (L.Đ.)
| | - Višnja Ležaić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (L.Đ.)
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Apostol E, Cojocaru A, Ion A, Dorobantu AM, Orzan OA. A Peculiar Presentation of a Debilitating Condition: Calciphylaxis. Cureus 2024; 16:e53457. [PMID: 38435180 PMCID: PMC10909394 DOI: 10.7759/cureus.53457] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Calciphylaxis is a debilitating condition associated with significant morbidity and mortality, often associated with patients with end-stage renal disease, in which the calcification of cutaneous arterioles and small arteries occurs, leading to subsequent ischemia and cutaneous infarction. Herein, we report the case of a diabetic patient with end-stage kidney disease on dialysis, presenting multiple intensely painful necrotic plaques on the lower extremities. The suspicion of calciphylaxis was raised based on the patient's medical history and clinical presentation, subsequently confirmed by radiological examination, which revealed calcifications along vascular pathways. Diagnosis can be established based on clinical and paraclinical grounds alone, and some clinicians may forego skin biopsy and initiate treatment presumptively. The management of calciphylaxis remains a challenge and requires a multidisciplinary approach since most patients experience intense pain that is often unresponsive to conventional analgesics, leading to a reduced quality of life.
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Affiliation(s)
- Eliza Apostol
- Dermatology, Elias Emergency University Hospital, Bucharest, ROU
| | - Anca Cojocaru
- Dermatology, Elias Emergency University Hospital, Bucharest, ROU
| | - Ana Ion
- Dermatology, Elias Emergency University Hospital, Bucharest, ROU
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Antignani PL, Jezovnik MK, Blinc A, Mikhailidis DP, Anagnostis P, Schernthaner GH, Jensterle M, Studen KB, Sabovic M, Poredos P. Hyperparathyroidism and Peripheral Arterial Disease. Curr Vasc Pharmacol 2024; 22:CVP-EPUB-137918. [PMID: 38284694 DOI: 10.2174/0115701611280905231227045826] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
Primary hyperparathyroidism (PHPT) is presented in various forms, including classic PHPT, characterised by increased parathyroid hormone (PTH) secretion, normohormonal PHPT, and normocalcaemic PHPT. Secondary hyperparathyroidism is characterised by increased PTH secretion triggered by factors such as vitamin D deficiency and kidney failure. This review aims to discuss the involvement of hyperparathyroidism (HPT) in atherosclerosis, including peripheral arterial disease (PAD). The increased level of PTH is involved in developing subclinical and overt vascular diseases, encompassing endothelial dysfunction, vascular stiffness, hypertension, and coronary and peripheral arterial diseases. It has been consistently associated with an augmented risk of cardiovascular morbidity and mortality, independent of classical risk factors for atherosclerosis. Chronic hypercalcemia associated with increased levels of PTH contributes to the development of calcification of vessel walls and atherosclerotic plaques. Vascular calcification can occur in the intima or media of the arterial wall and is associated with stiffness of peripheral arteries, which the formation of atherosclerotic plaques and narrowing of the vessel lumen can follow. For treating hyperparathyroidism, particularly SHPT, calcimimetics, novel phosphorus binders and novel vitamin D receptor activators are used. However, they are ineffective in severe PHPT. Therefore, parathyroidectomy remains the primary therapeutic option of PHPT.
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Affiliation(s)
| | - Mateja K Jezovnik
- The University of Texas Health Science Center at Houston, Department of Advanced, Cardiopulmonary Therapies and Transplantation, Houston, Texas, USA
| | - Ales Blinc
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, Slovenia
| | - Dimitri P Mikhailidis
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London Medical School, University College London (UCL) and Department of Clinical Biochemistry, Royal Free Hospital Campus (UCL), London, UK
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical, School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mojca Jensterle
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Katica Bajuk Studen
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - Miso Sabovic
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, Department of Internal Medicine, University of Ljubljana, Slovenia
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Fusaro M, Barbuto S, Gallieni M, Cossettini A, Re Sartò GV, Cosmai L, Cianciolo G, La Manna G, Nickolas T, Ferrari S, Bover J, Haarhaus M, Marino C, Mereu MC, Ravera M, Plebani M, Zaninotto M, Cozzolino M, Bianchi S, Messa P, Gregorini M, Gasperoni L, Agosto C, Aghi A, Tripepi G. Real-world usage of Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) biomarkers in nephrology practices. Clin Kidney J 2024; 17:sfad290. [PMID: 38223338 PMCID: PMC10784916 DOI: 10.1093/ckj/sfad290] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Indexed: 01/16/2024] Open
Abstract
Background Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications, and increase cardiovascular (CV) risk. Nephrologists' awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice. Methods A national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice. Results One hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10%. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1%) of both PTH and alkaline phosphatase (ALP), 100 (94.3%) of 25(OH)D, and 61 (57.5%) of 1.25(OH)2D; while most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7% and c-terminal: 93.4%), Klotho (95.3%; soluble form: 97.2%), tartrate-resistant acid phosphatase 5b (TRAP-5b) (92.5%), C-terminal telopeptide (CTX) (71.7%), and pro-collagen type 1 N-terminal pro-peptide (P1NP) (88.7%). As interesting data regarding Italian nephrologists' behavior to start treatment of secondary hyperparathyroidism (sHPT), the majority of clinicians used KDOQI guidelines (n = 55, 51.9%). In contrast, only 40 nephrologists (37.7%) relied on KDIGO guidelines, which recommended referring to values of PTH between two and nine times the upper limit of the normal range. Conclusion Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.
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Affiliation(s)
- Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Simona Barbuto
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università di Milano, Milano, Italy
- Post-Graduate School of Specialization in Nephrology, University of Milano, Milano, Italy
- Division of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Althea Cossettini
- Post-Graduate School of Specialization in Nephrology, University of Milano, Milano, Italy
| | | | - Laura Cosmai
- Division of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Thomas Nickolas
- Department of Medicine, Division of Nephrology, Columbia University, New York, NY, USA
| | - Serge Ferrari
- Service des Maladies Osseuses, Département de Médecine, HUG, Geneva, Switzerland
| | - Jordi Bover
- Servicio de Nefrología, Hospital Universitario Germans Trias i Pujol, Badalona (Barcelona), Spain
| | - Mathias Haarhaus
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carmela Marino
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
| | | | - Maura Ravera
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Martina Zaninotto
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefano Bianchi
- Department of Internal Medicine, Nephrology and Dialysis Complex Operative Unit, Livorno, Italy
| | - Piergiorgio Messa
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lorenzo Gasperoni
- Nephrology and Dialysis Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Caterina Agosto
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | | | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
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Andrian T, Stefan A, Nistor I, Covic A. Vitamin K supplementation impact in dialysis patients: a systematic review and meta-analysis of randomized trials. Clin Kidney J 2023; 16:2738-2749. [PMID: 38046003 PMCID: PMC10689161 DOI: 10.1093/ckj/sfad255] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Indexed: 12/05/2023] Open
Abstract
Vitamin K supplementation has been considered recently as a potential treatment for addressing vascular calcification in chronic kidney disease patients. We conducted a systematic review and meta-analysis to summarize the impact of vitamin K supplementation in dialysis patients. Electronic databases were searched for clinical randomized trials among patients treated with vitamin K. Random effects models were performed and risk of bias was evaluated with Cochrane tools and the search was conducted until 15 of September 2023. Eleven trials comprising 830 patients (both adult and pediatric, mainly hemodialysis) compared vitamin K with different controls: lower doses of vitamin K, standard care or placebo. Vitamin K supplementation had no effect on mortality. Vitamin K administration improved vitamin K levels and led to lower levels of dp-uc-MGP and moderately increased calcium levels [0.18 (0.04-0.32)]. Vitamin K1 proved more potency in reducing dp-uc-MGP [SMD -1.64 (-2.05, -1.23) vs. -0.56 (-0.82, -0.31)] and also raised serum vitamin K levels in comparison with vitamin K2 [5.69 (3.43, 7.94) vs. 2.25 (-2.36, 6.87)]. While it did not have a proved benefit in changing calcification scores [-0.14 (-0.37 ± 0.09)], vitamin K proved to be a safe product. There was some concern with bias. Vitamin K supplementation has no impact on mortality and did not show significant benefit in reversing calcification scores. Vitamin K1 improved vitamin K deposits and lowered dp-uc-MGP, which is a calcification biomarker more than vitamin K2. As it proved to be a safe product, additional randomized well-powered studies with improved treatment regimens are needed to establish the true impact of vitamin K in dialysis patients.
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Affiliation(s)
- Titus Andrian
- Internal Medicine, Nephrology, Universitatea de Medicina si Farmacie Grigore T Popa lasi, Iasi, Romania
- Nephrology, Dialysis, Transplantation, Spitalul Clinic Dr C I Parhon, Iasi, Romania
| | - Anca Stefan
- Nephrology, Dialysis, Transplantation, Spitalul Clinic Dr C I Parhon, Iasi, Romania
| | - Ionut Nistor
- Internal Medicine, Nephrology, Universitatea de Medicina si Farmacie Grigore T Popa lasi, Iasi, Romania
- Nephrology, Dialysis, Transplantation, Spitalul Clinic Dr C I Parhon, Iasi, Romania
| | - Adrian Covic
- Internal Medicine, Nephrology, Universitatea de Medicina si Farmacie Grigore T Popa lasi, Iasi, Romania
- Nephrology, Dialysis, Transplantation, Spitalul Clinic Dr C I Parhon, Iasi, Romania
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Matias P, Ávila G, Ferreira AC, Laranjinha I, Ferreira A. Hypomagnesemia: a potential underlooked cause of persistent vitamin D deficiency in chronic kidney disease. Clin Kidney J 2023; 16:1776-1785. [PMID: 37915933 PMCID: PMC10616498 DOI: 10.1093/ckj/sfad123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/20/2022] [Indexed: 11/03/2023] Open
Abstract
Magnesium and vitamin D play important roles in most cells of the body. These nutrients act in a coordinated fashion to maintain physiologic functions of various organs, and their abnormal balance could adversely affect these functions. Therefore, deficient states of both nutrients may lead to several chronic medical conditions and increased cardiovascular and all-cause mortality. Chronic kidney disease (CKD) patients have altered metabolism of both magnesium and vitamin D. Some studies indicate that magnesium could have a role in the synthesis and metabolism of vitamin D, and that magnesium supplementation substantially reversed the resistance to vitamin D treatment in some clinical situations. Recent observational studies also found that magnesium intake significantly interacted with vitamin D status and, particularly with the risk of cardiovascular mortality. It is therefore essential to ensure adequate levels of magnesium to obtain the optimal benefits of vitamin D supplementation in CKD patients. In this review, we discuss magnesium physiology, magnesium and vitamin D metabolism in CKD, potential metabolic interactions between magnesium and vitamin D and its clinical relevance, as well as the possible role of magnesium supplementation to assure adequate vitamin D levels.
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Affiliation(s)
- Patrícia Matias
- Nephrology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Gonçalo Ávila
- Nephrology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Ana Carina Ferreira
- NOVA Medical School, Lisbon, Portugal
- Nephrology department, Hospital Curry Cabral - Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | - Ivo Laranjinha
- Nephrology Department, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Aníbal Ferreira
- NOVA Medical School, Lisbon, Portugal
- Nephrology department, Hospital Curry Cabral - Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
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Seyman EE, Sadeh-Gonik U, Berman P, Blum I, Shendler G, Nathan B, Rothschild O, Molad J, Ben Assayag E, Hallevi H. Association between intracranial vessel calcifications, structural brain damage, and cognitive impairment after minor strokes: a prospective study. Front Neurol 2023; 14:1218077. [PMID: 37533476 PMCID: PMC10393263 DOI: 10.3389/fneur.2023.1218077] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Background Vascular calcifications are a hallmark of atherosclerosis, and in the coronary arteries are routinely used as a prognostic marker. Calcifications of intracranial vessels (ICC) are frequently observed on non-contrast CT (NCCT) and their effect on post-stroke cognitive impairment (PSCI) remains unclear. Our aim was to explore the association of ICC with prospective long-term cognitive function and advanced MRI-measures in a large prospective cohort of cognitively intact mild stroke survivors. Methods Data from the Tel-Aviv brain acute stroke cohort (TABASCO) study [ClinicalTrials.gov #NCT01926691] were analyzed. This prospective cohort study (n = 575) aimed to identify predictors of PSCI, in cognitively intact mild stroke survivors. A quantitative assessment of the intracranial calcium content - The ICC score (ICCS) was calculated semi-automatically on NCCT using a validated calcium quantification application. Participants underwent a 3 T-MRI and prospective comprehensive cognitive clinical and laboratory assessments at enrollment, 6, 12, and 24-months. Results Data were available for 531 participants (67.4 years, 59.5% males). The incidence of PSCI at two-years doubled in the high ICCS group (26% vs. 13.7%, p < 0.001). The high ICCS group had significantly greater small-vessel-disease (SVD) tissue changes and reduced microstructural-integrity assessed by Diffusion-Tensor-Imaging (DTI) maps (p < 0.05 for all). In multivariate analysis, a higher ICCS was independently associated with brain atrophy manifested by lower normalized white and gray matter, hippocampal and thalamic volumes (β = -0.178, β = -0.2, β = -0.137, β = -0.157; p < 0.05) and independently predicted PSCI (OR 1.83, 95%CI 1.01-3.35). Conclusion Our findings suggest that the ICCS, which is a simple and readily available imaging marker on NCCT, is associated with brain atrophy, microstructural damage, the extent of SVD, and may predict PSCI. This finding has implications for identifying individuals at risk for PSCI and implementing targeted interventions to mitigate this risk.
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Affiliation(s)
- Estelle Emanuelle Seyman
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Sadeh-Gonik
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Phillip Berman
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itay Blum
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Genady Shendler
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Bornstein Nathan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Brain Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ofer Rothschild
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeremy Molad
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einor Ben Assayag
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hen Hallevi
- Stroke Department Division of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Del Toro R, Palmese F, Feletti F, Zani G, Minguzzi MT, Maddaloni E, Napoli N, Bedogni G, Domenicali M. Relationship between Muscle Mass, Bone Density and Vascular Calcifications in Elderly People with SARS-CoV-2 Pneumonia. J Clin Med 2023; 12:jcm12062372. [PMID: 36983372 PMCID: PMC10059976 DOI: 10.3390/jcm12062372] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Little is known about the changes in organs and tissues that may make elder patients more vulnerable to acute stressors such as SARS-CoV-2 infection. METHODS In 80 consecutive elderly patients with SARS-CoV-2 infection, we evaluated the association between the descending thoracic aorta calcium score, L1 bone density and T12 skeletal muscle density measured on the same scan by high-resolution computed tomography. RESULTS At median regression, the ln-transformed DTA calcium score was inversely associated with L1 bone density (-0.02, 95%CI -0.04 to -0.01 ln-Agatston units for an increase of 1 HU) and with T12 muscle density (-0.03, -0.06 to -0.001 ln-Agatston units for an increase of 1 HU). At penalized logistic regression, an increase of 1 ln-Agatston unit of DTA calcium score was associated with an OR of death of 1.480 (1.022 to 2.145), one of 1 HU of bone density with an OR of 0.981 (0.966 to 0.996) and one of 1 HU of muscle density with an OR of 0.973 (0.948 to 0.999). These relationships disappeared after correction for age and age was the stronger predictor of body composition and death. CONCLUSIONS Age has a big effect on the relationship between vascular calcifications, L1 bone density and T12 muscle density and on their relationship with the odds of dying.
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Affiliation(s)
- Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Francesco Palmese
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Francesco Feletti
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Maria Teresa Minguzzi
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Giorgio Bedogni
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Marco Domenicali
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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Guidi L, Lareyre F, Chaudhuri A, Cong Duy L, Adam C, Carrier M, Réda HK, Elixène JB, Raffort J. Automatic measurement of vascular calcifications in patients with aorto-iliac occlusive disease to predict the risk of re-intervention after endovascular repair. Ann Vasc Surg 2022; 83:10-19. [PMID: 35271959 DOI: 10.1016/j.avsg.2022.02.013] [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] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is currently a lack of consensus and tools to easily measure vascular calcification using computed tomography angiography (CTA). The aim of this study was to develop a fully automatic software to measure calcifications and to evaluate the interest as predictive factor in patients with aorto-iliac occlusive disease. METHODS This study retrospectively included 171 patients who had endovascular repair of an aorto-iliac occlusive lesion at the University Hospital of Nice between January 2011 and December 2019. Calcifications volumes were measured from CT-angiography (CTA) using an automatic method consisting in 3 sequential steps: image pre-processing, lumen segmentation using expert system and deep learning algorithms and segmentation of calcifications. Calcification volumes were measured in the infrarenal abdominal aorta and the iliac arterial segments, corresponding to the common and the external iliac arteries. RESULTS Among 171 patients included with a mean age of 65 years, the revascularization was performed on the native external and internal iliac arteries in respectively: 83 patients (48.5%); 107 (62.3%) and 7 (4.1%). The mean volumes of calcifications were 2759 mm3 in the infrarenal abdominal aorta, 1821 mm3 and 1795 mm3 in the right and left iliac arteries. For a mean follow up of 39 months, TLR was performed in 55 patients (32.2%). These patients had higher volume of calcifications in the right and left iliac arteries, compared with patients who did not have a re-intervention (2274 mm3 vs 1606 mm3, p=0.0319 and 2278 vs 1567 mm3, p=0.0213). CONCLUSION The development of a fully automatic software would be useful to facilitate the measurement of vascular calcifications and possibly better inform the prognosis of patients.
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Affiliation(s)
- Lucas Guidi
- Department of Vascular Surgery, University Hospital of Nice, France
| | - Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, Inserm U1065, C3M, Nice, France.
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Lê Cong Duy
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, Inserm U1065, C3M, Nice, France
| | - Cédric Adam
- Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, France
| | - Marion Carrier
- Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, France
| | | | | | - Juliette Raffort
- Université Côte d'Azur, Inserm U1065, C3M, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France
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10
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Pellico J, Fernández-Barahona I, Ruiz-Cabello J, Gutiérrez L, Muñoz-Hernando M, Sánchez-Guisado MJ, Aiestaran-Zelaia I, Martínez-Parra L, Rodríguez I, Bentzon J, Herranz F. HAP-Multitag, a PET and Positive MRI Contrast Nanotracer for the Longitudinal Characterization of Vascular Calcifications in Atherosclerosis. ACS Appl Mater Interfaces 2021; 13:45279-45290. [PMID: 34529427 PMCID: PMC8485330 DOI: 10.1021/acsami.1c13417] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
Vascular microcalcifications are associated with atherosclerosis plaque instability and, therefore, to increased mortality. Because of this key role, several imaging probes have been developed for their in vivo identification. Among them, [18F]FNa is the gold standard, showing a large uptake in the whole skeleton by positron emission tomography. Here, we push the field toward the combined anatomical and functional early characterization of atherosclerosis. For this, we have developed hydroxyapatite (HAP)-multitag, a bisphosphonate-functionalized 68Ga core-doped magnetic nanoparticle showing high affinity toward most common calcium salts present in microcalcifications, particularly HAP. We characterized this interaction in vitro and in vivo, showing a massive uptake in the atherosclerotic lesion identified by positron emission tomography (PET) and positive contrast magnetic resonance imaging (MRI). In addition, this accumulation was found to be dependent on the calcification progression, with a maximum uptake in the microcalcification stage. These results confirmed the ability of HAP-multitag to identify vascular calcifications by PET/(T1)MRI during the vulnerable stages of the plaque progression.
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Affiliation(s)
- Juan Pellico
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, SE1 7EH London, U.K.
| | - Irene Fernández-Barahona
- Facultad
de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
- NanoMedMol
Group, Instituto de Química Medica (IQM), Consejo Superior
de Investigaciones Científicas (CSIC), 28006 Madrid, Spain
| | - Jesús Ruiz-Cabello
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Facultad
de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
- IKERBASQUE,
Basque Foundation for Science, 48013 Bilbao, Spain
| | - Lucía Gutiérrez
- Departamento
de Química Analítica, Instituto
de Nanociencia y Materiales de Aragón, Universidad de Zaragoza-CSIC
y CIBER-BBN, 50018 Zaragoza, Spain
| | - María Muñoz-Hernando
- Centro
Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
- NanoMedMol
Group, Instituto de Química Medica (IQM), Consejo Superior
de Investigaciones Científicas (CSIC), 28006 Madrid, Spain
| | - María J. Sánchez-Guisado
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
| | - Irati Aiestaran-Zelaia
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
| | - Lydia Martínez-Parra
- Center
for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), 20014 Donostia
San Sebastián, Spain
| | - Ignacio Rodríguez
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Facultad
de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jacob Bentzon
- Centro
Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Fernando Herranz
- CIBER
de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- NanoMedMol
Group, Instituto de Química Medica (IQM), Consejo Superior
de Investigaciones Científicas (CSIC), 28006 Madrid, Spain
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11
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Sogomonian R, Bernhardt L, Sood A, Bazi L, Kataria V, Gowda RM. Intravascular shockwave lithotripsy as a treatment modality for symptomatic mesenteric ischemia. Future Cardiol 2021; 17:1313-1320. [PMID: 33739167 DOI: 10.2217/fca-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic mesenteric ischemia has traditionally been treated with either open surgical revascularization or endovascular therapy. Endovascular surgery has typically been preferred due to the lower rates of peri-procedural and post-procedural morbidity, yet this comes at the expense of long-term durability. Intravascular shockwave lithotripsy is a technique utilized to modify intimal and medial calcified plaque in order to improve vessel expansion and patency. Intravascular lithotripsy has been investigated as both primary and adjunctive treatment for peripheral arterial and coronary arterial lesions, however, its use in the treatment of chronic mesenteric ischemia requires further investigation. We present a case of a 75-year-old woman with symptomatic mesenteric ischemia who underwent intravascular shockwave lithotripsy of a 99% stenosis superior mesenteric artery with an excellent outcome.
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Affiliation(s)
- Robert Sogomonian
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Logan Bernhardt
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai (Beth Israel), New York, NY 10003, USA
| | - Abhinav Sood
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Lucas Bazi
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Vikaas Kataria
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
| | - Ramesh M Gowda
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10003, USA
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12
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Anderson MA, Kordbacheh H, Joseph E, Bennett SE, Stanford FC, Kambadakone A. Computed tomography findings of metabolic syndrome in patients with acute colonic diverticulitis. J Med Imaging Radiat Oncol 2021; 65:279-285. [PMID: 33591625 DOI: 10.1111/1754-9485.13151] [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] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many factors associated with colonic diverticulitis are also part of the clinical definition of the metabolic syndrome. Computed tomography (CT) is commonly performed in symptomatic patients, such as those with suspected or known acute diverticulitis, and could add additional value for the health of these patients by identifying and reporting CT biomarkers of metabolic syndrome, if present and detectable. The purpose of this study was to identify CT biomarkers of metabolic syndrome in patients with acute colonic diverticulitis. METHODS We retrospectively reviewed 243 patients (mean-60 yrs, M:F:126:117) diagnosed with colonic diverticulitis on CT between March 2015 and March 2017 for hepatic steatosis, vascular calcifications, abdominal diameters and fat volumes. Criteria of metabolic syndrome were obtained from medical records. Differences in imaging biomarkers were compared using chi-square comparisons stratified by metabolic syndrome, abdominal diameter and fat volume. RESULTS Of 243 patients, 33% demonstrated hepatic steatosis and 71% atherosclerotic vascular calcifications on CT. 28% met criteria for metabolic syndrome. Patients with metabolic syndrome had higher occurrence of hepatic steatosis, sagittal diameter ≥ 35 cm, visceral fat > 5000 cm3 and subcutaneous fat > 8300 cm3 (P < 0.05), but not vascular calcifications (P > 0.05). CONCLUSIONS CT biomarkers of metabolic syndrome are commonly encountered in patients with acute diverticulitis. Recognizing and reporting these findings can guide towards further evaluation for metabolic syndrome.
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Affiliation(s)
- Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Hamed Kordbacheh
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Evita Joseph
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Susan E Bennett
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine- Neuroendocrine Units, Department of Pediatrics- Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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13
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Fernández P, Douthat W, Castellano M, Cardozo G, Garay G, de Arteaga J, Chiurchiu C, de la Fuente J. Biomarkers of bone and mineral disorders (FGF-23, fetuin-A) and vascular calcification scores as predictive tools for cardiovascular death in dialysis patients, at 10 years of follow-up. Medicina (B Aires) 2021; 81:191-197. [PMID: 33906137] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular disorders represent the leading cause of death in dialysis patients. Alterations of bone and mineral metabolism (BMM) and vascular calcifications play a fundamental role in it. The objective of this study was to evaluate the predictive role on cardiovascular mortality of the measurement of biomarkers of BMM and vascular calcifications. A prospective cohort study was performed. All prevalent patients on chronic dialysis in September 2009 at our institution, who completed the total of the complementary studies, were studied. BMM biomarkers were measured (FGF 23, fetuin A, PTH, calcium and phosphorus) and the vascular calcifications were evaluated using the Kauppila and Adragao scores. Follow-up was carried out until 1/1/2019, death or transplant. Of the 30 patients included, 7 (23.3%) died due to cardiovascular causes. The follow-up time was 44.1 ± 30.4 (range = 1.4-112) months. The Adragao score was the only predictive variable of long-term cardiovascular mortality (area under the curve = 0.82; 95% CI 0.64-0.94; p < 0.001). The best cut-off point was 5 (sensitivity = 85.7%; specificity = 78.3%). It was also an independent risk factor for cardiovascular mortality adjusted for age, diabetes mellitus, coronary heart disease, aortic calcifications, time spent on dialysis and follow-up time (adjusted OR = 1.77; 95% CI = 1.06-2.96; p = 0.028). The vascular calcifications quantified from the Adragao score were the only independent predictor of long-term cardiovascular mortality. This score represents a simple, useful and superior tool to the biomarkers of BMM.
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Affiliation(s)
- Pehuén Fernández
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina. E-mail:
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Mauro Castellano
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Gabriela Cardozo
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Gabriela Garay
- Laboratorio de Química Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
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14
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Zorlu Y, Brown C, Keil C, Ayhan MM, Haase H, Thompson RB, Lengyel I, Yücesan G. Fluorescent Arylphosphonic Acids: Synergic Interactions between Bone and the Fluorescent Core. Chemistry 2020; 26:11129-11134. [PMID: 32293767 PMCID: PMC7496659 DOI: 10.1002/chem.202001613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 12/23/2022]
Abstract
Herein, we report the third generation of fluorescent probes (arylphosphonic acids) to target calcifications, particularly hydroxyapatite (HAP). In this study, we use highly conjugated porphyrin-based arylphosphonic acids and their diesters, namely 5,10,15,20-tetrakis[m-(diethoxyphosphoryl)phenyl]porphyrin (m-H8 TPPA-OEt8 ) and 5,10,15,20-tetrakis [m-phenylphosphonic acid]porphyrin (m-H8 TPPA), in comparison with their positional isomers 5,10,15,20-tetrakis[p-(diisopropoxyphosphoryl)phenyl]porphyrin (p-H8 TPPA-iPr8 ) and 5,10,15,20-tetrakis [p-phenylphosphonic acid]porphyrin (p-H8 TPPA), which have phosphonic acid units bonded to sp2 carbon atoms of the fluorescent core. The conjugation of the fluorescent core is thus extended to the (HAP) through sp2 -bonded -PO3 H2 units, which generates increased fluorescence upon HAP binding. The resulting fluorescent probes are highly sensitive towards the HAP in rat bone sections. The designed probes are readily taken up by cells. Due to the lower reported toxicity of (p-H8 TPPA), these probes could find applications in monitoring bone resorption or adsorption, or imaging vascular or soft tissue calcifications for breast cancer diagnosis etc.
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Affiliation(s)
- Yunus Zorlu
- Department of ChemistryFaculty of ScienceGebze Technical University41400Gebze-KocaeliTurkey
| | - Connor Brown
- Wellcome-Wolfson Institute for Experimental MedicineSchool of Medicine, Dentistry and Biomedical ScienceQueen's University BelfastBelfastBT9 7BLUK
| | - Claudia Keil
- Technische Universität BerlinChair of Food Chemistry and ToxicologyStraße des 17. Juni 13510623BerlinGermany
| | - M. Menaf Ayhan
- Department of ChemistryFaculty of ScienceGebze Technical University41400Gebze-KocaeliTurkey
| | - Hajo Haase
- Technische Universität BerlinChair of Food Chemistry and ToxicologyStraße des 17. Juni 13510623BerlinGermany
| | - Richard B. Thompson
- Department of Biochemistry and Molecular BiologyUniversity of Maryland School of MedicineBaltimoreMaryland21201USA
| | - Imre Lengyel
- Wellcome-Wolfson Institute for Experimental MedicineSchool of Medicine, Dentistry and Biomedical ScienceQueen's University BelfastBelfastBT9 7BLUK
| | - Gündoğ Yücesan
- Technische Universität BerlinChair of Food Chemistry and ToxicologyStraße des 17. Juni 13510623BerlinGermany
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15
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Mayer O, Seidlerová J, Kučera R, Kučerová A, Černá V, Gelžinský J, Mateřánková M, Mareš Š, Kordíková V, Pešta M, Topolčan O, Cífková R, Filipovský J. Synergistic effect of sclerostin and angiotensin II receptor 1 polymorphism on arterial stiffening. Biomark Med 2020; 14:173-184. [PMID: 32057249 DOI: 10.2217/bmm-2019-0249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: We aimed to establish the association between sclerostin (a glycoprotein involved in bone metabolism) and development of pulse wave velocity (PWV) in the general population. Methods: A prospective cohort study with a total of 522 subjects. Aortic PWV was measured twice (at baseline and after approximately 8 years of follow-up) and intraindividual change in PWV per year (ΔPWV/year) was calculated. Results: ΔPWV/year increased across the sclerostin quintiles, but generally in a strong age-dependent manner. However, a significant independent positive association between sclerostin and ΔPWV/year was observed exclusively in C allele carriers of rs5186 polymorphism for the angiotensin II receptor 1 (n = 246). Conclusion: Sclerostin concentrations were associated with an accelerated natural course of arterial stiffening, but only in interaction with renin-angiotension system.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Radek Kučera
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Alena Kučerová
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.,Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Václava Černá
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.,Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Július Gelžinský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Markéta Mateřánková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Štěpán Mareš
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Veronika Kordíková
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Martin Pešta
- Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.,Department of Biology, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Ondřej Topolčan
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer's Hospital, Prague, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic.,Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
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16
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Baralić M, Brković V, Stojanov V, Stanković S, Lalić N, Đurić P, Đukanović L, Kašiković M, Petrović M, Petrović M, Stošović M, Ležaić V. Dual Roles of the Mineral Metabolism Disorders Biomarkers in Prevalent Hemodilysis Patients: In Renal Bone Disease and in Vascular Calcification. J Med Biochem 2019; 38:134-44. [PMID: 30867641 DOI: 10.2478/jomb-2018-0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Vascular calcification (VC) is highly prevalent in dialysis (HD) patients, and its mechanism is multifactorial. Most likely that systemic or local inhibitory factor is overwhelmed by promoters of VC in these patients. VC increased arterial stiffness, and left ventricular hypertrophy. Thus, the present study aimed to investigate the association of VC and myocardial remodeling and to analyze their relationship with VC promoters (fibroblast growth factor 23-FGF23, Klotho, intact parathormon-iPTH, vitamin D) in 56 prevalent HD patients (median values: age 54 yrs, HD vintage 82 months). Methods Besides routine laboratory analyzes, serum levels of FGF 23, soluble Klotho, iPTH, 1,25-dihydroxyvitamin D3; pulse wave velocity (PWV); left ventricular (LV) mass by ultrasound; and VCs score by Adragao method were measured. Results VC was found in 60% and LV concentric or eccentric hypertrophy in 50% patients. Dialysis vintage (OR 1.025, 95%CI 1.007–1.044, p=0.006) FGF23 (OR 1.006, 95% CI 0.992–1.012, p=0.029) and serum magnesium (OR 0.000, 95%CI 0.000–0.214, p=0.04) were associated with VC. Changes in myocardial geometry was associated with male sex (beta=-0.273, 95% CI -23.967 1.513, p=0.027), iPTH (beta 0.029, 95%CI -0.059–0.001, p=0.027) and vitamin D treatment (beta 25.49, 95%CI 11.325–39.667, p=0.001). Also, patients with the more widespread VC had the highest LV remodeling categories. PWV was associated patient’s age, cholesterol, diastolic blood pressure, LV mass (positively) and serum calcium (negatively), indicating potential link with atherosclerotic risk. Conclusions Despite to different risk factors for VC and myocardial remodeling, obtained results could indicate that risk factors intertwine in long-term treatment of HD patients and therefore careful and continuous correction of mineral metabolism disorders is undoubtedly of the utmost importance.
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17
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Serhal A, Koktzoglou I, Edelman RR. Feasibility of Image Fusion for Concurrent MRI Evaluation of Vessel Lumen and Vascular Calcifications in Peripheral Arterial Disease. AJR Am J Roentgenol 2019; 212:914-8. [PMID: 30714829 DOI: 10.2214/AJR.18.20000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE With MR angiography of peripheral arterial disease, calcifications are unapparent, so a separate calcification-sensitive pulse sequence (proton density-weighted in-phase 3D stack-of-stars [PDIP-SOS]) is needed for complete assessment. We hypothesized that, despite being acquired separately, MR angiography and PDIP-SOS images could be coregistered and fused without loss of significant diagnostic information. CONCLUSION In a prospective study of 15 patients, MR image fusion enabled the simultaneous display of vessel lumen and vascular calcifications similarly to CT angiography.
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18
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Truong DH, Riedhammer MM, Zinszer K. Non-uraemic calciphylaxis successfully treated with pamidronate infusion. Int Wound J 2018; 16:250-255. [PMID: 30393969 DOI: 10.1111/iwj.13019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 01/11/2023] Open
Abstract
Calciphylaxis is a rare and potentially fatal disease that affects the subcutaneous layer of the skin. It is a calcific vasculopathy induced by a systemic process that causes occlusion of small blood vessels. The mortality rate for individuals diagnosed with calciphylaxis is estimated between 52% and 81% with sepsis being the leading cause of death. Uraemic calciphylaxis and its known effective treatments are well documented in the literature. Unfortunately, there is no known effective treatment for non-uraemic calciphylaxis. Most of the current treatments for non-uraemic calciphylaxis are derived from uraemic calciphylaxis treatment protocols. We report a case of a 75-year-old female with calciphylaxis on the right lower extremity who was successfully treated with four pamidronate infusions in addition to local wound care. This case represents a non-uraemic calciphylaxis wound successfully treated with pamidronate infusions and standard wound care, and suggests that IV pamidronate can be an effective treatment option.
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Affiliation(s)
- David H Truong
- Podiatric Medicine and Surgery Residency, Geisinger Community Medical Center, Scranton, Pennsylvania
| | | | - Kathya Zinszer
- Department of Orthopaedics, Geisinger Medical Center, Danville, Pennsylvania
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19
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Piscopo G, Morrone L. [ASSOCIATION BETWEEN VERTEBRAL FRACTURES AND VASCULAR CALCIFICATIONS]. G Ital Nefrol 2017; 34:2017-vol6-9. [PMID: 29207225] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Several cross-sectional and prospective studies highlight the existence of an association between bone fractures and abdominal aortic calcifications, especially if particularly severe and independent from confounders such as aging, smoking habits and diabetes. This phenomenon affects not only the general population but also patients with chronic kidney disease in which cortical bone lesions are prevalent. Moreover, bone fractures and aortic calcifications have been proved to be linked to increased cardiovascular morbidity and mortality, both in the general populations and in patients with chronic kidney disease, who notoriously show elevated cardiovascular risks. Therefore, diagnostic investigations about bone fractures and abdominal aortic calcifications, particularly in patients with chronic kidney disease, may represent a useful tool for identification of patients with a higher cardiovascular risk in order to optimize therapies for bone metabolism disorders.
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Affiliation(s)
| | - Luigi Morrone
- UOC Nefrologia e Dialisi, Ospedale SS Annunziata, Taranto
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20
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Abstract
The effect of chronic metabolic acidosis (MA) on cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) is largely unknown. Therefore, we aimed to study this relationship in nondialysis CKD patients.This cross-sectional, single-center study prospectively enrolled 95 clinically stable CKD patients (median age 61 (58, 65) years, 60% male, median eGFR 27 (22, 32) mL/min). Data on CKD etiology, CVD history, CVD traditional, and nontraditional risk factors were obtained. Also, markers of subclinical CVD were assessed: intima-media thickness (IMT), abdominal aortic calcifications (Kauppila score-AACs), cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), ejection fraction, and interventricular septum thickness. Using the serum bicarbonate cutoff value of 22 mEq/L, comparisons between MA (<22 mEq/L; 43 patients) and non-MA (≥22 mEq/L; 52 patients) groups were performed.Vascular (40%), tubulointerstitial (24%), and glomerular (22%) nephropathies were the main causes of CKD. Twenty-three percent of patients had diabetes mellitus, but only 5% were considered to have diabetic nephropathy. Patients with chronic MA had lower eGFR (P < .01), higher iPTH (P = .01), higher serum phosphate (P < .01), and increased serum cholesterol (P = .04) and triglycerides (P = .01).Higher ABI (P = .04), lower IMT (P = .03), CAVI (P = .05), and AACs (P = .03) were found in patients with chronic MA.Separate binomial logistic regression models were performed using ABI (cutoff 0.9), CAVI (cutoff 9), IMT (cutoff 0.1 cm), and AACs (cutoff 1) as dependent variables. MA was used as independent variable and adjustments were made for iPTH, serum phosphate, eGFR, proteinuria, cholesterol, triglycerides, CVD score. The absence of MA was retained as an independent predictor only for the presence of AACs.In conclusion, the present study shows a potential advantageous effect of MA on vascular calcifications in predialysis CKD patients. Thus, a guideline relaxation of the serum bicarbonate target might prove to be beneficial in CKD patients at high risk of vascular calcifications. However, one should always consider the negative effects of MA. Therefore, additional research is warranted before any clear clinical recommendation.
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Affiliation(s)
- Cristina Căpuşă
- Nephrology Department, “Carol Davila” University of Medicine and Pharmacy
- “Dr Carol Davila” Teaching Hospital of Nephrology
| | - Gabriel Ştefan
- Nephrology Department, “Carol Davila” University of Medicine and Pharmacy
- “Dr Carol Davila” Teaching Hospital of Nephrology
| | - Simona Stancu
- Nephrology Department, “Carol Davila” University of Medicine and Pharmacy
- “Dr Carol Davila” Teaching Hospital of Nephrology
| | | | | | - Gabriel Mircescu
- Nephrology Department, “Carol Davila” University of Medicine and Pharmacy
- “Dr Carol Davila” Teaching Hospital of Nephrology
- Romanian Renal Registry, Bucharest, Romania
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21
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Patil PV, Patil MG, Patil AM. Isolated intrasplenic vascular calcifications in a child with type 1 diabetes mellitus---A case report. J Clin Ultrasound 2017; 45:438-440. [PMID: 27813102 DOI: 10.1002/jcu.22418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
We report a case of vascular calcifications in the spleen of a 7-year-old girl who was diagnosed with type 1 diabetes mellitus (DM). The possible etiology for vascular calcifications might be medial sclerosis associated with DM. To the best of our knowledge, this finding has not yet been reported in the literature. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:438-440, 2017.
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Affiliation(s)
- Parag V Patil
- Department of Radiology, Lifecare Hospital, Musaffah, Box 133500, Abu Dhabi, United Arab Emirates
| | - Manojkumar G Patil
- Department of Pediatrics, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, India, 411018
| | - Abhijit M Patil
- Department of Radiology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, India, 411018
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22
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Mayer O. [Matrix Gla protein as natural inhibitor of vascular calcification and potential treatment target]. Cas Lek Cesk 2017; 155:13-6. [PMID: 27481196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Vascular calcification was once regarded as an advanced stage of atherosclerosis only. However, calcification is currently considered as highly regulated and potentially reversible process.Matrix Gla protein (MGP) represents natural inhibitor of vascular calcification, whereas vitamin K is key co-factor of its maturation to the active form. There is accumulating evidence that vitamin K status and corresponding MGP activity may influence cardiovascular risk. This review summarizes pathophysiological mechanism and recent evidence relative to MGP. Moreover, available data concerning vitamin K supplementation are depicted.
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23
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Marinelli A, Di Napoli A. [ Vascular calcifications in subjects with and without chronic renal failure: types, sites and risk factors]. G Ital Nefrol 2017; 34:88-99. [PMID: 28682566] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Vascular calcifications worse outcomes in the general population and in patients on dialysis. We investigated 146 patients on chronic hemodialysis and 63 healthy controls with normal renal function under 65 years of age. All subjects underwent B-mode ultrasonography of common and internal carotid artery, abdominal aorta, common and superficial femoral artery and posterior tibial artery to assess the presence of intimal and medial calcifications. Intimal and media calcifications were present at the level of the carotid vessel, the abdominal aorta, the common femoral artery, the superficial femoral artery and the posterior tibial artery, respectively in 45%, 50%, 45%, 50%, 42% of patients on dialysis and in 5%, 15%, 24%, 5%, 2% of controls (p <0,01). On multivariate logistic analysis of regression, after adjustment for potential confounders, carotid intimal calcification, abdominal aortic calcification, medial calcification of the superficial femoral artery and posterior tibial artery calcification were associated with dialysis and with cardiovascular disease. Only intimal arterial calcification were associated with older age and smoking. Vascular calcifications are extremely common in middle-aged patients on chronic hemodialysis. Ultrasonography currently available in Nephrology, is a sensitive, reproducible, inexpensive imaging technique to identify arterial intimal and medial calcification in high-risk cardiovascular subjects.
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Affiliation(s)
| | - Anteo Di Napoli
- Registro Italiano di Dialisi e Trapianto Renale, Roma, Italia
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24
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Ratti C, Grassi L, Ferramosca E, Raggi P. [Imaging in CKD]. G Ital Nefrol 2017; 34:205-222. [PMID: 28682040] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Imaging has contributed to the successful reduction of cardiovascular morbidity and mortality in the general population and it has demonstrated excellent potential among patients with chronic kidney disease (CKD). The well-known severity of cardiovascular disease in patients suffering from CKD requires an accurate risk stratification of these patients in several clinical situations. Alterations of both structure and function of the myocardium as well as severe vasculopathy are highly prevalent in patients with advanced CKD. Hence sophisticated imaging techniques are at times necessary to make an accurate assessment of risk. Two main forms of arterial pathology develop in patients with CKD: atherosclerosis, with accumulation of inflammatory cells, lipids, fibrous tissue and calcium in the sub-intimal space of the artery, and arteriosclerosis. The latter is characterized by thickening and calcification of the muscular layer of the arterial wall and it is not necessarily associated with typical atherosclerotic changes. This review explores the indications, strengths and weaknesses of several invasive and non-invasive imaging modalities employed to evaluate myocardial and vascular disease in CKD.
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Affiliation(s)
- Carlo Ratti
- Unità Operativa di Cardiologia, Ospedale Ramazzini, Carpi, Modena, Italy
| | - Laura Grassi
- Unità Operativa di Cardiologia, Nuovo Ospedale Civile Sant'Agostino Estense, Baggiovara, Modena, Italy
| | - Emiliana Ferramosca
- Unità Operativa Complessa di Nefrologia, Dialisi e Trapianto. Ospedale Vito Fazzi, Lecce, Italy
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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25
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Ferreira Botelho MP, Koktzoglou I, Collins JD, Giri S, Carr JC, Gupta N, Edelman RR. MR imaging of iliofemoral peripheral vascular calcifications using proton density-weighted, in-phase three-dimensional stack-of-stars gradient echo. Magn Reson Med 2016; 77:2146-2152. [PMID: 27297954 DOI: 10.1002/mrm.26295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 11/08/2022]
Abstract
PURPOSE The presence of vascular calcifications helps to determine percutaneous access for interventional vascular procedures and has prognostic value for future cardiovascular events. Unlike CT, standard MRI techniques are insensitive to vascular calcifications. In this prospective study, we tested a proton density-weighted, in-phase (PDIP) three-dimensional (3D) stack-of-stars gradient-echo pulse sequence with approximately 1 mm3 isotropic spatial resolution at 1.5 Tesla (T) and 3T to detect iliofemoral peripheral vascular calcifications and correlated MR-determined lesion volumes with CT angiography (CTA). METHODS The study was approved by the Institutional Review Board. The prototype PDIP stack-of-stars pulse sequence was applied in 12 patients with iliofemoral peripheral vascular calcifications who had undergone CTA. RESULTS Vascular calcifications were well visualized in all subjects, excluding segments near prostheses or stents. The location, size, and shape of the calcifications were similar to CTA. Quantitative analysis showed excellent correlation (r2 = 0.84; P < 0.0001) between MR- and CT-based measures of calcification volume. In one subject in whom three pulse sequences were compared, PDIP stack-of-stars outperformed cartesian 3D gradient-echo and point-wise encoding time reduction with radial acquisition (PETRA). CONCLUSION In this pilot study, a PDIP 3D stack-of-stars gradient-echo pulse sequence with high spatial resolution provided excellent image quality and accurately depicted the location and volume of iliofemoral vascular calcifications. Magn Reson Med 77:2146-2152, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Marcos P Ferreira Botelho
- Radiology, Northwestern Medicine, Chicago, Illinois, USA.,Radiology, Northshore University HealthSystem, Evanston, Illinois, USA
| | - Ioannis Koktzoglou
- Radiology, Northshore University HealthSystem, Evanston, Illinois, USA.,Radiology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | - James C Carr
- Radiology, Northwestern Medicine, Chicago, Illinois, USA
| | - NavYash Gupta
- Surgery, Northshore University HealthSystem, Evanston, Illinois, USA
| | - Robert R Edelman
- Radiology, Northwestern Medicine, Chicago, Illinois, USA.,Radiology, Northshore University HealthSystem, Evanston, Illinois, USA
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26
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Woelfle-Roos JV, Dautel L, Wernerus D, Woelfle KD, Reichel H. Vascular Calcifications on the Preoperative Radiograph: Predictor of Ischemic Complications in Total Knee Arthroplasty? J Arthroplasty 2016; 31:1078-82. [PMID: 26753606 DOI: 10.1016/j.arth.2015.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 09/17/2015] [Revised: 11/12/2015] [Accepted: 11/20/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vascular calcifications seen on the preoperative radiograph of patients scheduled for total knee arthroplasty (TKA) are intuitively seen as a risk factor for ischemic complications though there is no empiric evidence to support this assumption. The aim of this study was the correlation of perioperative ischemic complications and vascular calcifications of patients undergoing TKA. METHODS In this retrospective analysis, all 825 patients who had undergone primary TKA in the period 2009-2011 with intraoperative use of a tourniquet were included. Patients with pathologic pulse status and history of vascular intervention were excluded. Vascular calcifications seen on the preoperative radiograph were classified as intimal-type and medial-type calcifications and were correlated to perioperative ischemic complications. RESULTS Vascular calcifications were seen in 268 patients (medial type: n = 54, intimal type: n = 214). Major ischemic complications such as arterial thrombosis were seen in 2 patients, one of them with intimal-type calcifications and one without (complication rate 0.5% vs 0.2%, P = .715). The rate of minor ischemic complications such as protracted wound healing was significantly elevated in patients with intimal-type calcifications (6.1%) when compared to patients with medial-type calcifications (1.9%) and those without (1.6%, P = .003) even when multiple regression analysis was performed taking into account 2 potential influencing factors "age" and "diabetes mellitus" (P = .008). CONCLUSION Owing to the significantly increased risk of ischemic complications in patients with intimal-type calcifications undergoing TKA, we recommend high alertness to the presence of calcifications on preoperative radiographs, careful intraoperative soft tissue management, and postoperative monitoring of the vascular status.
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Affiliation(s)
| | - Laura Dautel
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | - Dirk Wernerus
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | | | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
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27
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Caluwé R, Pyfferoen L, De Boeck K, De Vriese AS. The effects of vitamin K supplementation and vitamin K antagonists on progression of vascular calcification: ongoing randomized controlled trials. Clin Kidney J 2015; 9:273-9. [PMID: 26985380 PMCID: PMC4792621 DOI: 10.1093/ckj/sfv146] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 10/03/2015] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
Background The extent and the progression of vascular calcification (VC) are independent predictors of cardiovascular risk in the haemodialysis population. Vitamin K is essential for the activation of matrix gla protein (MGP), a powerful inhibitor of tissue calcification. Functional vitamin K deficiency may contribute to the high VC burden in haemodialysis patients. In addition, haemodialysis patients are frequently treated with vitamin K antagonists, mainly to prevent stroke in atrial fibrillation, potentially compounding the cardiovascular risk in these already vulnerable patients. New oral anticoagulants (NOACs) are valuable alternatives to vitamin K antagonists in the general population, but their use in dialysis has been encumbered by substantial renal clearance. However, a recent pharmacokinetic study provided information on how to use rivaroxaban in haemodialysis patients. Methods We conduct a randomized, prospective, multicentre, open-label interventional clinical trial that will include 117 chronic haemodialysis patients with non-valvular atrial fibrillation, treated with or candidates for treatment with vitamin K antagonists. Patients will be randomized to a vitamin K antagonist titrated weekly to an international normalized ratio between 2 and 3, a daily dose of rivaroxaban of 10 mg, or a daily dose of rivaroxaban 10 mg with a thrice weekly supplement of 2000 µg vitamin K2. Cardiac computed tomography, pulse wave velocity (PWV) measurements and MGP sampling will be performed at baseline, 6 months, 12 months and 18 months. Primary endpoints include progression of coronary artery and thoracic aorta calcification and changes in PWV. Secondary endpoints are progression of aortic and mitral valve calcification, all-cause mortality, major adverse cardiovascular events, stroke and bleeding. The ClinicalTrials.gov database was searched to retrieve related trials. Results Seven trials, three of which are performed in the haemodialysis population, evaluate whether pharmacological doses of vitamin K1 or K2 retard progression of VC. Five studies compare the effect of warfarin and NOACs on progression of VC, the present study being the only conducted in the dialysis population. Conclusion Vitamin K deficiency may be a modifiable cardiovascular risk factor in the haemodialysis population. Conversely, vitamin K antagonists may aggravate VC burden in haemodialysis patients. Several ongoing trials may provide an answer to these questions in the near future.
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Affiliation(s)
| | - Lotte Pyfferoen
- Department of Medical Imaging , AZ Sint-Jan Brugge , Brugge , Belgium
| | - Koen De Boeck
- Division of Nephrology , ZNA Hospital , Antwerp , Belgium
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases , AZ Sint-Jan Brugge , Brugge , Belgium
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28
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Khouzam NM, Wesseling-Perry K, Salusky IB. The role of bone in CKD-mediated mineral and vascular disease. Pediatr Nephrol 2015; 30:1379-88. [PMID: 25168424 DOI: 10.1007/s00467-014-2919-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/08/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Abstract
Cardiovascular disease is the leading cause of death in pediatric patients with chronic kidney disease (CKD), and vascular calcifications start early in the course of CKD. Based on the growing body of evidence that alterations of bone and mineral metabolism and the therapies designed to treat the skeletal consequences of CKD are linked to cardiovascular calcifications, the Kidney Disease, Improving Global Outcomes (KDIGO) working group redefined renal osteodystrophy as a systemic disorder of mineral and bone metabolism due to CKD, and this newly defined disorder is now known as "chronic kidney disease-mineral bone disorder (CKD-MBD)". Elevated fibroblast growth factor 23 (FGF23), a bone-derived protein, is the first biochemical abnormality to be associated with CKD-MBD, and high FGF23 levels correlate with increased cardiovascular morbidity and mortality, suggesting that bone is central to both initiating and perpetuating the abnormal mineral metabolism and vascular disease in CKD. The current standard therapies for CKD-MBD affect FGF23 levels differently; non-calcium-based binders with or without concurrent use of dietary phosphate restriction reduce FGF23 levels, while calcium-based binders seem to either increase or have no effect on FGF23 levels. Active vitamin D sterols increase FGF23 levels, whereas therapy with calcimimetics decreases FGF23 levels. Thus, the appropriate therapy that will minimize the rise in FGF23 and prevent cardiovascular morbidity remains to be defined.
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29
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Solow EB, Yu F, Thiele GM, Sokolove J, Robinson WH, Pruhs ZM, Michaud KD, Erickson AR, Sayles H, Kerr GS, Gaffo AL, Caplan L, Davis LA, Cannon GW, Reimold AM, Baker J, Schwab P, Anderson DR, Mikuls TR. Vascular calcifications on hand radiographs in rheumatoid arthritis and associations with autoantibodies, cardiovascular risk factors and mortality. Rheumatology (Oxford) 2015; 54:1587-95. [PMID: 25854268 DOI: 10.1093/rheumatology/kev027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To examine whether vascular calcifications on hand films in RA might aid in determining mortality risk. METHODS Hand radiographs from 906 RA patients were scored as positive or negative for vascular calcifications. Patient characteristics associated with vascular calcifications were assessed using multivariable logistic regression, and associations with mortality were examined using Cox proportional hazards regression. Cytokines and multiplex ACPA were measured in both groups. RESULTS A total of 99 patients (11%) demonstrated radiographic vascular calcifications. Factors independently associated with vascular calcifications included diabetes [odds ratio (OR) 2.85; 95% CI 1.43, 5.66], cardiovascular disease at enrolment (OR 2.48; 95% CI 1.01, 6.09), prednisone use (OR 1.90; 95% CI 1.25, 2.91), current smoking (OR 0.06; 95% CI 0.01, 0.23) and former smoking (OR 0.36; 95% CI 0.27, 0.48) vs never smoking. In cytokine and ACPA subtype analysis, IL-4 and anti-citrullinated apolipoprotein E were significantly increased in patients with vascular calcifications in fully adjusted multivariable models. After multivariable adjustment, vascular calcifications were associated with an increase in all-cause mortality (hazard ratio 1.41; 95% CI 1.12, 1.78; P = 0.004). CONCLUSION Vascular calcifications on hand radiographs were independently associated with increased all-cause mortality in RA. Mechanisms underpinning the associations of IL-4 and select ACPA with vascular calcifications and their utility as biomarkers predictive of cardiovascular disease risk in RA merit further study.
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Affiliation(s)
- E Blair Solow
- Division of Rheumatic Diseases, UT Southwestern, Dallas, TX
| | - Fang Yu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Geoffrey M Thiele
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Jeremy Sokolove
- Division of Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA
| | - William H Robinson
- Division of Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA
| | - Zachary M Pruhs
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Kaleb D Michaud
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE, National Data Bank for Rheumatic Diseases, Wichita, KS
| | - Alan R Erickson
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Harlan Sayles
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Gail S Kerr
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Angelo L Gaffo
- Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Liron Caplan
- Division of Rheumatology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Lisa A Davis
- Division of Rheumatology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Grant W Cannon
- Division of Rheumatology, George Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Andreas M Reimold
- Division of Rheumatic Diseases, UT Southwestern, Dallas, TX, Division of Rheumatology, Dallas Veterans Affairs Medical Center, Dallas, TX
| | - Joshua Baker
- Division of Rheumatology, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Pascale Schwab
- Division of Rheumatology, Portland Veterans Affairs Medical Center, Portland, OR and
| | - Daniel R Anderson
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE
| | - Ted R Mikuls
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE,
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30
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Cernaro V, Santoro D, Lucisano S, Nicocia G, Lacquaniti A, Buemi M. The future of phosphate binders: a perspective on novel therapeutics. Expert Opin Investig Drugs 2014; 23:1459-63. [PMID: 25243756 DOI: 10.1517/13543784.2014.962652] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic kidney disease-mineral bone disorder (CKD-MBD) is a common complication of CKD. The therapeutic strategies for the treatment of CKD-MBD include phosphate binders, active vitamin D analogs and calcimimetics. The first class of drugs provided nephrologists with a range of phosphate binders that are able to decrease circulating phosphate and parathyroid hormone but involve some tolerability and safety issues. In the past 2 years, new phosphate binders have been launched and others are still under development. Serum phosphate increases only in the late stages of CKD but clinical abnormalities begin to occur earlier when multiple mechanisms try to compensate for the progressive reduced ability of the kidney to eliminate phosphorus with urine. Accordingly, starting phosphate binders when phosphatemia reaches values higher than normal may represent a late therapeutic approach. Serum phosphorus is not the ideal biomarker for the diagnosis and treatment of phosphate imbalance. This role could be better played by fibroblast growth factor 23, whose serum concentrations rise earlier in CKD. A more detailed knowledge of the mechanisms underlying CKD-MBD development will provide new therapeutic targets and then new perspectives for the treatment of phosphate imbalance in the future.
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Affiliation(s)
- Valeria Cernaro
- University of Messina, Department of Clinical and Experimental Medicine , Via Consolare Valeria n. 1, 98124 Messina , Italy +39 090 2212396 ; +39 090 2212329 ;
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31
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Bacchetta J, Harambat J, Cochat P, Salusky IB, Wesseling-Perry K. The consequences of chronic kidney disease on bone metabolism and growth in children. Nephrol Dial Transplant 2012; 27:3063-71. [PMID: 22851629 PMCID: PMC3471552 DOI: 10.1093/ndt/gfs299] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 04/29/2012] [Indexed: 12/12/2022] Open
Abstract
Growth retardation, decreased final height and renal osteodystrophy (ROD) are common complications of childhood chronic kidney disease (CKD), resulting from a combination of abnormalities in the growth hormone (GH) axis, vitamin D deficiency, hyperparathyroidism, hypogonadism, inadequate nutrition, cachexia and drug toxicity. The impact of CKD-associated bone and mineral disorders (CKD-MBD) may be immediate (serum phosphate/calcium disequilibrium) or delayed (poor growth, ROD, fractures, vascular calcifications, increased morbidity and mortality). In 2012, the clinical management of CKD-MBD in children needs to focus on three main objectives: (i) to provide an optimal growth in order to maximize the final height with an early management with recombinant GH therapy when required, (ii) to equilibrate calcium/phosphate metabolism so as to obtain acceptable bone quality and cardiovascular status and (iii) to correct all metabolic and clinical abnormalities that can worsen bone disease, growth and cardiovascular disease, i.e. metabolic acidosis, anaemia, malnutrition and 25(OH)vitamin D deficiency. The aim of this review is to provide an overview of the mineral, bone and vascular abnormalities associated with CKD in children in terms of pathophysiology, diagnosis and clinical management.
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Affiliation(s)
- Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron, France.
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Adragao T, Herberth J, Monier-Faugere MC, Branscum AJ, Ferreira A, Frazao JM, Malluche HH. Femoral bone mineral density reflects histologically determined cortical bone volume in hemodialysis patients. Osteoporos Int 2010; 21:619-25. [PMID: 19554246 PMCID: PMC4501027 DOI: 10.1007/s00198-009-0988-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/22/2009] [Indexed: 12/01/2022]
Abstract
UNLABELLED We evaluated the associations between dual energy X-ray absorptiometry (DXA) and histologically determined cancellous and cortical bone volume by controlling for vascular calcifications and demographic variables in hemodialysis (HD) patients. Femoral bone mineral density (f-BMD) was associated with cortical porosity. INTRODUCTION Assessment of bone mass in chronic kidney disease patients is of clinical importance because of the association between low bone volume, fractures, and vascular calcifications. DXA is used for noninvasive assessment of bone mass whereby vertebral results reflect mainly cancellous bone and femoral results reflect mainly cortical bone. Bone histology allows direct measurements of cancellous and cortical bone volume. The present study evaluates the association between DXA and histologically determined cancellous and cortical bone volumes in HD patients. METHODS In 38 HD patients, DXA was performed for assessment of bone mass, anterior iliac crest bone biopsies for bone volume, and multislice computed tomography for vascular calcifications. RESULTS While lumbar bone mineral density (l-BMD) by DXA was not associated with histologically measured cancellous bone volume, coronary Agatson score showed a borderline statistically significant association (P = 0.055). When controlled for age and dialysis duration, f-BMD by DXA was associated with cortical porosity determined by histology (P = 0.005). CONCLUSIONS The usefulness of l-BMD for predicting bone volume is limited most probably because of interference by soft tissue calcifications. In contrast, f-BMD shows significant association with cortical porosity.
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Affiliation(s)
- T. Adragao
- Nephrology Department, Santa Cruz Hospital, Lisbon, Portugal
| | - J. Herberth
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - M.-C. Monier-Faugere
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - A. J. Branscum
- Departments of Biostatistics, Statistics, and Epidemiology, University of Kentucky, Lexington, KY, USA
| | - A. Ferreira
- Nephrology Department, Curry Cabral Hospital, Lisbon, Portugal
| | - J. M. Frazao
- Nephrology Department, Hospital de S. João, Medical School and Nephrology Research and Development Unit, University of Porto, Porto, Portugal
| | - H. H. Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA. Division of Nephrology, Bone & Mineral Metabolism, UK Medical Center, Room MN 564, 800 Rose Street, Lexington 40536-0084 KY, USA
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Hruska KA, Mathew S, Lund RJ, Memon I, Saab G. The pathogenesis of vascular calcification in the chronic kidney disease mineral bone disorder: the links between bone and the vasculature. Semin Nephrol 2009; 29:156-65. [PMID: 19371806 PMCID: PMC2758096 DOI: 10.1016/j.semnephrol.2009.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Considerable scientific progress in the pathogenesis of vascular calcification that has accrued in recent years is reviewed in this article. Factors regulating mesenchymal cell differentiation and their role in the neointimal calcification of atherosclerosis and the vascular media calcification observed in chronic kidney disease and diabetes are discussed, as is the role of bone regulatory proteins in bone mineralization and vascular calcification. This includes recent studies related to fetuin-A, and the discovery of a new circulating hormone involved in regulating phosphate homeostasis and sensing skeletal hydroxyapatite precipitation. Finally, the relationship between skeletal mineralization and vascular mineralization is discussed in terms of their links, especially through serum phosphate concentrations.
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Affiliation(s)
- Keith A Hruska
- Department of Pediatrics, Division of Nephrology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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