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Sun L, Huang Z, Fei S, Ni B, Wang Z, Chen H, Tao J, Han Z, Ju X, Gu M, Tan R. Vascular calcification progression and its association with mineral and bone disorder in kidney transplant recipients. Ren Fail 2023; 45:2276382. [PMID: 37936391 PMCID: PMC10653689 DOI: 10.1080/0886022x.2023.2276382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The assessment and prevention of vascular calcification (VC) in kidney transplant recipients (KTRs) have not been systematically studied. We aimed to evaluate VC change one year after kidney transplantation (KT) and identify their influencing factors. METHODS 95 KTRs (68 males; ages 40.2 ± 10.8 years) were followed one year after KT. Changes in bone mineral density (BMD) and bone metabolism biomarkers were assessed. Coronary artery calcification (CAC) and thoracic aortic calcification (TAC) were measured using 192-slice third-generation dual-source CT. The relationship between bone metabolism indicators and VC and the factors influencing VC were analyzed. RESULTS Postoperative estimated glomerular filtration rate was 79.96 ± 24.18 mL/min*1.73 m2. One year after KT, serum phosphorus, intact parathyroid hormone (iPTH), osteocalcin, type I collagen N-terminal peptide (NTx), type I collagen C-terminal peptide, and BMD decreased, 25-hydroxyvitamin D remained low, and VC increased. Post-CAC and TAC were negatively correlated with pre-femoral neck BMD, and TAC was positively correlated with post-calcium. CAC and TAC change were positively correlated with post-calcium and 25-hydroxyvitamin D. Increased CAC was positively associated with hemodialysis and pre-femoral neck osteopenia. CAC change was positively associated with prediabetes, post-calcium, and pre-CAC and negatively associated with preoperative and postoperative femoral neck BMD, and NTx change. Increased TAC was positively associated with age, prediabetes, preoperative parathyroid hyperplasia/nodule, post-calcium, and post-femoral neck osteopenia. TAC change was positively associated with age, diabetes, pre-triglyceride, pre-TAC, dialysis time, post-calcium and post-iPTH, and negatively associated with post-femoral neck BMD. CONCLUSIONS Mineral and bone disorders persisted, and VC progressed after KT, showing a close relationship.
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Affiliation(s)
- Li Sun
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhengkai Huang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Fei
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Ni
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zijie Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijian Han
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaobing Ju
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhang H, Li G, Yu X, Yang J, Jiang A, Cheng H, Fu J, Liang X, Liu J, Lou J, Wang M, Xing C, Zhang A, Zhang M, Xiao X, Yu C, Wang R, Wang L, Chen Y, Guan T, Peng A, Chen N, Hao C, Liu B, Wang S, Shen D, Jia Z, Liu Z. Progression of Vascular Calcification and Clinical Outcomes in Patients Receiving Maintenance Dialysis. JAMA Netw Open 2023; 6:e2310909. [PMID: 37126347 PMCID: PMC10152309 DOI: 10.1001/jamanetworkopen.2023.10909] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Importance Baseline findings from the China Dialysis Calcification Study (CDCS) revealed a high prevalence of vascular calcification (VC) among patients with end-stage kidney disease; however, data on VC progression were limited. Objectives To understand the progression of VC at different anatomical sites, identify risk factors for VC progression, and assess the association of VC progression with the risk of cardiovascular events and death among patients receiving maintenance dialysis. Design, Setting, and Participants This cohort study was a 4-year follow-up assessment of participants in the CDCS, a nationwide multicenter prospective cohort study involving patients aged 18 to 74 years who were undergoing hemodialysis or peritoneal dialysis. Participants were recruited from 24 centers across China between May 1, 2014, and April 30, 2015, and followed up for 4 years. A total of 1489 patients receiving maintenance dialysis were included in the current analysis. Data were analyzed from September 1 to December 31, 2021. Exposures Patient demographic characteristics and medical history; high-sensitivity C-reactive protein laboratory values; serum calcium, phosphorus, and intact parathyroid hormone (iPTH) values; and previous or concomitant use of medications. Main Outcomes and Measures The primary outcome was progression of VC at 3 different anatomical sites (coronary artery, abdominal aorta, and cardiac valves) and identification of risk factors for VC progression. Participants received assessments of coronary artery calcification (CAC), abdominal aortic calcification (AAC), and cardiac valve calcification (CVC) at baseline, 24 months, 36 months, and 48 months. Secondary outcomes included (1) the association between VC progression and the risk of all-cause death, cardiovascular (CV)-related death, and a composite of all-cause death and nonfatal CV events and (2) the association between achievement of serum calcium, phosphorus, and iPTH target levels and the risk of VC progression. Results Among 1489 patients, the median (IQR) age was 51.0 (41.0-60.0) years; 59.5% of patients were male. By the end of 4-year follow-up, progression of total VC was observed in 86.5% of patients; 69.6% of patients had CAC progression, 72.4% had AAC progression, and 33.4% had CVC progression. Common risk factors for VC progression at the 3 different anatomical sites were older age and higher fibroblast growth factor 23 levels. Progression of CAC was associated with a higher risk of all-cause death (model 1 [adjusted for age, sex, and body mass index]: hazard ratio [HR], 1.97 [95% CI, 1.16-3.33]; model 2 [adjusted for all factors in model 1 plus smoking status, history of diabetes, and mean arterial pressure]: HR, 1.89 [95% CI, 1.11-3.21]; model 3 [adjusted for all factors in model 2 plus calcium, phosphorus, intact parathyroid hormone, and fibroblast growth factor 23 levels and calcium-based phosphate binder use]: HR, 1.92 [95% CI, 1.11-3.31]) and the composite of all-cause death and nonfatal CV events (model 1: HR, 1.98 [95% CI, 1.19-3.31]; model 2: HR, 1.91 [95% CI, 1.14-3.21]; model 3: HR, 1.95 [95% CI, 1.14-3.33]) after adjusting for all confounding factors except the presence of baseline calcification. Among the 3 targets of calcium, phosphorus, and iPTH, patients who achieved no target levels (model 1: odds ratio [OR], 4.75 [95% CI, 2.65-8.52]; model 2: OR, 4.81 [95% CI, 2.67-8.66]; model 3 [for this analysis, adjusted for all factors in model 2 plus fibroblast growth factor 23 level and calcium-based phosphate binder use]: OR, 2.76 [95% CI, 1.48-5.16]), 1 target level (model 1: OR, 3.71 [95% CI, 2.35-5.88]; model 2: OR, 3.62 [95% CI, 2.26-5.78]; model 3: OR, 2.19 [95% CI, 1.33-3.61]), or 2 target levels (model 1: OR, 2.73 [95% CI, 1.74-4.26]; model 2: OR, 2.69 [95% CI, 1.71-4.25]; model 3: OR, 1.72 [95% CI, 1.06-2.79]) had higher odds of CAC progression compared with patients who achieved all 3 target levels. Conclusions and Relevance In this study, VC progressed rapidly in patients undergoing dialysis, with different VC types associated with different rates of prevalence and progression. Consistent achievement of serum calcium, phosphorus, and iPTH target levels was associated with a lower risk of CAC progression. These results may be useful for increasing patient awareness and developing appropriate strategies to improve the management of chronic kidney disease-mineral and bone disorder among patients undergoing dialysis.
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Affiliation(s)
- Haitao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Guisen Li
- Department of Nephrology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xueqing Yu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Junwei Yang
- Center of Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aili Jiang
- Department of Kidney Diseases and Blood Purification, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hong Cheng
- Nephrology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junzhou Fu
- Department of Nephrology, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun Liu
- National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jizhuang Lou
- Department of Blood Purification Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Mei Wang
- Division of Nephrology, Peking University People's Hospital, Beijing, China
| | - Changying Xing
- Department of Nephrology, Jiangsu Province Hospital, First Affiliated Hospital Nanjing Medical University, Nanjing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Zhang
- Department of Nephrology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital of Central South University, Changsha, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Wang
- Department of Nephrology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Li Wang
- Department of Nephrology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Yuqing Chen
- Renal Division, Department of Internal Medicine, Peking University First Hospital, Beijing, China
| | - Tianjun Guan
- Department of Nephrology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Ai Peng
- Center for Nephrology and Metabolomics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital Fudan University, Shanghai, China
| | - Bicheng Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Suxia Wang
- Department of Nephrology, The 960th Hospital of the PLA, Jinan, China
| | | | | | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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El-Husseini A, Abdalbary M, Lima F, Issa M, Ahmed MT, Winkler M, Srour H, Davenport D, Wang G, Faugere MC, Malluche HH. Low Turnover Renal Osteodystrophy With Abnormal Bone Quality and Vascular Calcification in Patients With Mild-to-Moderate CKD. Kidney Int Rep 2022; 7:1016-1026. [PMID: 35570986 PMCID: PMC9091581 DOI: 10.1016/j.ekir.2022.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Limited information is available on renal osteodystrophy (ROD) and vascular calcification (VC) during early chronic kidney disease (CKD). This study was designed to evaluate ROD and VC in 32 patients with CKD stages II to IV. Methods Patients underwent dual-energy X-ray absorptiometry (DXA) for assessment of bone mineral density (BMD) and trabecular bone score (TBS), thoracic computed tomography for VC scoring using the Agatston method, and anterior iliac crest bone biopsy for mineralized bone histology, histomorphometry, and Fourier transform infrared spectroscopy (FTIR). Classical and novel bone markers were determined in the blood. Results Mean estimated glomerular filtration rate (eGFR) was 44 ± 16 ml/min per 1.73 m2. Of the patients, 84% had low bone turnover. In Whites, eGFR correlated negatively with the turnover parameter activation frequency (Ac.f) (r -0.48, P = 0.019) and with parameters of bone formation. Most patients had VC (>80%) which correlated positively with levels of phosphorus, c-terminal fibroblast growth factor-23, and activin. Aortic calcifications (ACs) correlated negatively with bone formation rate (BFR) and Ac.f (rho -0.62, -0.61, P < 0.001). TBS correlated negatively with coronary calcification (rho -0.42, P = 0.019) and AC (rho -0.57, P = 0.001). These relationships remained after adjustment of age. The mineral-to-matrix ratio, an FTIR metric reflecting bone quality, was negatively related to Ac.f and positively related to AC. Conclusion Low bone turnover and VC are predominant in early stages of CKD. This is the first study demonstrating mineral abnormalities indicating reduced bone quality in these stages of CKD.
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Affiliation(s)
- Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Mohamed Abdalbary
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Florence Lima
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Mohamed Issa
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | | | - Michael Winkler
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Habib Srour
- Department of Anesthesia, University of Kentucky, Lexington, Kentucky, USA
| | - Daniel Davenport
- Division of Healthcare Outcomes & Optimal Patient Services, University of Kentucky, Lexington, Kentucky, USA
| | - Guodong Wang
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Marie-Claude Faugere
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Hartmut H. Malluche
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
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Lankinen R, Hakamäki M, Hellman T, Koivuviita NS, Metsärinne K, Järvisalo MJ. Progression of Aortic Calcification in Stage 4-5 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation. Kidney Blood Press Res 2021; 47:23-30. [PMID: 34818248 DOI: 10.1159/000518670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Abdominal aortic calcification (AAC) is common in chronic kidney disease (CKD) patients and associated with increased mortality. Comparative data on the AAC score progression in CKD patients transitioning from conservative treatment to different modalities of renal replacement therapy (RRT) are lacking and were examined. METHODS 150 study patients underwent lateral lumbar radiograph to study AAC in the beginning of the study before commencing RRT (AAC1) and at 3 years of follow-up (AAC2). We examined the associations between repeated laboratory tests taken every 3 months, echocardiographic and clinical variables and AAC increment per year (ΔAAC), and the association between ΔAAC and outcomes during follow-up. RESULTS At the time of AAC2 measurement, 39 patients were on hemodialysis, 39 on peritoneal dialysis, 39 had a transplant, and 33 were on conservative treatment. Median AAC1 was 4.8 (0.5-9.0) and median AAC2 8.0 (1.5-12.0) (p < 0.0001). ΔAAC was similar across the treatment groups (p = 0.19). ΔAAC was independently associated with mean left ventricular mass index (LVMI) (log LVMI: β = 0.97, p = 0.02) and mean phosphorus through follow-up (log phosphorus: β = 1.19, p = 0.02) in the multivariable model. Time to transplantation was associated with ΔAAC in transplant recipients (per month on the waiting list: β = 0.04, p = 0.001). ΔAAC was associated with mortality (HR 1.427, 95% confidence interval 1.044-1.950, p = 0.03). CONCLUSION AAC progresses rapidly in patients with CKD, and ΔAAC is similar across the CKD treatment groups including transplant recipients. The increment rate is associated with mortality and in transplant recipients with the time on the transplant waiting list.
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Affiliation(s)
- Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina S Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland.,Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland.,Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
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Rantasalo V, Gunn J, Kiviniemi T, Hirvonen J, Saarenpää I, Kivelev J, Rahi M, Lassila E, Rinne J, Laukka D. Intracranial aneurysm is predicted by abdominal aortic calcification index: A retrospective case-control study. Atherosclerosis 2021; 334:30-38. [PMID: 34461392 DOI: 10.1016/j.atherosclerosis.2021.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Patients with intracranial aneurysms (IA) have excess mortality for cardiovascular diseases, but little is known on whether atherosclerotic manifestations and IA coexist. We investigated abdominal aortic calcification index (ACI) association with unruptured and ruptured IAs. METHODS This retrospective case-control study reviews all tertiary centers patients (n = 24,660) who had undergone head computed tomography angiography (CTA), magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) for any reason between January 2003 and May 2018. Patients (n = 2020) with unruptured or ruptured IAs were identified, and patients with available abdominal CT were included. IA patients were matched by sex and age to controls (available abdomen CT, no IAs) in ratio of 1:3. ACI was measured from abdomen CT scans and patient records were reviewed. RESULTS 1720 patients (216 ruptured IA (rIA), 246 unruptured IA (UIA) and 1258 control) were included. Mean age was 62.9 ± 11.9 years and 58.2% were female. ACI (OR 1.02 per increment, 95%CI 1.01-1.03) and ACI>3 (OR 5.77, 95%CI 3.29-10.11) increased risk for rIA compared to matched controls. UIA patients' ACI was significantly higher but ACI did not increase odds for UIA compared to matched controls. History of coronary artery disease was less frequent in rIA patients. There was no calcification in aorta in 8.8% rIA and 13.6% UIA patients (matched controls 25.7% and 22.6% respectively, p < 0.01). CONCLUSIONS Aortic calcification is greater in rIA and UIA patients than matched controls. ACI increases risk for rIAs.
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Affiliation(s)
- Ville Rantasalo
- Department of Surgery, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jarmo Gunn
- Department of Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Saarenpää
- Clinical Neurosciences, University of Turku, Turku, Finland; Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Juri Kivelev
- Clinical Neurosciences, University of Turku, Turku, Finland; Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Melissa Rahi
- Clinical Neurosciences, University of Turku, Turku, Finland; Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Elli Lassila
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, University of Turku, Turku, Finland; Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Dan Laukka
- Clinical Neurosciences, University of Turku, Turku, Finland; Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
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Li M, Cheng J, Zhao J, Xue W, Bao H, Song Y, Qin L. Relationship between intact parathyroid hormone and all-cause death, cardiovascular events, and ectopic calcification in patients with diabetic kidney disease: A retrospective study. Diabetes Res Clin Pract 2021; 177:108926. [PMID: 34161808 DOI: 10.1016/j.diabres.2021.108926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
AIM We aimed to investigate the relationship between intact parathyroid hormone (iPTH) levels and all-cause death, cardiovascular events, and ectopic calcification in patients with diabetic kidney disease (DKD). METHODS In this retrospective cohort study, we collected the clinical data of 508 patients with clinically diagnosed DKD. The primary and secondary outcomes were all-cause death or cardiovascular events and ectopic calcification, respectively. We used different regression methods to analyze the relationship between various clinical parameters and the two clinical outcomes. RESULTS We found that iPTH was a risk factor for all-cause death and cardiovascular events (hazards ration [HR]: 2.817, 95% confidence interval [CI]: 1.045-6.562, P = 0.016). Meanwhile, diabetes duration (HR: 1.090, 95% CI: 1.045-1.138, P < 0.0001), triglycerides (TG) (HR: 1.254, 95% CI: 1.049-1.499, P = 0.013), and iPTH (HR: 1.954, 95% CI: 1.001-3.813, P = 0.049) were independent risk factors for ectopic calcification. In contrast to patients with lower iPTH levels (iPTH < 31.7 pg/mL), patients with higher iPTH levels (iPTH ≥ 31.7 pg/mL) had increased ectopic calcification rate (P = 0.002) and decreased survival time (P < 0.001). CONCLUSION In patients with DKD, higher iPTH levels were significantly related to worsen clinical outcomes.
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Affiliation(s)
- Mengyuan Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jiafen Cheng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jian Zhao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Wen Xue
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Hui Bao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yaxiang Song
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
| | - Ling Qin
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
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Nakai K, Yamamoto S, Inoue M, Kohara C, Shukuri T, Motoyama K, Mitsuiki K. Pretransplant dialysis treatment and vascular calcification of the iliac artery and abdominal aorta in kidney transplant patients. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Patients with chronic kidney disease often suffer from cardiovascular disease, and vascular calcification has been identified as one of the risk factors for cardiovascular disease. We aimed to examine the effect of dialysis treatment before kidney transplantation on graft survival, vascular calcification, and its progression after kidney transplantation.
Methods
Among the 102 patients who underwent kidney transplant between 2008 and 2017, two patients were excluded for moved and lost to follow-up and primary nonfunction. The clinical characteristics and laboratory data were assessed according to pretransplant treatment modality. Rapid progression of vascular calcification was defined when patients showed an increase in the highest tertile of progression of each iliac artery calcification thickness (IACT) and aortic calcification index (ACI).
Results
Cox proportional hazard models did not show any significant association between pretransplant treatment modality and graft survival to the doubling of creatinine from nadir creatinine during the first 3 months after kidney transplantation. At baseline, the IACT was significantly higher in hemodialysis patients than in preemptive kidney transplant patients, whereas the ACI was comparable among the pretransplant treatment modality groups. IACT was independently associated with dialysis vintage. There was no significant association between rapid progression of vascular calcification (IACT and ACI) and dialysis modality.
Conclusions
Dialysis modality was an independent factor related to IACT, whereas there was no legacy effect for the progression of vascular calcification after kidney transplantation.
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Hellman T, Lankinen R, Järvisalo MJ, Hakamäki M, Koivuviita NS, Raitakari OT, Metsärinne K. Arterial endothelial function, carotid artery intima-media thickness and abdominal aortic calcification in diabetic and nondiabetic CKD stage 4-5 patients not on dialysis. Diabetes Res Clin Pract 2021; 171:108559. [PMID: 33271231 DOI: 10.1016/j.diabres.2020.108559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
AIMS We aimed to study the effect of diabetes (DM) on endothelial dysfunction assessed by flow-mediated vasodilatation (FMD), carotid intima-media thickness (cIMT) and abdominal aortic calcification score (AAC) in chronic kidney disease (CKD) stage 4-5 patients not on dialysis. METHODS Altogether 199 non-dialysis CKD stage 4-5 patients enrolled in the Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study with plain lumbar radiograph for the assessment of AAC were included. Data on cIMT and FMD were available for 172 and 161 patients, respectively. RESULTS Median age was 65 (IQR 54-76) years, 88 (44.2%) patients had DM and median eGFR was 12 (IQR 10-14) ml/min/1.73 m2 in the study. FMD [controls: 3.3(2.0-6.7)% vs. DM-patients: 4.3(1.3-6.6)%, p = 0.73] and cIMT [controls: 0.65(0.58-0.87)mm vs. DM-patients: 0.67(0.59-0.81)mm, p = 0.65], were similar between the groups. AAC was higher in patients with DM [controls: 5(1-9) vs. DM-patients: 7(2-13), p = 0.01]. The significant multivariate determinants for AAC were older age (β = 0.22, p < 0.0001), pulse pressure (β = 0.05, p < 0.0001), DM (β = 1.33, p = 0.04) and ProBNP (per µg/l β = 0.18, p = 0.0008). AAC and cIMT were associated with incident cardiovascular death independent of DM. CONCLUSIONS DM is associated with increased AAC but not increased cIMT or attenuated FMD in advanced CKD patients.
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Affiliation(s)
- Tapio Hellman
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland.
| | - Roosa Lankinen
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko J Järvisalo
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland; Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland; Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Markus Hakamäki
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Niina S Koivuviita
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland
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9
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Arase H, Yamada S, Tanaka S, Tokumoto M, Tsuruya K, Nakano T, Kitazono T. Association Between Plasma Intact Parathyroid Hormone Levels and the Prevalence of Atrial Fibrillation in Patients With Chronic Kidney Disease - The Fukuoka Kidney Disease Registry Study. Circ J 2020; 84:1105-1111. [PMID: 32507801 DOI: 10.1253/circj.cj-19-1201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parathyroid hormone (PTH) has been associated with cardiovascular disorders; however, it is unknown whether plasma PTH concentrations are associated with atrial fibrillation (AF) in patients with chronic kidney disease (CKD).Methods and Results:The present cross-sectional study analyzed baseline data of 3,384 patients registered in the Fukuoka Kidney Disease Registry Study, a Japanese multicenter prospective cohort study of patients with non-dialysis-dependent CKD. The outcome was prevalence of AF, and the main risk factor was plasma intact PTH concentration. Associations between plasma intact PTH concentration quartiles (Q1-Q4, from lowest to highest) and the presence of AF were analyzed using logistic regression. In all, 185 patients had AF; 22, 34, 59, and 70 patients were in Q1, Q2, Q3, and Q4 of PTH concentrations, respectively. The prevalence of AF increased incrementally with increases in plasma intact PTH. In the logistic regression model, patients with higher plasma intact PTH concentrations (Q2-Q4) had higher adjusted odds ratios (95% confidence intervals) for the prevalence of AF relative to the reference group (Q1), namely 1.33 (0.76-2.34), 1.82 ([1.06-3.13), and 1.99 (1.08-3.64), respectively (P=0.016). CONCLUSIONS Higher plasma intact PTH concentrations were significantly and incrementally associated with an increased prevalence of AF in non-dialysis-dependent CKD patients.
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Affiliation(s)
- Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University.,Department of Nephrology, Nara Medical University
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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10
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Iwakawa N, Tanaka A, Ishii H, Kataoka T, Niwa K, Hitora Y, Tashiro H, Mitsuda T, Kojima H, Hirayama K, Furusawa K, Yoshida R, Suzuki S, Murohara T. Impact of Diabetes Mellitus on the Aortic Wall Changes as Atherosclerosis Progresses: Aortic Dilatation and Calcification. J Atheroscler Thromb 2020; 27:509-515. [PMID: 31554764 PMCID: PMC7355097 DOI: 10.5551/jat.50930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: An inverse association between diabetes mellitus (DM) and aortic dilatation has recently been reported. However, little is known about the association between DM and the progression of aortic dilatation/calcification as atherosclerosis progresses. Methods: We identified 216 patients who had undergone percutaneous coronary intervention (PCI) and abdominal computed tomography (CT) during the PCI and follow-up phases. The patients were classified into two groups: those with DM (DM+ group; n = 107) and those without DM (DM− group; n = 109). The infrarenal aortic diameter and aortic calcification index (ACI) were measured, and annual changes were calculated using measurement results obtained during the PCI and follow-up phases. Results: Infrarenal aortic diameters were significantly shorter in the DM+ group than in the DM− group during the PCI phase, and no significant ACI differences were observed between the DM+ and DM− groups. The median duration between the PCI and follow-up phase CT was 3.0 years. The growth rate of the infrarenal aortic dilatation from the PCI phase in the DM+ group was similar to that in the DM− group. Annual ACI changes were significantly larger in the DM+ group than in the DM− group. Multivariate logistic regression analysis indicated that the prevalence of DM was an independent predictor of rapid aortic calcification progression (odds ratio: 2.51; 95% confidence interval: 1.23–5.14; p = 0.01). Conclusion: Our findings suggest that DM negatively affects aortic dilatation during an earlier phase of atherosclerosis progression and positively affects the progression of aortic calcification in a later phase.
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Affiliation(s)
- Naoki Iwakawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kiyoshi Niwa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yusuke Hitora
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Takayuki Mitsuda
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroki Kojima
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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11
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Wang Z, Chen Z, Ma X, Yu H, Chen X. The predictive value of serum galectin 3 for abdominal aortic calcification in maintenance hemodialysis patients: A prospective cohort study. Hemodial Int 2020; 24:212-220. [PMID: 32048459 DOI: 10.1111/hdi.12825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Heterotopic vascular calcification is a common complication of maintenance hemodialysis (MHD) patients. Galectin 3 (Gal-3) has been reported to be associated with cardiovascular calcification. The current study aims to explore the potential predictive value of serum Gal-3 for severe abdominal aortic calcification (AAC) and AAC progression in MHD patients. METHODS A prospective cohort who underwent hemodialysis during July 2014 at the Blood Purification Center of Ruijin Hospital were followed up for 3 years. Two AAC assessments were performed: one at baseline and one after the 3-year follow-up period. Serum Gal-3 was detected with quantitative ELISA kits. SPSS 23.0 and MedCalc 11.4.2.0 were used to analyze the data. FINDINGS One hundred and fifty-two patients were recruited. Approximately 59.9% were male, the median age was 60 (50-67) years. Logistic regression analysis indicated that serum Gal-3 was an independent risk factor for both follow-up severe AAC and AAC progression. Receiver operating characteristic (ROC) curve analysis revealed significant prognostic value of serum Gal-3 for predicting severe AAC and AAC progression within 3 years. DISCUSSION We found serum Gal-3 is correlated to vascular calcification in ESRD patients. Gal-3 may be a potential biomarker of vascular calcification for MHD patients.
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Affiliation(s)
- Zhiyu Wang
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijin Chen
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobo Ma
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijin Yu
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaonong Chen
- Division of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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New Insights into the Roles of Monocytes/Macrophages in Cardiovascular Calcification Associated with Chronic Kidney Disease. Toxins (Basel) 2019; 11:toxins11090529. [PMID: 31547340 PMCID: PMC6784181 DOI: 10.3390/toxins11090529] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease (CVD) is an important cause of death in patients with chronic kidney disease (CKD), and cardiovascular calcification (CVC) is one of the strongest predictors of CVD in this population. Cardiovascular calcification results from complex cellular interactions involving the endothelium, vascular/valvular cells (i.e., vascular smooth muscle cells, valvular interstitial cells and resident fibroblasts), and monocyte-derived macrophages. Indeed, the production of pro-inflammatory cytokines and oxidative stress by monocyte-derived macrophages is responsible for the osteogenic transformation and mineralization of vascular/valvular cells. However, monocytes/macrophages show the ability to modify their phenotype, and consequently their functions, when facing environmental modifications. This plasticity complicates efforts to understand the pathogenesis of CVC-particularly in a CKD setting, where both uraemic toxins and CKD treatment may affect monocyte/macrophage functions and thereby influence CVC. Here, we review (i) the mechanisms by which each monocyte/macrophage subset either promotes or prevents CVC, and (ii) how both uraemic toxins and CKD therapies might affect these monocyte/macrophage functions.
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13
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Okamoto T, Hatakeyama S, Kodama H, Horiguchi H, Kubota Y, Kido K, Momota M, Hosogoe S, Tanaka Y, Takashima T, Saitoh F, Suzuki T, Ohyama C. The relationship between poor nutritional status and progression of aortic calcification in patients on maintenance hemodialysis. BMC Nephrol 2018; 19:71. [PMID: 29558928 PMCID: PMC5861641 DOI: 10.1186/s12882-018-0872-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 03/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background Although aortic calcification has a significant negative impact on prognosis in patients on hemodialysis (HD), risk factors for aortic calcification progression remain unclear. The aim of this study was to investigate the relationship between malnutrition and aortic calcification progression in patients on HD. Methods Between April 2015 and October 2016, we treated 232 patients on HD. Of those, we retrospectively evaluated data from 184 patients who had had regular blood tests and computed tomography (CT) scans. The abdominal aortic calcification index (ACI) was quantitatively measured by abdominal CT. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). A normalized treatment ratio of functional urea clearance was evaluated by Kt/V. The difference in ACI values between 2015 and 2016 was evaluated as a ΔACI, and patients were stratified into two groups according to ΔACI value: high (≥75th percentile, ΔACI-high group) and low (<75th percentile, ΔACI-low group). Variables such as age, sex, comorbidities, dialysis vintage, serum data, and GNRI were compared between ΔACI-high and ΔACI-low patients. Factors independently associated with a higher ΔACI progression (ΔACI ≥75th percentile) were determined using multivariate logistic analysis. Results Median values of ACIs in 2015 and 2016 were 40.8 and 44.6%, respectively. Of 184 patients, 125 (68%) patients experienced ACI progression for 1 year. The median ΔACI and 75th percentile of ΔACI were 2.5% and 5.8%, respectively. The number of patients in the ΔACI-low and ΔACI-high groups were 128 (70%) and 56 (30%), respectively. There were significant differences in sex, presence of diabetic nephropathy, HD vintage, serum albumin, serum phosphate, C-reactive protein, intact parathyroid hormone, Kt/V, and GNRI. Multivariate logistic regression analysis revealed that independent factors associated with a higher ΔACI progression were male sex, serum phosphate levels, HD vintage, and GNRI of < 90. Conclusions Our results suggest that poor nutritional status is an independent risk factor for the progression of aortic calcification. Nutrition management may have the potential to improve progression of aortic calcification in patients on HD. Trial registration UMIN Clinical Trials Registry UMIN000028050.
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Affiliation(s)
- Teppei Okamoto
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, 101-1 Okabe, Aomori, 038-0003, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
| | - Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yuka Kubota
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Koichi Kido
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Shogo Hosogoe
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, 101-1 Okabe, Aomori, 038-0003, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Yoshimi Tanaka
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, 101-1 Okabe, Aomori, 038-0003, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Tooru Takashima
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, 101-1 Okabe, Aomori, 038-0003, Japan
| | - Fumitada Saitoh
- Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, 101-1 Okabe, Aomori, 038-0003, Japan
| | - Tadashi Suzuki
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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14
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Evans M, Methven S, Gasparini A, Barany P, Birnie K, MacNeill S, May MT, Caskey FJ, Carrero JJ. Cinacalcet use and the risk of cardiovascular events, fractures and mortality in chronic kidney disease patients with secondary hyperparathyroidism. Sci Rep 2018; 8:2103. [PMID: 29391567 PMCID: PMC5794851 DOI: 10.1038/s41598-018-20552-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/08/2018] [Indexed: 01/31/2023] Open
Abstract
With the aim to expand the randomized controlled trial evidence of cinacalcet treatment to the unselected, general chronic kidney disease (CKD) population we analysed a large inception cohort of CKD patients in the region of Stockholm, Sweden 2006-2012 (both non-dialysis, dialysis and transplanted) with evidence of secondary hyperparathyroidism (SHPT). We used marginal structural models to account for both confounding by indication and time-dependent confounding. Over 37 months, 435/3,526 (12%) initiated cinacalcet de novo. Before cinacalcet initiation, parathyroid hormone (PTH) had increased progressively to a median of 636ng/L. After cinacalcet initiation, PTH declined, as did serum calcium and phosphate. In total, 42% of patients experienced a fatal/non-fatal cardiovascular event, 32% died and 9% had a new fracture. The unadjusted cardiovascular odds ratio (OR) associated with cinacalcet treatment was 1.01 (95% confidence interval: 0.83, 1.22). In the fully weighted model, the cardiovascular odds was lower in cinacalcet treated patients (OR 0.67: 0.48, 0.93). The adjusted ORs for all-cause mortality and for fractures were 0.79 (0.56, 1.11) and 1.08 (0.59, 1.98) respectively. Our study suggests cinacalcet treatment improves biochemical abnormalities in the wider CKD population, and adds real-world support that treating SHPT with cinacalcet may have beneficial effects on cardiovascular outcomes.
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Affiliation(s)
- Marie Evans
- United Kingdom Renal Registry (UKRR), Southmead Hospital, Bristol, BS10 5NB, UK.
- Division of Renal Medicine, Department CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Shona Methven
- United Kingdom Renal Registry (UKRR), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Alessandro Gasparini
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Peter Barany
- United Kingdom Renal Registry (UKRR), Southmead Hospital, Bristol, BS10 5NB, UK
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Stephanie MacNeill
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Fergus J Caskey
- United Kingdom Renal Registry (UKRR), Southmead Hospital, Bristol, BS10 5NB, UK
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Juan-Jesus Carrero
- Department of medical epidemiology and biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Disthabanchong S, Boongird S. Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease. World J Nephrol 2017; 6:100-110. [PMID: 28540199 PMCID: PMC5424431 DOI: 10.5527/wjn.v6.i3.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/27/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Vascular calcification (VC) is common among patients with chronic kidney disease (CKD). The severity of VC is associated with increased risk of cardiovascular events and mortality. Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load. VC is observed in arteries of all sizes from small arterioles to aorta, both in the intima and the media of arterial wall. Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC. Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods. Mammography, especially useful among women, offers a unique way to study breast arterial calcification, which is largely a medial-type calcification. Ultrasonography is suitable for calcification in superficial arteries. Analyses of wall thickness and lumen size are also possible. Computed tomography (CT) scan, the gold standard, is the most sensitive technique for evaluation of VC. CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.
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16
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Ichii T, Morimoto R, Okumura T, Ishii H, Tatami Y, Yamamoto D, Aoki S, Hiraiwa H, Furusawa K, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Suzuki S, Yasuda Y, Murohara T. Impact of Renal Functional/Morphological Dynamics on the Calcification of Coronary and Abdominal Arteries in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2017; 24:1092-1104. [PMID: 28392544 PMCID: PMC5684475 DOI: 10.5551/jat.39271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Fast-progressing vascular calcification (VC) is accompanied by renal atrophy and functional deterioration along with atherosclerosis in patients with chronic kidney disease (CKD). However, the relationship between VC progression and renal functional and/or morphological changes remains unclear. Methods: We included 70 asymptomatic patients with CKD without hemodialysis in our study. To identify temporal variations, the coronary artery calcification score (CACS), abdominal aortic calcification index (ACI), and renal parenchymal volume index (RPVI) were determined via spiral computed tomography scans taken during the study. We investigated significant factors related to annualized variations of CACS (ΔCACS/y) and ACI (ΔACI/y). Results: During the follow-up period (4.6 years), median values of CACS [in Agatston units (AU)] and ACI increased from 40.2 to 113.3 AU (p = 0.053) and from 13.2 to 21.7% (p = 0.036), respectively. Multivariate analysis revealed that CACS at baseline (p < 0.001) and diabetes mellitus (DM) status (p = 0.037) for ΔCACS/y and ACI at baseline (p = 0.017) and hypertension (HT) status (p = 0.046) for ΔACI/y were significant independent predictors. Furthermore, annualized RPVI variation was significantly related to both ΔCACS/y and ΔACI/y (R = −0.565, p < 0.001, and R = −0.289, p = 0.015, respectively). On the other hand, independent contributions of the estimated glomerular filtration rate (eGFR) and annualized eGFR variation to VC progression were not confirmed. Conclusion: The degree of VC at baseline, DM, HT, and changes in renal volume, but not eGFR, had a strong impact on VC progression in patients with CKD.
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Affiliation(s)
- Takeo Ichii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine.,Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yosuke Tatami
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Dai Yamamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Soichiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yoshinari Yasuda
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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17
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Abstract
Chronic decline in renal function is accompanied by deterioration of bone structure and function and progressive calcification of the vascular system. Both disease states have been linked with increased morbidity and mortality in chronic kidney disease. The severe alterations of mineral metabolism inherent with loss of renal function have an impact on vascular calcification development and progression, and several investigators have focused on ways to reduce their impact on vascular health. Imaging has contributed an important role in the assessment of vascular calcification, and the impact of various interventions aimed at curbing their progression.
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Affiliation(s)
- Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - W Charles O'Neill
- Department of Medicine, Division of Nephrology, Emory University, Atlanta, Georgia
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