BACKGROUND: Although the prevalence of cardiovascular disease decreases in the general population, this pattern is not followed in hemodialysis patients. Hence cardiovascular events still occur in 50% of cases resulting in hemodialysis patients. One of the risk factors is vascular calcification. The pathogenesis is not yet fully understood, but recent years studies have shown that vascular calcification in chronic kidney disease (CKD) occurs as a result of the interaction of stimulatory and inhibitory factors. One of the inhibitory factors is Fetuin-A. Until now there has been no data on levels of Fetuin-A as a risk factor for abdominal aortic calcification in Indonesia. AIM: To determine the effect of Fetuin-A levels on abdominal aortic calcification in regular hemodialysis patients. METHODS: This study was a cross-sectional study on 76 regular hemodialysis patients at Rasyida Renal Hospital Medan. Fetuin-A level was examined by enzyme-linked immunosorbent assay (ELISA). Assessment of abdominal aortic calcification was done by lateral lumbar X-ray. RESULTS: Most patients (68.4%) had abdominal aortic calcification, in both layers; intima and media (44.7%). Abdominal aortic calcification was associated with Fetuin-A level and age. Multivariate analysis showed that high Fetuin-A levels were significantly associated with abdominal aortic calcification. CONCLUSION: High Fetuin-A level appeared to be a protective factor against abdominal aortic calcification in regular hemodialysis patients in Indonesia.
BACKGROUND: Hypertension is one of the most common diseases around the world, which is the most risk factor related to cardiovascular disease. The quality of life of hypertensive patients is influenced by various factors, namely age, sex, educational background, ethnicity and nutritional status. Another factor that is also important is the quality of sleep.AIM: We aimed the assessment of sleep quality using a PSQI questionnaire, and quality of life assessment with the SF-36 questionnaire.METHODS: This study was a cross-sectional study of 45 respondents at the H. Adam Malik Central General Hospital in Medan in 2018. Assessment of sleep quality was performed through the PSQI questionnaire (Pittsburgh Sleep Quality Index), and quality of life assessment was carried out with the SF-36 questionnaire.RESULTS: The prevalence of impaired sleep quality in hypertensive patients was 35.6%. Most patients have a good quality of life, with 71.1%. In this study, sleep quality was found to be related to the quality of life (p = 0.037). Furthermore, variables related to sleep quality were sex (gender) (p = 0.003) and education (p = 0.005). In multivariate analysis, the quality of life is predominantly influenced by sleep quality (p = 0.025).CONCLUSION: The quality of life of hypertensive patients is influenced by the quality of sleep.
BACKGROUND: The vascular calcification process in chronic kidney disease (CKD) is a complication caused by mineral and bone abnormalities and becomes the risk of cardiovascular disease and mortality in CKD patients. KLOTHO is an inhibitor of calcification and its expression has been observed to decrease in CKD patients. The KLOTHO gene G395A polymorphism is a genetic variation that is common in Asian populations and is associated with vascular dysfunction in hemodialysis patients. OBJECTIVE: The objective of the study was to determine the association between the KLOTHO gene G395A polymorphism and carotid artery calcification in regular hemodialysis patients. METHODS: This study was an analytical study with a cross-sectional design and was carried out at Rasyida Kidney Hospital Medan. Venous blood sample was taken from the patients who met the inclusion criteria for examination of the KLOTHO gene -395 polymorphism and carotid ultrasonography was assessed to evaluate the thickness of the tunica media-intima as a marker of vascular calcification. RESULTS: The majority of the study subjects were men, as many as 35 patients (50.7%). From the results of the KLOTHO gene -395 polymorphism, it was found that the majority of subjects had GG genotypes as many as 36 people (52.2%) followed by GA genotypes as many as 30 people (43,5%) and AA genotypes as many as 3 (4,3%). There was a statistically significant of the association between KLOTHO gene -395 polymorphism and the incidence of carotid artery calcification (p = 0,015). CONCLUSION: There was an association between the KLOTHO gene G395A polymorphism and carotid artery calcification in regular hemodialysis patients.
Objective: Homeostasis of serum phosphorus and calcitriol level is regulated mainly by fibroblast growth factor 23 (FGF23). Studies show that elevated serum FGF23 level was significantly associated with aortic calcification severity, peripheral blood vessels, and a higher score of coronary artery calcification in patients undergoing hemodialysis. We did this cross-sectional study to determine the FGF23 diagnostic value for abdominal aortic calcification in Indonesian hemodialysis patients. Materials and Methods: This study included seventy-five, chronic hemodialysis patients. An enzyme-linked immunosorbent assay method was used to measure serum intact FGF23 level, and abdominal aortic calcification was detected by lateral lumbar X-ray. The diagnostic value of FGF23 was analyzed using receiver operating characteristic (ROC) curves. Results: fifty-one (68.0%) patients had abdominal aortic calcification (AAC). Serum intact FGF23 level ranged from 217 to 950 pg/mL with a median level of 328 pg/mL. The FGF23 levels in the serum of patients with AAC were significantly higher than those without AAC ( P < 0.001). The best cutoff point was 277 pg/mL. The calculated area under the ROC curves was 0.959 (95% confidence interval, 0.912–1.00); sensitivity was 94.0% and specificity was 84.0% ( P < 0.001). Conclusion: serum intact FGF23 level may be proposed as a proper tool for abdominal aortic calcification in Indonesian hemodialysis patients.
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