Arterial Disease and Vascular Access in Diabetic Patients

Baktiroğlu, Selçuk; Yanar, Fatih; Özata, İbrahim Halil; Öner, Gizem; Ercan, Damla

doi:10.5301/jva.5000532

Cited by 15 publications

(11 citation statements)

References 22 publications

(25 reference statements)

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“…Chronic hyperglycemia is the main characteristic of diabetes, which can cause vascular inflammation, vasoconstriction, thrombosis, VC, and atherosclerosis by stimulating ROS overproduction and generation of pro-inflammatory cytokines and advanced glycation end products ( Paneni et al, 2013 ; Baktiroglu et al, 2016 ; Henning, 2018 ). Cerebral arterial calcification is associated with the occurrence of stroke ( Bugnicourt et al, 2011 ), cognitive impairment, and dementia ( Bos et al, 2015 ), and a high level of cerebral arterial calcification is emerging as a predictor of poor neurological recovery after revascularization treatment in ischemic stroke patients ( Lee et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

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Selenium-Containing Protein From Selenium-Enriched Spirulina platensis Attenuates High Glucose-Induced Calcification of MOVAS Cells by Inhibiting ROS-Mediated DNA Damage and Regulating MAPK and PI3K/AKT Pathways

Liu

Zhang

et al. 2020

Front. Physiol.

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Hyperglycemia is the main feature of diabetes and may increase the risk of vascular calcification (VC), which is an independent predictor for cardiovascular and cerebrovascular diseases (CCD). Selenium (Se) may decrease the risk of CCD, and previous studies confirmed that Se-containing protein from Se-enriched Spirulina platensis (Se-SP) exhibited novel antioxidant potential. However, the effect of Se-SP against VC has been not investigated. Herein, the protective effect and underlying mechanism of Se-SP against high glucose-induced calcification in mouse aortic vascular smooth muscle cells (MOVAS) were explored. Inductively coupled plasma atomic emission spectroscopy (ICP-AES) results showed time-dependent uptake of Se-SP in MOVAS cells, which significantly inhibited high glucose-induced abnormal proliferation. Se-SP co-treatment also effectively attenuated high glucose-induced calcification of MOVAS cells, followed by decreased activity and expression of alkaline phosphatase (ALP). Further investigation revealed that Se-SP markedly prevented reactive oxygen species (ROS)-mediated DNA damage in glucose-treated MOVAS cells. ROS inhibition by glutathione (GSH) effectively inhibited high glucose-induced calcification, indicating that Se-SP could act as ROS inhibitor to inhibit high glucose-induced DNA damage and calcification. Moreover, Se-SP dramatically attenuated high glucose-induced dysfunction of mitogen-activated protein kinases (MAPKs) and phosphatidylinositol-3-kinase/AKT (PI3K/AKT) pathways. Se-SP after Se addition achieved enhanced potential in inhibiting high glucose-induced calcification, which validated that Se-SP as a new Se species could be a highly effective treatment for human CCD.

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Section: Discussionmentioning

confidence: 99%

“…High glucose is a typical hallmark of diabetes and is involved in atherosclerosis and VC ( Baktiroglu et al, 2016 ), contributing to the high morbidity and mortality of CCD ( Bugnicourt et al, 2011 ; Leon and Maddox, 2015 ). VSMCs play an important role in the process of diabetic VC.…”

Section: Discussionmentioning

confidence: 99%

Selenium-Containing Protein From Selenium-Enriched Spirulina platensis Attenuates High Glucose-Induced Calcification of MOVAS Cells by Inhibiting ROS-Mediated DNA Damage and Regulating MAPK and PI3K/AKT Pathways

Liu

Zhang

et al. 2020

Front. Physiol.

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“…Lyu et al reported that lower fetuin-A levels and higher levels of osteopontin and bone morphogenetic protein-7, as markers of VC, were associated with vascular failure [17]. The calcification score obtained using the Doppler ultrasound can predict lower blood access flow, which is a predictive sign of access failure [18], and Baktiroglu et al stated that the poor outcomes of vascular access in diabetes are due to arterial disease [19]. To sum up, these previous studies indirectly suggested a relationship between VC and access survival.…”

Section: Discussionmentioning

confidence: 99%

Quantified Vascular Calcification at the Dialysis Access Site: Correlations with the Coronary Artery Calcium Score and Survival Analysis of Access and Cardiovascular Outcomes

Kim

Lee

Choi

et al. 2020

JCM

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Vascular calcification is a major contributor to mortality in end-stage renal disease (ESRD) patients. In this study, we investigated whether there was a correlation between the coronary artery calcium score (CACS) and the vascular calcification score (VCS), and whether higher VCS increased the incidence of interventions and major adverse cardiac and cerebrovascular events (MACCE). ECG-gated CT, including vascular access and the coronary vessel, was taken. CACS and VCS were calculated by the Agatston method. A comparison of CACS and survival analysis according to VCS groups was performed. Using a cutoff of VCS = 500, 77 patients were divided into two groups. The vintage was significantly older in the higher VCS group. The median CACS was higher in the higher VCS group (21 [0, 171] vs. 552 [93, 2430], p < 0.001). The hazard ratio (HR) for interventions and MACCEs in the higher VCS group increased by 3.2 and 2.3, respectively. Additionally, a longer duration of hemodialysis and higher magnesium levels (>2.5 mg/dL) showed lower HRs for interventions (<1). We quantified VCS and found that it was associated with the CACS. Additionally, higher VCS increased the risk of access interventions and MACCE. VCS of the access site may be suggested as a biomarker to predict ESRD patients.

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“…Individuals with diabetes remain the most likely subset of the dialysis population to encounter a dialysis access‐related complication 145 . Calcification and stiffening of the arteries (i.e., access inflow) are prominent features of diabetic vasculature in ESKD individuals 146 and may contribute to early postoperative juxta‐anastomotic AVF stenosis and impaired AVF maturation. Peripheral atherosclerotic arterial lesions were present in 40% of a study population undergoing AVF creation, where a multivariable logistic regression with sex, age, race, diabetes, and access location showed that only diabetes predicted pre‐operative arterial micro‐calcification ( P < .001) 147 …”

Section: Special Considerations For Dialysis Access In the Eskd Populmentioning

confidence: 99%

When ESKD complicates the management of diabetes mellitus

William

Morales

Rosas

2020

Seminars in Dialysis

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Given the increased incidence and prevalence of ESKD (end-stage kidney disease) attributed to diabetes mellitus, it is important to consider the physiological and global sociodemographic factors that give rise to unique challenges in providing excellent care to this population. The individual with diabetes and ESKD faces alterations of glucose homeostasis that require close therapeutic attention, as well as the consideration of safe and effective means of maintaining glycemic control. Implementation of routine monitoring of blood glucose and thoughtful alteration of the individual's hypoglycemic drug regimen must be employed to reduce the risk of neurological, cardiovascular, and diabetes-specific complications that may arise as a result of ESKD. Titration of insulin therapy may become quite challenging, as kidney replacement therapy often significantly impacts insulin requirements. New medications have significantly improved the ability of the clinician to provide effective therapies for the management of diabetes, but have also raised an equal amount of uncertainty with respect to their safety and efficacy in the ESKD population. Additionally, the clinician must consider the challenges related to the delivery of kidney replacement therapy, and how inter-modality differences may impact glycemic control, diabetes, and ESKD-related complications, and issues surrounding dialysis vascular access creation.

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Arterial Disease and Vascular Access in Diabetic Patients

Abstract: Although some authors report inferior outcomes of vascular access procedures in diabetic patients, there is evidence that most of the problems encountered can be dealt with by careful patient selection, surgical skill, and experience.

Cited by 15 publications

References 22 publications

Selenium-Containing Protein From Selenium-Enriched Spirulina platensis Attenuates High Glucose-Induced Calcification of MOVAS Cells by Inhibiting ROS-Mediated DNA Damage and Regulating MAPK and PI3K/AKT Pathways

Selenium-Containing Protein From Selenium-Enriched Spirulina platensis Attenuates High Glucose-Induced Calcification of MOVAS Cells by Inhibiting ROS-Mediated DNA Damage and Regulating MAPK and PI3K/AKT Pathways

Quantified Vascular Calcification at the Dialysis Access Site: Correlations with the Coronary Artery Calcium Score and Survival Analysis of Access and Cardiovascular Outcomes

When ESKD complicates the management of diabetes mellitus

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