Association Between Risk Factors Including Bone-Derived Biomarkers and Aortic Arch Calcification in Maintenance Hemodialysis Patients

Nitta, Kosaku; Hanafusa, Norio; Okazaki, Masayuki; Komatsu, Masatoshi; Kawaguchi, Hiroshi; Tsuchiya, Ken

doi:10.1159/000494441

Cited by 12 publications

(12 citation statements)

References 35 publications

(39 reference statements)

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“…At present, there is no good index to reflect the pathophysiological mechanism of vascular calcification, and guide clinical diagnosis and treatment. The classical markers, such as serum calcium ( 17 ), serum phosphorus ( 18 ), PTH ( 18 ), AKP ( 19 ) and FGF23 ( 20 ), are not specific and sensitive enough to reflect the pathophysiologic mechanisms underlying the process of VC ( 21 ). A review focuses on the pathophysiological mechanisms of vascular and valvular calcification in general population, list OC as one of the promoters in a table.…”

Section: Discussionmentioning

confidence: 99%

“…OC is positively correlated with phosphorus, iPTH, FGF23 and AACs, but the multiple logistics regression analysis revealed that only age and OC(OR=1.10, P=0.008)were risk factors for high AACs (≥5). There have been studies in dialysis patients showed increasing VC severity with age, regardless of factors such as dialysis vintage, dyslipidemia, PTH level and hypertension ( 21 ). It can be said that the effect of age on vascular calcification is well recognized.…”

Section: Discussionmentioning

confidence: 99%

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Osteocalcin and Abdominal Aortic Calcification in Hemodialysis Patients: An Observational Cross-Sectional Study

et al. 2021

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ObjectivesTo investigate the serum level of osteocalcin (OC), also known as bone Gla protein, in maintenance hemodialysis (MHD) patients and its correlation with abdominal aortic calcification (AAC).MethodsFrom July 2017 to February 2020, we enrolled 108 adult MHD patients. Routine fasting blood laboratory tests were performed before the start of the second hemodialysis in a week. Abdominal aortic calcification score (AACs) was assessed within 1 month. Pearson correlation and Logistic regression were used to analyze the data.ResultsThe OC level was 231.56 (25.92,361.33) ng/ml, elevating significantly in this group of MHD patients. It had a positive correlation with serum phosphorus (r = 0.511, P = 0.001), intact parathyroid hormone(iPTH) (r = 0.594, P = 0.0001), fibroblast growth factor 23(FGF23) (r = 0.485, P = 0.003) and a negative correlation with age(r = -0.356, P = 0.039). Based on the AACs, patients were divided into two groups. Serum OC level were higher in patients with AACs≥5 (p=0.032). A multiple logistics regression analysis revealed that age (odds ratio [OR]1.14, P=0.005) and OC(OR=1.10, P=0.008)were risk factors for high AACs(≥5).ConclusionThe study implicated that OC elevated significantly in this group of MHD patients.OC is positively correlated with phosphorus, iPTH, FGF23, and a negative correlation with age. OC was a risk factor for vascular calcification in this study, but this study did not classify osteocalcin as c-OC and unOC. Whether unOC is associated more directly with vascular calcification requires further study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Osteocalcin and Abdominal Aortic Calcification in Hemodialysis Patients: An Observational Cross-Sectional Study

et al. 2021

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“…Many studies have shown that the presence and progression of AoAC are strong risk factors for cardiovascular morbidity and mortality [ 28 , 29 , 30 ]. The etiology of VC is multifactorial in patients with ESRD, and it has been reported to involve aging, diabetes, smoking, oxidative stress, inflammation, hyperfibrinogenemia, dysregulation of fibroblast growth factor 23, intact parathyroid hormone, calcium and phosphorus, protein-energy wasting, loss of osteopontin and fetuin-A, the osteoprotegerin/receptor activator of NF-kB/receptor activator of the NF-kB ligand system, as well as an increase in sclerostin [ 31 , 32 , 33 ]. In addition, apoptosis and osteochondrogenic differentiation of vascular smooth muscle cells have also been shown to play important roles in arterial medial calcification, which can induce tunica media remodeling and increase arterial stiffness and reduce vascular compliance [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Aortic Arch Calcification and Cardiomegaly Are Associated with Overall and Cardiovascular Mortality in Hemodialysis Patients

Liu

Chung

et al. 2021

JPM

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Patients with end-stage renal disease have a higher risk of cardiovascular morbidity and mortality. In this study, we investigated the predictive ability of a combination of cardiothoracic ratio (CTR) and aortic arch calcification (AoAC) for overall and cardiovascular mortality in patients receiving hemodialysis. We also evaluated the predictive power of AoAC and CTR for clinical outcomes. A total of 365 maintenance hemodialysis patients were included, and AoAC and CTR were measured using chest radiography at enrollment. We stratified the patients into four groups according to a median AoAC score of three and CTR of 50%. Multivariable Cox proportional hazards analysis was used to identify the risk factors of mortality. The predictive performance of the model for clinical outcomes was assessed using the χ2 test. Multivariable analysis showed that, compared to the AoAC < 3 and CTR < 50% group, the AoAC ≥ 3 and CTR < 50% group (hazard ratio [HR], 4.576; p < 0.001), and AoAC ≥ 3 and CTR ≥ 50% group (HR, 5.912; p < 0.001) were significantly associated with increased overall mortality. In addition, the AoAC < 3 and CTR ≥ 50% (HR, 3.806; p = 0.017), AoAC ≥ 3 and CTR < 50% (HR, 4.993; p = 0.002), and AoAC ≥ 3 and CTR ≥ 50% (HR, 8.614; p < 0.001) groups were significantly associated with increased cardiovascular mortality. Furthermore, adding AoAC and CTR to the basic model improved the predictive ability for overall and cardiovascular mortality. The patients who had a high AoAC score and cardiomegaly had the highest overall and cardiovascular mortality among the four groups. Furthermore, adding AoAC and CTR improved the predictive ability for overall and cardiovascular mortality in the hemodialysis patients.

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“…The progression of vascular calcification has been associated with factors including aging, diabetes mellitus, inflammation, oxidative stress, uremic toxins, the renin-angiotensin system activity, high blood pressure, hyperlipidemia, and mineral disorders [25]. Hyperphosphatemia is considered the main factor in the pathophysiology of AoAC [26].…”

Section: Discussionmentioning

confidence: 99%

Effects of Ferric Citrate Hydrate on Calciprotein Particle Levels and Aortic Arch Calcification Progression in Patients on Maintenance Hemodialysis: A Comparison with Calcium Carbonate

Akiyama¹,

Kuro‐o²,

Miura³

et al. 2020

IJCM

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Background: Arterial calcification is a predictive marker in patient on hemodialysis (HD), but the relationship between arterial calcification and calciprotein particles (CPPs) is unclear. Methods: We examined the effects of ferric citrate hydrate (JTT-751) on CPP level and evaluated changes in aortic arch calcification (AoAC) grade in patients on maintenance HD (MHD). In total, 70 MHD patients were enrolled in the study and followed for 24 months. We measured serum CPP levels and fibroblast growth factor 23 (FGF 23) among propensity score-matched MHD patients. One group (n = 35) was treated with CaCO 3 and the other (n = 35) was treated with ferric citrate hydrate (JTT-751). AoAC was assessed on chest-X rays. Eligible patients continued the same treatment. Results: All 70 patients completed the study. Serum CPP levels reduced in the JTT-751 group, but were not significantly different in the CaCO 3 group. Among patients whose baseline AoAC score (AoACS) was ≤ 4 (median), median AoACS increased from 0 (0-3) to 3 (2-4) (p < 0.05) and Δ% AoACS was 2 (0%-4%) in the JTT-751 group. In the CaCO 3 group, median AoACS increased from 2 (0-2) to 3 (0-4) (p < 0.05) and Δ% AoACS was 1 (0%-3%). Conclusion: These results indicate that the administration of JTT-751 decreased serum CPP levels but did not inhibit AoAC progression in patients on MHD.

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Association Between Risk Factors Including Bone-Derived Biomarkers and Aortic Arch Calcification in Maintenance Hemodialysis Patients

Cited by 12 publications

References 35 publications

Osteocalcin and Abdominal Aortic Calcification in Hemodialysis Patients: An Observational Cross-Sectional Study

Osteocalcin and Abdominal Aortic Calcification in Hemodialysis Patients: An Observational Cross-Sectional Study

Aortic Arch Calcification and Cardiomegaly Are Associated with Overall and Cardiovascular Mortality in Hemodialysis Patients

Effects of Ferric Citrate Hydrate on Calciprotein Particle Levels and Aortic Arch Calcification Progression in Patients on Maintenance Hemodialysis: A Comparison with Calcium Carbonate

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