Association of Bone Activity, Calcium Load, Aortic Stiffness, and Calcifications in ESRD

London, Gérard M.; Marchais, Sylvain J.; Guérin, Alain P.; Boutouyrie, Pierre; Mëtivier, Fabien; Vernejoul, Marie‐Christine de

doi:10.1681/asn.2007050622

Cited by 257 publications

(199 citation statements)

References 45 publications

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“…In patients with CKD-5D, PWV may be increased by dosing with calcium, calcitriol, or its analogs and by phosphate exposure (30)(31)(32), although physiologic levels of 25(OH)D and 1,25(OH) 2 D may maintain stability of the vascular smooth muscle phenotype (33). In this study, baseline PWV values were directly associated with age and inversely to 25(OH)D levels.…”

Section: Pwvmentioning

confidence: 63%

Effects of Cholecalciferol on Functional, Biochemical, Vascular, and Quality of Life Outcomes in Hemodialysis Patients

Hewitt

O'Connor

O’Shaughnessy

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Observational studies suggest that calciferol supplementation may improve laboratory and patient-level outcomes of hemodialysis patients with reduced 25-hydroxyvitamin D [25(OH)D] levels. This randomized controlled trial examined effects of cholecalciferol supplementation in patients on hemodialysis.Design, setting, participants, & measurements Sixty patients with 25(OH)D levels #24 ng/ml (#60 nmol/L) were randomized to receive 50,000 IU oral cholecalciferol or placebo, once weekly for 8 weeks and then monthly for 4 months. At baseline (autumn 2011) and 6 months, testing evaluated muscle strength, functional capacity, laboratory parameters, pulse wave velocity (PWV), and health-related quality of life (HRQOL) using the Kidney Disease Quality of Life-36 survey.Results Patients were well matched by treatment allocation. Median age was 62 years (range, 20-86), 52% were women, 55% had a history of diabetes, and mean serum 25(OH)D was 1765 ng/ml (43613 nmol/L). Patients were assessed over 6 months by repeated-measures ANOVA. Patients allocated to cholecalciferol had significantly higher values of 25(OH)D (P,0.001), 1,25-dihydroxyvitamin D (P=0.04), and tartrate-resistant acid phosphatase-5b) (P=0.04) and a greater reduction in phosphorus values (P=0.03) than placebo-treated patients Values of serum calcium, intact parathyroid hormone, and episodes of hypercalcemia and hyperphosphatemia did not differ significantly between the groups. No significant differences were detected in muscle strength, functional capacity, PWV, or HRQOL.Conclusions In this randomized controlled trial, patients supplemented with cholecalciferol had higher 25(OH)D, 1,25-dihydroxyvitamin D, and tartrate-resistant acid phosphatase-5b levels, without increased calcium or phosphorus values. However, no effects were detected in muscle strength, functional capacity, PWV, or HRQOL.

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Section: Pwvmentioning

confidence: 63%

Effects of Cholecalciferol on Functional, Biochemical, Vascular, and Quality of Life Outcomes in Hemodialysis Patients

Hewitt

O'Connor

O’Shaughnessy

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…In dialysis patients, coronary artery calcification score was found to be inversely correlated with vertebral bone mass (11,12). In addition, a high systemic arterial calcification score combined with bone histomorphometry suggestive of low bone activity was observed in hemodialysis patients (13,14). Arterial stiffening and low spine BMD or calcaneal osteopenia were significantly associated in CKD and hemodialysis patients (15)(16)(17).…”

mentioning

confidence: 96%

“…One important difference between these publications resides in the arterial territories analyzed and the relationships of the different bone changes (bone volume, osteoblasts number, or tetracycline labeling), which do not necessarily reflect the same mechanisms. Adragao et al (18) studied coronary artery calcifications, whereas London et al (13,14) examined the aorta and systemic arteries.Researchers investigating the arterial system should keep in mind the marked heterogeneity of the arterial tree (19). Blood vessel formation recruits cells of different origins whose components are derived from vascular smooth muscle cells (VSMC) and pericytes.…”

mentioning

confidence: 99%

Bone–Vascular Axis in Chronic Kidney Disease

London¹

2009

Clinical Journal of the American Society of Nephrology

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C hronic kidney disease (CKD) is characterized by changes in mineral metabolism associated with alterations of its hormonal regulation and various forms of bone disease. In the past, these associations focused attention on the kidney-bone axis. The last decade has seen renewed interest on interactions among mineral metabolism disorders and extraosseous and cardiovascular calcifications observed in CKD or end-stage renal disease (ESRD). Vascular calcification is an active process similar to bone formation that implicates a variety of proteins involved in bone and mineral metabolism (1,2) and is considered part of a systemic dysfunction defined as CKD-mineral and bone disorder (3). Growing evidence linking bone with different functional and structural characteristics of the arterial tree has contributed to developing the concept of the bone-vascular axis (4).The first observations suggesting the existence of the bonevascular axis were the frequent associations of osteoporosis and atherosclerotic vascular calcifications observed in postmenopausal women (5-7). Longitudinal population-based studies revealed a relationship between the progression of vascular calcifications and bone demineralization, and others were identified between bone mineral density (BMD) and aortic or central artery calcifications (6), or coronary arteries in type 2 diabetes (8). The osteopenia-osteoporosis association was also linked with arterial functional indexes, such as aortic stiffness and interactions independent of calcifications, suggesting broader biologic interplay (9,10).Relationships between bone and vascular modifications were also observed in CKD and ESRD patients. In dialysis patients, coronary artery calcification score was found to be inversely correlated with vertebral bone mass (11,12). In addition, a high systemic arterial calcification score combined with bone histomorphometry suggestive of low bone activity was observed in hemodialysis patients (13,14). Arterial stiffening and low spine BMD or calcaneal osteopenia were significantly associated in CKD and hemodialysis patients (15)(16)(17).In the present issue of the Journal, Adragao et al. (18) provide new evidence linking altered bone metabolism to coronary calcifications in patients with stage-5 CKD on hemodialysis. In their cross-sectional study performed on 38 hemodialyzed patients, they analyzed the relationships between bone biopsy parameters (bone volume/total volume, bone formation rate/ bone surface, and activation frequency) and coronary calcifications determined by multislide computer tomography. Their principal conclusion was that low bone volume is associated with more coronary calcifications, whereas histomorphometric parameters of bone turnover were independent of coronary calcifications.Their results complete those of Barreto et al. (12), who found a negative correlation between coronary calcifications and trabecular bone volume or its thickness. The absence of correlations between histomorphometric indexes of bone turnover and coronary calcifications dif...

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“…Analysis: Vascular calcifi cation is recognized as a risk factor for cardiovascular events in both CKD patients and in individuals in the general population. [8][9] The mechanisms responsible for the increased vascular calcifi cation seen in ESRD patients have been the subject of much research over the last 15 years. Some epidemiologic and cohort studies have implicated calcium loads from either the dialysate or from oral phosphate binders in the development of vascular calcifi cations, but this association has not been observed in all observational settings.…”

Section: Nephrology Literature Watchmentioning

confidence: 99%

“…Some epidemiologic and cohort studies have implicated calcium loads from either the dialysate or from oral phosphate binders in the development of vascular calcifi cations, but this association has not been observed in all observational settings. 8,[10][11][12][13] In the general population, calcium supplementation is associated with reduced blood pressure and has been advocated by some as potentially reducing cardiovascular risk through a favorable effect on blood pressure. The results of two large studies, one of which is reviewed here (Pentti and colleagues), challenge conventional wisdom and provide evidence for potential harm with calcium supplementation in a healthy elderly population.…”

Section: Nephrology Literature Watchmentioning

confidence: 99%