Detección de las calcificaciones cardiovasculares: ¿una herramienta útil para el nefrólogo?

Abstract

Chronic kidney disease (CKD) has been used as a model and source of knowledge concerning the mechanisms, clinical relevance and accelerated progression of cardiovascular (CV) calcification, as well as its consequences in clinical practice, despite we know that it is a late secondary ossification phenomenon and only circumstantial evidence is available. In this comprehensive review, we firstly describe the types of CV calcification which affect CKD patients, and we analyse how its presence is directly associated with CV events and increased mortality in these patients. We also justify the use of CV calcification assessment in regular nephrology clinical practice, because CV calcification is an important predictor of clinical outcome in these patients. Consequently, we believe that CV calcification assessment is a tool that could and should be used by nephrologists when making a decision concerning individual patients, consistent with the current trend of an ever-more-personalised therapeutic approach.

Hipertrofia ventricular izquierda y valvulopatías en la enfermedad renal crónica. Prevalencia y factores de riesgo asociados

“…PP: pared posterior; RWT: espesor relativo de pared de ventrículo izquierdo; SIV: septum iterventricular; VI: ventrículo izquierdo. (auriculares, ventriculares, valvulares) era mayor en la ERC en estadios III-V, y que el menor FGe fue un factor de riesgo independiente de HVI, lo cual condice con la literatura existente [4][5][6][7][8][9][10][14][15][16][17] . En un estudio previo, nacional, del PSRU 8 se observó una tasa de nuevo evento cardiovascular de 10.1 por 100 pacientes-año y una tasa de mortalidad global de 6.2 (2.03 por 100 paciente-año de causa cardiovascular), con una asociación de evento cardiovascular y mortalidad con factores de riesgo tradicionales, así como vinculados a la ERC.…”

“…La HVI es un predictor independiente de mortalidad cardiovascular en pacientes con ERC identificado hace varias décadas [4][5][6][7][8][9][10][14][15][16][17] . En una cohorte japonesa de pacientes con ERC 21 , Nitta, et al reportan como factores de riesgo independientes de HVI, el presentar antecedentes de ECV, la PAS, el índice de masa corporal y los niveles de calcemia.…”

“…La hipertrofia ventricular izquierda (HVI) es altamente prevalente en portadores de ERC (50-80%, según el estadio) [9][10][11] , por estímulos hemodinámicos (hipertensión arterial [HTA], sobrehidratación), inflamación e injuria oxidativa 12 , anemia, exceso de mineralocorticoides 13 , alteraciones del metabolismo óseo-mineral 14,15 . Existen menos reportes sobre la frecuencia de afectación valvular (calcificada o no) en el curso de la ERC y de sus factores de riesgo 16,17 .…”

The Use of Imaging Techniques in Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD)—A Systematic Review

“…Depending on resources, routine screening for cardiovascular calcification in CKD patients is controversial [ 79 ] because of the lack of specific therapies proven to reverse or attenuate vascular calcification in this population. Nevertheless, cardiovascular calcification assessment should be performed in order to predict and modify clinical outcomes especially in dialysis patients where some of the treatments used for CKD–MBD may enhance vascular calcification progression [ 80 ]. The KDIGO guidelines propose an assessment of vascular calcification in patients where it could modify therapeutic options [ 26 ].…”

An Investigation on the One-year Rate of Arteriovenous Fistula Failure and Its Related Factors in Patients with End-stage Renal Disease; an Experience in Golestan Province of Iran

“…The first evidence of a link between chronic kidney diseases and cardiovascular diseases dates back more than 40 years ago (5). Cardiovascular (CV) events are the leading causes of mortality and morbidity in patients with ESRD, with an incidence rate of 10 to 30 times higher than the general population.…”