Differences in Risk Factors and Prevalence of Vascular Calcification between Pre-Dialysis and Hemodialysis Balkan Nephropathy Patients

Abstract

Aims: The aim of this study was to compare the risk factors and prevalence of vascular calcification (VC) in pre-dialysis and hemodialysis (HD) patients with Balkan endemic nephropathy (BEN) or other kidney diseases (non-BEN). Materials and Methods: The study involved 115 patients, 32 pre-dialysis and 83 HD patients, separated into groups of BEN and non-BEN patients. In addition to interviews, objective examinations and laboratory analyses, VC was assessed using Adragao score. Results: Patients with BEN were significantly older in both groups, while pre-dialysis BEN patients had significantly lower systolic blood pressure, serum cholesterol and phosphorus levels, but higher urinary excretion of phosphorus than non-BEN patients. These differences were lost in HD groups. In pre-dialysis patients, prevalence of VC was lower in BEN than in non-BEN group and mean VC score differed significantly between them (2.8 (1.7) vs. 4.6 (1.8); p = 0.009). No significant difference in VC score was found between BEN and non-BEN patients on HD. Multivariate analysis showed that in pre-dialysis patients VC score >4 was associated with lower iPTH and higher serum cholesterol level, but in the HD group with higher serum triglyceride level and longer HD vintage. Conclusions: Lower prevalence of risk factors for VC in the BEN than non-BEN patients was found in pre-dialysis but not in HD group and this was reflected in the prevalence and severity of VC in the groups. Prevalence of VC and mean VC score were significantly lower in pre-dialysis BEN than in non-BEN patients but not for those on HD.

Orthostatic Hypotension in Asymptomatic Patients with Chronic Kidney Disease

“…This results in an adaptive mechanism relying on the reduction of adrenergic receptor concentration on effector cells, which significantly increases the risk of sudden CV complications [25,36]. During emotional stress, vascular stress (e.g., fluctuations in arterial blood pressure and/or body fluid status), metabolic stress (e.g., hypoglycemia, underdialysis) natural balancing mechanisms fail because they are impaired due to a reduced receptor response [37]. Treatment with β-blockers further impairs the described balancing mechanisms, and the impact of this drug group on the presence of OH in CKD demonstrated in our study may indirectly suggest AN in CKD.…”

Comparative Analysis of Vascular Calcification Risk Factors and Biomarkers in Pre-Hemodialysis and Prevalent Hemodialysis Patients

“…Furthermore, while the underlying kidney disease appears to be similar between the groups, the prevalence of BEN is significantly higher in the pre-HD group. Although the exact mechanism is unknown, some literature suggests that BEN is associated with lower VC compared to other causes of ESRD due to better serum phosphorus levels [15], implying that there may be underlying factors or protective mechanisms associated with this specific condition that affects phosphate metabolism. Considering circulating biomarkers, Fetuin A as a calcification inhibitor was higher and FGF 23 involved in phosphate homeostasis was lower compared to the HD group of patients, and both may have protective effects against VC development.…”