Early markers of cardiovascular risk in chronic kidney disease

Lai, Silvia; Dimko, Mira; Galani, Alessandro; Coppola, Bettina; Innico, Georgie; Frassetti, Nicla; Mazzei, Egidio Domenico; Mariotti, Amalia

doi:10.3109/0886022x.2014.982489

Cited by 29 publications

(31 citation statements)

References 38 publications

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“…Several studies have identified V’E/V’CO 2 , anaerobic threshold, and V’O 2max as prognostic factors in cardiovascular diseases [62-63]. We found, also, a significant increase of cTnT in ADPKD patients, a sensitive and specific marker of ischemic myocardial damage, renally cleared, and widely used as a predictor of cardiovascular events [53]. Our results indicate an increase of the indexes of inflammation and endothelial dysfunction, with reduced tolerance to stress and decreased anaerobic threshold to CPET, in young ADPKD patients, with preserved renal function, in the early stages of disease, compared to control group.…”

Section: Discussionmentioning

confidence: 76%

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Lai

Mastroluca

Matino

et al. 2017

Kidney Blood Press Res

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Background/Aims: Cardiovascular disease is the most frequent cause of morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) patients, often before the onset of renal failure, and the pathogenetic mechanism is not yet well elucidated. The aim of the study was to identify early and noninvasive markers of cardiovascular risk in young ADPKD patients, in the early stages of disease. Methods: A total of 26 patients with ADPKD and 24 control group, matched for age and sex, were enrolled, and we have assessed inflammatory indexes, mineral metabolism, metabolic state and markers of atherosclerosis and endothelial dysfunction (carotid intima media thickness (IMT), ankle brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI), left ventricular mass index (LVMI)) and cardiopulmonary exercise testing (CPET), maximal O₂ uptake (V’O₂max), and O₂ uptake at lactic acid threshold (V’O₂@LT). Results: The ADPKD patients compared to control group, showed a significant higher mean value of LVMI, RRI, homocysteine (Hcy), Homeostasis Model Assessment-insulin resistance (HOMA-IR), serum uric acid (SUA), Cardiac-troponinT (cTnT) and intact parathyroid hormone (iPTH) (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.007, p=0.019; respectively), and a lower value of FMD and 25-hydroxyvitaminD (25-OH-VitD) (p<0.001, p<0.001) with reduced parameters of exercise tolerance, as V’O₂max, V’O₂max/Kg and V’O₂max (% predicted) (p<0.001, p<0.001, p=0.018; respectively), and metabolic response indexes (V’O₂@LT, V’O₂ @LT%, V’O₂@LT/Kg,) (p<0.001, p=0.14, p<0.001; respectively). Moreover, inflammatory indexes were significantly higher in ADPKD patients, and we found a positive correlation between HOMA-IR and C-reactive protein (CRP) (r=0.507, p=0.008), and a negative correlation between HOMA-IR and 25-OH-VitD (r=-0.585, p=0.002). Conclusion: In our study, ADPKD patients, in the early stages of disease, showed a greater insulin resistance, endothelial dysfunction, inflammation and mineral metabolism disorders, respect to control group. Moreover, these patients presented reduced tolerance to stress, and decreased anaerobic threshold to CPET. Our results indicate a major and early cardiovascular risk in ADPKD patients. Therefore early and noninvasive markers of cardiovascular risk and CPET should be carried out, in ADPKD patients, in the early stages of disease, despite the cost implication.

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Section: Discussionmentioning

confidence: 76%

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Lai

Mastroluca

Matino

et al. 2017

Kidney Blood Press Res

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“…Patients with chronic kidney disease (CKD) have markedly increased rates of cardiovascular (Foley et al 1995;Lai et al 2015) and cerebrovascular disease (Dad and Weiner 2015) and mortality even before reaching end-stage renal disease (ESRD). Therefore, it is critical to identify early biomarkers predicting major adverse cardiovascular and cerebrovascular events (MACCEs) or survival in patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

Higher Serum Levels of Osteoglycin Are Associated with All-Cause Mortality and Cardiovascular and Cerebrovascular Events in Patients with Advanced Chronic Kidney Disease

Baek

Hui

Kang

et al. 2017

Tohoku J. Exp. Med.

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Patients with chronic kidney disease (CKD) have markedly increased rates of major adverse cardiovascular and cerebrovascular events (MACCEs) and mortality. Therefore, identifying early biomarkers predicting clinical outcomes in patients with CKD is critical. We aimed to determine whether osteoglycin, a basic component of the vascular extracellular matrix, was associated with MACCEs or all-cause mortality, using data from a prospective randomized controlled study, K-STAR (Kremezin STudy Against Renal disease progression in Korea: NCT 00860431). A total of 383 patients (mean age: 56.4 years, men/women = 252/131) with CKD stage 3 to 4 from the original trial were enrolled in the present study. We measured serum osteoglycin level and examined the impact of osteoglycin on clinical outcomes. The mean value of osteoglycin levels was 13.3 ± 9.4 ng/mL (healthy control: 5.3 ± 2.1 ng/mL). In multivariable analysis, lower levels of proteinuria and hemoglobin and higher levels of C-reactive protein were significantly associated with higher osteoglycin levels. Estimated glomerular filtration rate was not related to osteoglycin level. During a mean follow-up period of 56 months, 25 deaths, 61 MACCEs, and 76 composite outcomes (all-cause mortality or MACCEs) occurred. In the non-diabetic group, each 1-ng/mL increase in serum osteoglycin was associated with all-cause mortality and composite outcome (hazard ratio [HR] = 1.058, P = 0.031; HR = 1.041, P = 0.036). However, osteoglycin levels were not associated with mortality, MACCEs, or composite outcome in the diabetic group. Our results indicate that serum osteoglycin is a potential predictor of adverse outcomes in patients with CKD.

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“…In these patients with early renal failure and activated coagulation system, prevalence of coronary heart disease, cerebrovascular disease, and peripheral arteriopathy was significantly higher than in patients with GFR of 90 mL/min per 1.72 m 2 or more and cardiovascular disease was independently predicted by both plasma D-dimer and fibrinogen levels. Consistently, in 50 patients with stage 2-3 renal failure plasma fibrinogen was significantly increased possibly contributing to the high cardiovascular morbidity of these patients [35] . In the 3758 patients with GFR of 20 to 70 mL/min per 1.72 m 2 of the Chronic Renal Insufficiency…”

Section: Non-traditional Cardiovascular Risk Factorsmentioning

confidence: 52%

Early renal failure as a cardiovascular disease: Focus on lipoprotein(a) and prothrombotic state

Catena¹

2015

WJN

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Patients with renal failure are at increased risk of cardiovascular events even at the earliest stages of disease. In addition to many classic cardiovascular risk factors, many conditions that are commonly identified as emerging risk factors might contribute to occurrence of cardiovascular disease. Changes in circulating levels of many of these emerging risk factors have been demonstrated in patients with early stages of renal failure caused by different types of renal disease and have been associated with detection of cardiovascular complications. However, for most of these factors evidence of benefits of correction on cardiovascular outcome is missing. In this article, we comment on the role of lipoprotein(a) and prothrombotic factors as potential contributors to cardiovascular events in patients with early renal failure.

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Early markers of cardiovascular risk in chronic kidney disease

Cited by 29 publications

References 38 publications

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Higher Serum Levels of Osteoglycin Are Associated with All-Cause Mortality and Cardiovascular and Cerebrovascular Events in Patients with Advanced Chronic Kidney Disease

Early renal failure as a cardiovascular disease: Focus on lipoprotein(a) and prothrombotic state

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