Effect of Renal Transplantation on Coronary Artery Calcification in Hemodialysis Patients

Abedi, Samira; Tarzamni, Mohammad Kazem; Nakhjavani, M.R.J.; Bohlooli, A.

doi:10.1016/j.transproceed.2009.07.037

Cited by 17 publications

(13 citation statements)

References 7 publications

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“…In the majority of kidney transplant recipients both serum phosphorus and PTH are expected to normalize after transplant, abrogating the effect of phosphorus as a vascular toxin. This does not immediately correct pre-established vascular lesions, although some cal- cified lesions may be gradually reabsorbed after successful transplantation (35). As a result, it is possible that the mortality risk in those with moderate increases in serum phosphorus (Ͼ7.5 to 9.0 mg/dl) may be reduced after transplant.…”

Section: Discussionmentioning

confidence: 99%

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Sampaio

Molnar

Kövesdy

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Serum phosphorus levels are associated with mortality, cardiovascular disease, and renal function loss in individuals with and without chronic kidney disease. The association of pretransplant serum phosphorus levels with transplant outcomes is not clear. The selected 9384 primary kidney recipients were divided into five groups according to pretransplant serum phosphorus levels (mg/dl): Ͻ3.5, 3.5 to Ͻ5.5 (reference group), 5.5 to Ͻ7.5, 7.5 to Ͻ9.5, and Ն9.5. Unadjusted and multivariate adjusted risks for transplant outcomes were compared. ResultsPatients were 48 Ϯ 14 years old and included 37% women and 27% African Americans. After multivariate adjustment, all-cause and cardiovascular death hazard ratios were 2.44 (95% confidence interval: 1.28 to 4.65) and 3.63 (1.13 to 11.64), respectively, in recipients in the Ն9.5 group; allograft loss hazard ratios were 1.42 (1.04 to 1.95) and 2.36 (1.33 to 4.17) in recipients with 7.5 to Ͼ9.5 and Ն9.5, respectively. No significant association with delayed graft function was found.Conclusions Pretransplant phosphorus levels 7.5 to Ͻ9.5 mg/dl and Ն9.5 mg/dl were associated with increased risk of functional graft failure and increased risk of all-cause and cardiovascular deaths, respectively, when compared with 3.5 to Ͻ5.5 mg/dl. Additional studies are needed to examine whether more aggressive control of pretransplant serum phosphorus may improve posttransplant outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Sampaio

Molnar

Kövesdy

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…First, we may improve the outcomes by changing the condition of being HD. This may include renal transplantation [23]; however, this procedure is still not common in Japan. Then, usage of a higher quality dialyzer may be a possible approach, since some of the hormonal factors that influence poor outcomes may be filtered [24].…”

Section: Discussionmentioning

confidence: 99%

Angiographic and clinical outcomes of 100 consecutive severe calcified lesions requiring rotational atherectomy prior to sirolimus-eluting stent implantation in hemodialysis and non-hemodialysis patients

Kyono

Kozuma

Shiratori

et al. 2010

Cardiovasc Interv and Ther

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Both severe calcified lesions and hemodialysis (HD) are predictors for high rates of restenosis, even in the drug-eluting stent era. We sought to investigate the angiographic and clinical outcome in a population of HD versus non-hemodialysis (non-HD) patients with severe calcified lesions requiring rotational atherectomy. One hundred consecutive lesions (28 lesions in the HD group, 72 in the non-HD group) from 82 patients (19 patients in the HD group, 63 in the non-HD group) requiring rotational atherectomy prior to sirolimus-eluting stent (SES) implantation were analyzed post-procedure and at 8 months. Clinical outcomes were assessed at 12 months. Inclusion criteria were calcified lesions with >270° of superficial calcification on the intravascular ultrasound (IVUS), lesions that the IVUS could not cross, or undilatable lesions. There were no differences in patient characteristics except for age. Although both baseline and post-procedure angiographic findings were similar between the two groups, late loss in stented segment was significantly greater in the HD group than in the non-HD group (HD vs. non-HD: 0.69 ± 0.74 mm vs. 0.34 ± 0.50; P = 0.030). Also, the HD group revealed significantly worse clinical outcomes. In conclusion, mid-term results of highly complex, severely calcified lesions requiring rotational atherectomy in non-HD patients were permissible as compared to on-label lesions. However, in HD patients, both angiographic and clinical outcomes were still suboptimal in this lesion subset, even using SES.

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“…A 39% decrease in coronary artery calcification, similar to that observed in mouse aortic allografts, was found 6 months after renal transplantation in 31 patients. 8 However, no change was noted after renal transplantation in another study. 9 Although renal failure was eliminated, this experimental approach was complicated by the metabolic derangements in transplant patients that can cause progression of atherosclerosis and the accompanying calcification.…”

Section: Discussionmentioning

confidence: 91%

“…Although reversibility of uremic vascular calcification has been reported in humans, 7 this has not been observed in any large interventional studies aimed at correcting disordered mineral metabolism in patients with chronic kidney disease or endstage renal disease. Studies in patients before and after renal transplantation have shown regression 8 or no change 9 in coronary artery calcification. However, this calcification is largely atherosclerotic 10 and can progress after transplantation as a result of other metabolic factors.…”

mentioning

confidence: 99%

Persistence of Vascular Calcification after Reversal of Uremia

Lomashvili

Manning

Weitzmann

et al. 2017

The American Journal of Pathology

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The extent to which vascular calcification is reversible and the possible mechanisms are unclear. To address this, calcified aortas from uremic mice were transplanted orthotopically into normal mice, and the calcium content, histology, and minerals of the allografts were compared with the nontransplanted donor aorta. Calcium content decreased immediately after transplantation but remained constant thereafter, with 68% AE 12% remaining after 34 weeks. X-ray diffraction showed the presence of apatite in both donor aortas and allografts. Osteoclasts were absent in the allografts and there was no expression of the macrophage marker CD11b, the osteoclast marker tartrate-resistant acid phosphatase, or carbonic anhydrase II. The initial loss of calcium was less in heavily calcified aortas and was associated with an increase in the Ca/P ratio from 1.49 to 1.63, consistent with a loss of nonapatitic calcium. The results indicate that vascular calcification persists after reversal of uremia, because of a lack of active resorption of apatite. This failure to resorb established calcifications may contribute to the severity of vascular calcification and suggests that therapy should be aimed at prevention.

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Effect of Renal Transplantation on Coronary Artery Calcification in Hemodialysis Patients

Cited by 17 publications

References 7 publications

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Association of Pretransplant Serum Phosphorus with Posttransplant Outcomes

Angiographic and clinical outcomes of 100 consecutive severe calcified lesions requiring rotational atherectomy prior to sirolimus-eluting stent implantation in hemodialysis and non-hemodialysis patients

Persistence of Vascular Calcification after Reversal of Uremia

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