Evaluation of the role of severe hyperparathyroidism on coronary artery calcification in dialysis patients

Hernandes, Fabiana Rodrigues; Barreto, Fellype Carvalho; Rocha, Lillian Andrade da; Draibe, S. A.; Canziani, Maria E.; Carvalho, Adelino Moreira de

doi:10.5414/cnp67089

Cited by 15 publications

(11 citation statements)

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“…In our study, almost 90% of all MHD patients had detectable coronary calcification; only 16 of the 153 MHD patients who randomly underwent EBCT had CACS ϭ 0. Some but not all studies that have examined the potential risk factors of coronary artery calcification among patients with CKD have implicated both the conventional risk factors such as diabetes (31) and dyslipidemia (32,33) and CKD-specific factors such as inflammation (34 -37), fetuin deficiency (38,39), SHPT (40), hypercalcemia or high calcium load (41), and high calcium-phosphorus product (42); however, there have been contradictory data about the association of some of these factors and vascular calcification. One study did not find any associations between blood levels of minerals or PTH and CACS in nondialyzed patients with CKD (43).…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Shantouf¹,

Kövesdy²,

Kim³

et al. 2009

Clinical Journal of the American Society of Nephrology

140

115

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Background and objectives: Recent in vitro studies have shown a link between alkaline phosphatase and vascular calcification in patients with chronic kidney disease (CKD). High serum levels of alkaline phosphatase are associated with increased death risk in epidemiologic studies of maintenance hemodialysis (MHD) patients. We hypothesized that coronary artery calcification is independently associated with increased serum alkaline phosphatase levels in MHD patients.Design, setting, participants, & measurements: We examined the association of coronary artery calcification score (CACS) and alkaline phosphatase in 137 randomly selected MHD patients for whom markers of malnutrition, inflammation, and bone and mineral disorders were also measured.Results: Serum alkaline phosphatase was the only measure with significant and robust association with CACS (P < 0.003), whereas either other biochemical markers had no association with CACS or their association was eliminated after controlling for case-mix variables. Serum alkaline phosphatase >120 IU/L was a robust predictor of higher CACS and was particularly associated with the likelihood of CACS >400 (multivariate odds ratio 5.0 95% confidence interval 1.6 to 16.3; P ‫؍‬ 0.007). Serum alkaline phosphatase of approximately 85 IU/L seemed to be associated with the lowest likelihood of severe coronary artery calcification, but in the lowest tertile of alkaline phosphatase, the CACS predictability was not statistically significant.Conclusions: An association between serum alkaline phosphatase level and CACS exists in MHD patients. Given the high burden of vascular calcification in patients with CKD, examining potential therapeutic interventions to modulate the alkaline phosphatase pathway may be warranted.

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Section: Discussionmentioning

confidence: 99%

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Shantouf¹,

Kövesdy²,

Kim³

et al. 2009

Clinical Journal of the American Society of Nephrology

140

115

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“…We also attempted to assess and collect data on long-term metabolic control. These included calcium, phosphorus, PTH, ALP, and VDA use (1,3,6,12,18,24,30,36, and 48 months after surgery). CSR agonist (CNC) use was assessed 24 and 48 months after surgery.…”

Section: Patient Cohortmentioning

confidence: 99%

“…Elevated parathyroid hormone (PTH) levels are very common among end‐stage renal disease (ESRD) patients and the excessive elevation of PTH is difficult to control with medications alone . Although activated vitamin‐D or analogs (VDA), e.g., calcitriol, paricalcitol, doxelcalciferol lower PTH levels, they do it so at the price of promoting both calcium and phosphorus retention and increasing extra‐osseous calcification with escalating doses . Responsiveness may depend on parathyroid gland size as well .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Although activated vitamin-D or analogs (VDA), e.g., calcitriol, paricalcitol, doxelcalciferol lower PTH levels, 4 they do it so at the price of promoting both calcium and phosphorus retention and increasing extra-osseous calcification with escalating doses. 1,5,6 Responsiveness may depend on parathyroid gland size as well. 7 All these measures lead to an excessive utilization of phosphorus binders, pill burden, gastrointestinal side effects and cost.…”

Section: Introductionmentioning

confidence: 99%

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Targeted surgical parathyroidectomy in end‐stage renal disease patients and long‐term metabolic control: A single‐center experience in the current era

Fülöp

Koch

Musa

et al. 2018

Hemodialysis International

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“…In a large observational study that enrolled 40,538 hemodialysis patients, PTH concentrations ≥ 600 pg/mL were associated with an increase in the relative risk of death, all-cause, cardiovascular, and fracture-related hospitalization [32] . Moreover, it has been reported that high PTH levels are associated with vascular calcification and left ventricular hypertrophy [33,34] . PTH may lead to deleterious effects on the cardiovascular system due to the ubiquitous expression of its main receptor, PTH1R.…”

Section: Middle Moleculesmentioning

confidence: 99%

Uremia Retention Molecules and Clinical Outcomes

Barreto¹,

Barreto²,

Canziani³

2017

Expanded Hemodialysis: Innovative Clinical Approach in Dialysis

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Chronic kidney disease is characterized by the accumulation of organic compounds in the bloodstream that may exert a variety of toxic effects in the body. These compounds, collectively known as uremic toxins, may be classified according to their physicochemical properties as free water-soluble low molecular weight molecules, middle molecules or protein-bound uremic toxins. Most of these retention molecules, due to either their size and/or binding to protein, constitute a complex therapeutic challenge to the nephrologist, particularly in end-stage renal disease, because of their limited removal by conventional dialysis therapies. Therefore, we review in this article the current clinical evidences that have supported the important role of uremic toxins in uremia by contributing to the adverse outcomes related to chronic kidney disease, such as increased mortality and cardiovascular events, as well as renal impairment progression that cannot be solely explained by traditional risk factors. These observations have ultimately contributed to testing new therapeutic targets, such as the gut, and the development of modern dialysis strategies to manage chronic kidney disease patients.

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Evaluation of the role of severe hyperparathyroidism on coronary artery calcification in dialysis patients

Cited by 15 publications

References 0 publications

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Targeted surgical parathyroidectomy in end‐stage renal disease patients and long‐term metabolic control: A single‐center experience in the current era

Uremia Retention Molecules and Clinical Outcomes

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