Hyperphosphatemia and hs-CRP Initiate the Coronary Artery Calcification in Peritoneal Dialysis Patients

Abstract

Background. Coronary artery calcification (CAC) contributes to high risk of cardiocerebrovascular diseases in dialysis patients. However, the risk factors for CAC initiation in peritoneal dialysis (PD) patients are not known clearly. Methods. Adult patients with baseline CaCS = 0 and who were followed up for at least 3 years or until the conversion from absent to any measurable CAC detected were included in this observational cohort study. Binary logistic regression was performed to identify the risk factors for CAC initiation in PD patients. Results. 70 patients recruited to our study were split into a noninitiation group (n = 37) and an initiation group (n = 33) according to the conversion of any measurable CAC during their follow-up or not. In univariate analysis, systolic blood pressure, serum phosphorus, fibrinogen, hs-CRP, serum creatinine, and triglycerides were positively associated with the initiation of CAC, while the high density lipoprotein and nPCR did the opposite function. Multivariate analysis revealed that hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation after adjustments. Conclusions. Hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation in PD patients. These results suggested potential clinical strategies to prevent the initiation of CAC in PD patients.

DNMT3A regulates differentiation of osteoblast and autophagy of vascular smooth muscle cells in vascular medial calcification induced by high phosphorus through ERK1/2 signaling

“…VC is involved in several risk factors. Previous studies have shown that hyperphosphorus was closely related to VC progress and mortality in general and CKD patients (Shang et al, 2017;Ritter & Slatopolsky, 2016;Selamet et al, 2016;Eddington et al, 2010;Dhingra et al, 2007), and hyperphosphorus is a key risk factor for regulating VC in CKD patients (Kendrick & Chonchol, 2011). Consistent with previous studies, we found that phosphorus in CKD patients with VC was significantly higher than those without VC, and phosphorus also stimulated calcification in VSMCs in a time manner.…”

High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis

“…Cardiovascular disease is the leading cause of death in peritoneal dialysis patients [29]. Traditional risk factors such as hypertension, diabetes, hyperlipidemia, smoking, and male sex do not explain the abnormally high incidence of cardiovascular disease in this patient population.…”

Hyperphosphatemia and Cardiovascular Disease

“…The prospective cohort study, CRIC, included 1,123 patients with mild to moderate CKD (EGFR 20–70 ml/min/1.73 m 2 ), and demonstrated that serum phosphate > 3.9 mg/dL was significantly associated with coronary artery calcification ( Mendes et al, 2017 ; Bundy et al, 2018 ). Shang et al (2017) selected 70 peritoneal dialysis patients without coronary artery calcification as the research objects, followed up for at least 3 years, and revealed that hyperphosphatemia was an independent risk factor for coronary artery calcification in dialysis patients. Two large cohort studies showed that serum phosphate > 3.9 mg/dL was independently associated with coronary artery calcification, even in the normal range ( Patel et al, 2015 ).…”