Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease

Abstract

Background: Patients with chronic kidney disease (CKD) are associated with high prevalence rates of proteinuria, vascular calcification and cardiomegaly. In this study, we investigated relationships among proteinuria, aortic arch calcification (AoAC) and cardio-thoracic ratio (CTR) in patients with CKD stage 3A-5. In addition, we investigated correlations among proteinuria and decline in renal function, overall and cardiovascular (CV) mortality. Methods: We enrolled 482 pre-dialysis patients with CKD stage 3A-5, and determined AoAC and CTR using chest radiography at enrollment. The patients were stratified into four groups according to quartiles of urine protein-to-creatinine ratio (UPCR). Results: The patients in quartile 4 had a lower estimated glomerular filtration rate (eGFR) slope, and higher prevalence rates of rapid renal progression, progression to commencement of dialysis, overall and CV mortality. Multivariable analysis showed that a high UPCR was associated with high AoAC (unstandardized coefficient β: 0.315; p = 0.002), high CTR (unstandardized coefficient β: 1.186; p = 0.028) and larger negative eGFR slope (unstandardized coefficient β:-2.398; p < 0.001). With regards to clinical outcomes, a high UPCR was significantly correlated with progression to dialysis (log per 1 mg/g; hazard ratio [HR], 2.538; p = 0.003), increased overall mortality (log per 1 mg/g; HR, 2.292; p = 0.003) and increased CV mortality (log per 1 mg/g; HR, 3.195; p = 0.006). Conclusions: Assessing proteinuria may allow for the early identification of high-risk patients and initiate interventions to prevent vascular calcification, cardiomegaly, and poor clinical outcomes.

Parathyroidectomy is associated with slow progression of vascular calcification in maintenance haemodialysis patients: A propensity score‐matched case–control study

“…23,24 Ogawa, Kauppila and Adragao scoring methods have been used successfully in assessing the progression of vascular calcification over time. 15,16,[25][26][27] The control subjects in the present study had less severe degree of hyperparathyroidism with lower serum calcium compared to the study group. This situation was inevitable since it was not possible to have patients with similar degree of hyperparathyroidism that had not undergone parathyroidectomy for a long period of time.…”

“…13,14 Ogawa scoring system has also been used successfully in assessing the progression of AoAC over time. 15,16 Briefly, AoAC score was determined using a circular scale with 16 circumferences that divided the aortic arch into 16 sections. Each section with calcification was counted and then combined yielding a final score ranging between 0 and 16.…”

Hyperaldosteronemia as a risk factor of renal dysfunction in patients with heart failure with preserved ejection fraction

“…Высокая клиническая и прогностическая значимость альбуминурии не вызывает сомнения. Микроальбуминурия служит маркером повышенного риска сердечно-сосудистых событий, прогрессирующей ХБП и смерти от всех причин [15]. Взаимосвязь альбуминурии с такими общепринятыми маркерами сердечно-сосудистого риска, как АГ, СД и метаболический синдром, лишь частично объясняет ее негативное влияние на кардиоваскулярную систему.…”

Contribution of Gut Microbiota-Derived Uremic Toxins to the Cardiovascular System Mineralization

“…Adeney et al demonstrated that even in patients with moderately advanced CKD (eGFR < 60 mL/min per 1.73 m 2 , mean 50.6 mL/min per 1.73 m 2 ) Shanahan without symptomatic cardiovascular disease (CVD), but with high serum phosphate level the prevalence and advancement of coronary artery calcification (CAC), calcification of descending aorta and mitral valve were significantly more pronounced as compared to subjects with normal kidney function [ 7 ]. Several studies reported the association between the risk of CV events and CV death and the degree of VC identified in several locations (coronary arteries, aortic arch and abdominal aorta) in different CKD patient groups (peritoneal dialysis, hemodialysis and pre-dialysis) [ 8 , 9 , 10 ]. The risk of cardiovascular and cerebrovascular events attributed to VC is largely independent from “traditional” risk factors for development of atherosclerosis, such as smoking, obesity or serum LDL-cholesterol [ 11 , 12 , 13 , 14 ].…”