Progressive Vascular Calcification over 2 Years Is Associated with Arterial Stiffening and Increased Mortality in Patients with Stages 4 and 5 Chronic Kidney Disease

Sigrist, Mhairi K.; Taal, Maarten W.; Bungay, Peter M.; McIntyre, Christopher W.

doi:10.2215/cjn.02190507

Cited by 283 publications

(257 citation statements)

References 32 publications

(30 reference statements)

Supporting

Mentioning

234

Contrasting

Unclassified

Order By: Relevance

“…In line with previous studies (3,4,8,9), hyperphosphatemia was confirmed as an independent risk factor of VC, mortality, and hospitalization. Phosphorus could increase cardiovascular mortality by mechanisms other than VC, such as through fibroblast growth factor-23, which has been implicated in the pathogenesis of both myocardial hypertrophy and atherosclerosis (31,32).…”

Section: Discussionsupporting

confidence: 90%

“…Hong et al (29) postulated that the high prevalence of aortic calcification and its association with age may limit its prognostic value for the survival of patients on dialysis. The same reasoning could be applied to patients with nondialysis CKD, in whom the presence of aortic calcification is age related and very prevalent, which was reported in this study and others (1)(2)(3)(4)(5)(6)(7)(8)(9). This discovery of the independent prognostic value that a plain radiograph of hands may have in detecting VC constitutes the most original finding of this study.…”

Section: Discussionsupporting

confidence: 60%

“…Several studies have reported on the high prevalence of vascular calcification (VC) in patients with nondialysis CKD (1)(2)(3)(4)(5)(6)(7)(8)(9). It has been postulated that the early diagnosis of VC and the treatment of the factors that promote it could reduce the high rate of cardiovascular mortality observed in patients with CKD (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Górriz¹,

Molina²,

Cerverón³

et al. 2015

Clinical Journal of the American Society of Nephrology

154

131

View full text Add to dashboard Cite

Background and objectives Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed.Design, setting, participants, & measurements The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop .30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models.Results VC was present in 79% of patients and prominent in 47% (AS$3 or KS.6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P,0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P,0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS$3. After a median followup of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS$3 but not KS.6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P,0.001). VC did not predict renal progression.Conclusions VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Górriz¹,

Molina²,

Cerverón³

et al. 2015

Clinical Journal of the American Society of Nephrology

154

131

View full text Add to dashboard Cite

show abstract

“…Sudden death is the commonest cause, followed by heart failure (1). Vascular calcification (2), microcirculatory dysfunction (3), impaired coronary flow reserve (4), ineffective vasoregulation during HD, and ultrafiltration (UF) (5) contribute to cardiovascular morbidity and predispose patients to demand myocardial ischemia. It is becoming clear that processes relating to the dialysis procedure itself are implicated.…”

Section: Introductionmentioning

confidence: 99%

Frequent Hemodialysis Schedules Are Associated with Reduced Levels of Dialysis-induced Cardiac Injury (Myocardial Stunning)

Jefferies

Virk

Schiller

et al. 2011

Clinical Journal of the American Society of Nephrology

Self Cite

225

169

View full text Add to dashboard Cite

SummaryBackground and objectives Recurrent hemodialysis (HD)-induced ischemic cardiac injury (myocardial stunning) is common and associated with high ultrafiltration (UF) requirements, intradialytic hypotension, longterm loss of systolic function, increased likelihood of cardiovascular events, and death. More frequent HD regimens are associated with lower UF requirements and improved hemodynamic tolerability, improved cardiovascular outcomes, and reduced mortality compared with conventional thrice-weekly HD. This study investigated the hypothesis that modification of UF volume and rate with more frequent HD therapies would abrogate dialysis-induced myocardial stunning.Design, settings, participants, & measurements A cross-sectional study of 46 patients established on hemodialysis Ͼ3 months compared four groups receiving the current range of quotidian therapies: conventional thrice-weekly HD (CHD3); more-frequent HD five to six times/week in a center (CSD) and at home (HSD); and home nocturnal HD (HN). Serial echocardiography quantitatively assessed regional systolic function to identify intradialytic left ventricular regional wall motion abnormalities (RWMAs). Cardiac troponin T (cTnT), N-terminal prohormone brain natriuretic peptide (NT-proBNP), and inflammatory markers were quantified.Results More frequent HD regimens were associated with lower UF volumes and rates compared with CHD3. Intradialytic fall in systolic BP was reduced in CSD and HSD groups and abolished in HN group. Mean RWMAs per patient reduced with increasing dialysis intensity (CHD3 Ͼ CSD Ͼ HSD Ͼ HN). Homebased groups demonstrated lower high-sensitivity C-reative protein levels, with trends to lower cTnT and NT-proBNP levels in the more frequent groups.Conclusions Frequent HD regimes are associated with less dialysis-induced myocardial stunning compared with conventional HD. This may contribute to improved outcomes associated with frequent HD therapies.

show abstract

“…Among the most serious CKD-MBD morbidities are vascular and soft-tissue calcification (3)(4)(5) and renal osteodystrophy (6), which often result in increases in markers of bone metabolism, including serum alkaline phosphatase (AP) (7).…”

mentioning

confidence: 99%

Cinacalcet Lowers Serum Alkaline Phosphatase in Maintenance Hemodialysis Patients

Belozeroff¹,

Goodman²,

Ren³

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: Studies suggest an association between elevated serum alkaline phosphatase (AP) and increased mortality in hemodialysis patients, but the effect of existing therapies on AP is not fully understood. We assessed the effects of cinacalcet on AP in a secondary analysis of controlled trial data.Design, setting, participants, & measurements: This was a post hoc analysis of data from three 26-wk randomized, double-blind, placebo-controlled, phase 3 trials and a 26-wk double-blind, placebo-controlled extension trial that investigated cinacalcet in secondary hyperparathyroidism treatment in dialysis patients. Hemodialysis patients (n ‫؍‬ 890) with intact parathyroid hormone >300 pg/ml and serum calcium >8.4 mg/dl received cinacalcet plus standard therapy or standard therapy alone for up to 52 wk. Total, not bone-specific, AP was assessed (proportion of cinacalcet/control subjects achieving a >20% or any AP reduction from baseline; the proportion of subjects with AP >120 U/L) at baseline; the end of titration; and study weeks 26, 42, and 52.Results: At 52 wk, a greater proportion of cinacalcet-treated patients had either a >20% (39 versus 18%) or any (58 versus 36%) AP reduction compared with control subjects, respectively. The likelihood of achieving either a >20% or any AP reduction (determined by relative proportion) was 2.33 (95% confidence interval 1.50 to 3.61) and 1.74 (95% confidence interval 1.31 to 2.31), respectively, at week 52. Cinacalcet treatment tended toward a decreased percentage of patients with AP >120 U/L (baseline, 42.6%; week 52, 30.6%) compared with control (35.0 to 48.6%, respectively).Conclusions: In this combined analysis of controlled trials of patients who were receiving hemodialysis, cinacalcet lowered total serum AP.

show abstract

Progressive Vascular Calcification over 2 Years Is Associated with Arterial Stiffening and Increased Mortality in Patients with Stages 4 and 5 Chronic Kidney Disease

Cited by 283 publications

References 32 publications

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Frequent Hemodialysis Schedules Are Associated with Reduced Levels of Dialysis-induced Cardiac Injury (Myocardial Stunning)

Cinacalcet Lowers Serum Alkaline Phosphatase in Maintenance Hemodialysis Patients

Contact Info

Product

Resources

About