Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Dahle, Dag Olav; Åsberg, Anders; Hartmann, Anders; Holdaas, Hallvard; Bachtler, Matthias; Jenssen, Trond; Dionisi, Mauro

doi:10.1111/ajt.13443

Cited by 78 publications

(85 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Secondary calciprotein particles (but not primary calciprotein particles) have been shown to induce vascular calcification in vitro (5), and low T 50 has been shown to be associated with cardiovascular events and all-cause mortality in ESKD (6), CKD stages 3 and 4 (7), and kidney transplant recipients (8,9). Increasing T 50 might, therefore, prevent calcification and reduce the incidence of cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease

Bressendorff

Hansen²,

Schou

et al. 2018

CJASN

View full text Add to dashboard Cite

Background and objectives Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Low serum calcification propensity is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases (i.e., improves) serum calcification propensity in vitro, but so far, no clinical trials have investigated whether increasing serum magnesium increases serum calcification propensity in subjects with ESKD.Design, setting, participants, & measurements We conducted a single-center, randomized, double-blinded, parallel group, controlled clinical trial, in which we examined the effect of increasing dialysate magnesium from 1.0 to 2.0 mEq/L for 28 days compared with maintaining dialysate magnesium at 1.0 mEq/L on serum calcification propensity in subjects undergoing hemodialysis for ESKD. The primary end point was the value of calcification propensity, measured by T50, at the end of the intervention.Results Fifty-nine subjects were enrolled in the trial, and of these, 57 completed the intervention and were analyzed for the primary outcome. In the standard dialysate magnesium group, serum calcification propensity was 233681 minutes (mean6SD) at baseline (mean of days 27 and 0) and 229693 minutes at follow-up (mean of days 21 and 28), whereas in the high dialysate magnesium group, serum calcification propensity was 247669 minutes at baseline and 302666 minutes at follow-up. The difference in serum calcification propensity between the two groups at follow-up (primary analysis) was 73 minutes (between-group difference; 95% confidence interval, 30 to 116; P,0.001), and the between-group difference in serum magnesium was 0.88 mg/dl (95% confidence interval, 0.66 to 1.10; P=0.001).Conclusions Increasing dialysate magnesium increases serum calcification propensity in subjects undergoing maintenance hemodialysis.

show abstract

Section: Introductionmentioning

confidence: 99%

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease

Bressendorff

Hansen²,

Schou

et al. 2018

CJASN

View full text Add to dashboard Cite

show abstract

“…The half-maximum time for this conversion is called “T 50 ” and is given in minutes (min) [15]. Low T 50 -time (i.e., low resistance towards calcification) is associated with progressive aortic stiffening and with all-cause mortality in non-dialysis CKD [16], dialysis [17], and transplant patients [18, 19]. …”

Section: Introductionmentioning

confidence: 99%

Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Aigner¹,

Cejka²,

Sliber³

et al. 2019

Kidney Blood Press Res

View full text Add to dashboard Cite

Background: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD) and metabolic acidosis might accelerate vascular calcification. The T₅₀ calcification inhibition test (T₅₀-test) is a global functional test analyzing the overall propensity of calcification in serum, and low T₅₀-time is associated with progressive aortic stiffening and with all-cause mortality in non-dialysis CKD, dialysis, and transplant patients. Low serum bicarbonate is associated with a short T₅₀-time and alkali supplementation could be a simple modifier of calcification propensity. The aim of this study was to investigate the short-term effect of oral sodium bicarbonate supplementation on T₅₀-time in CKD patients. Material and Methods: The SoBic-study is an ongoing randomized-controlled trial in CKD-G3 and G4 patients with chronic metabolic acidosis (serum HCO₃^– ≤21 mmol/L), in which patients are randomized to either achieve serum HCO₃^– levels of 24 ± 1 mmol/L (intervention group) or 20 ± 1 mmol/L (rescue group). The effect of bicarbonate treatment on T₅₀-time was assessed. Results: The study cohort consisted of 35 (14 female) patients aged 57 (±15) years, and 18 were randomized to the intervention group. The mean T₅₀-time was 275 (± 64) min. After 4 weeks, the mean change of T₅₀-time was 4 (±69) min in the intervention group and 18 min (±56) in the rescue group (β = –25; 95% CI: –71 to 22; p = 0.298). Moreover, change of serum bicarbonate in individual patients was not associated with change in T₅₀-time, analyzed by regression analysis. Change of serum phosphate had a significant impact on change of T₅₀-time (β = –145; 95% CI: –237 to –52). Conclusion: Oral sodium bicarbonate supplementation showed no effect on T₅₀-time in acidotic CKD patients.

show abstract

“…The transformation time point reflects the ability of a given serum to delay the crystallization cascade and is specific for individual patient sera. Excitingly, the transformation time point has to date been shown to correlate with prognosis many years in advance in various large cohorts [59][60][61][62] including more than 5,000 patients. This indicates a considerable intraindividual and technical stability of the test result.…”

mentioning

confidence: 99%

“…While the precise mechanistic link between test result and outcome has not been firmly elucidated in detail yet, it appears reasonable that they might be based at least in part on the development of vascular calcification/soft tissue calcification, oxidative stress, and inflammatory events, which may all be triggered alone or in combination by circulating nanocrystals. The occurrence of naturally occurring CPPs in the circulation has of note been demonstrated both indirectly (by measuring sedimentable fetuin-A) [59,63] and directly (using cryo-TEM imaging) [64] .…”

mentioning

confidence: 99%

Hope for CKD-MBD Patients: New Diagnostic Approaches for Better Treatment of CKD-MBD

Hocher¹

2017

Kidney Dis

View full text Add to dashboard Cite

Background: Chronic kidney disease-mineral and bone disorder (CKD-MBD) patients have a huge morbidity and mortality. Only relatively minor progress in therapeutic strategies has been made in the past decades. This is at least partially due to a lack of predictive diagnostic tools allowing personalized treatment of CKD-MBD patients. Summary: In this review we describe recent progress in the diagnosis of disturbances of calcium and phosphate metabolism in patients with CKD-MBD, measuring biological active nonoxidized parathyroid hormone as well as the overall likelihood of a patient to get calcified. Key Message: There is hope. The new tools have the potential of allowing personalized therapy for the treatment of CKD-MBD and hence improving outcome.

show abstract

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients

Cited by 78 publications

References 39 publications

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease

Oral Sodium Bicarbonate Supplementation Does Not Affect Serum Calcification Propensity in Patients with Chronic Kidney Disease and Chronic Metabolic Acidosis

Hope for CKD-MBD Patients: New Diagnostic Approaches for Better Treatment of CKD-MBD

Contact Info

Product

Resources

About