Study design and subject baseline characteristics in the ADVANCE Study: effects of cinacalcet on vascular calcification in haemodialysis patients

Floege, Jürgen; Raggi, Paolo; Block, Geoffrey A.; Torres, Pablo; Csiky, Botond; Naso, Agostino; Nossuli, Kaldin; Moustafa, Moustafa; Goodman, William G.; López, N Carrillo; Downey, Gerard; Dehmel, Bastian; Chertow, Glenn M.

doi:10.1093/ndt/gfp762

Cited by 39 publications

(27 citation statements)

References 30 publications

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“…17 Accordingly, DA might be associated with endothelial dysfunction. Also, vascular calcification, which increases with the duration of dialysis, 18 might be responsible for the impairment of vasoconstriction and for arterial stiffness resulting in IDH. Finally, the observation that in the present study the IDWG was significantly correlated with DA may also contribute to explain the association of IDH with DA.…”

Section: Discussionmentioning

confidence: 99%

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Bossola¹,

Laudisio²,

Antocicco³

et al. 2013

Renal Failure

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Objective: Intradialytic hypotension (IDH) is common in patients on chronic hemodialysis, but knowledge on determinants is still unclear. The present study aims at evaluating the association between IDH and dialytic age (DA) in patients on chronic hemodialysis. Methods: Between January 2012 and January 2013, 82 patients on chronic hemodialysis for at least 1 year were screened for inclusion in the present study. Of these, 14 were excluded because of advanced heart failure (n.9), history of alcohol/substance abuse (n.1), diagnosis of dementia (n.2), actual instability of clinical conditions requiring hospitalization (n.2). IDH was defined as a decrease in systolic blood pressure !20 mmHg or a decrease in mean arterial pressure (MAP) by 10 mmHg associated with clinical events and need for nursing interventions. The number of IDH episodes in 10 consecutive hemodialysis sessions was recorded for each patient. Linear and logistic regressions were adopted to assess the adjusted association between IDH and DA. Conclusion: DA is associated with an increased probability of IDH and with increased number of IHD events. Studies are needed to understand the underlying factors of such an association.

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Section: Discussionmentioning

confidence: 99%

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Bossola¹,

Laudisio²,

Antocicco³

et al. 2013

Renal Failure

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“…At present, an ongoing randomized, multicenter phase IV study (ADVANCE) evaluates the effect of cinacalcet combined with low dose vitamin D versus flexible vitamin D dosing on the progression of coronary artery calcification in hemodialysis patients. 118 One study investigating the effect of cinacalcet on cardiovascular morbidity and mortality showed a significant reduction in hospitalization and a trend toward reduced mortality among patients treated with cinacalcet versus placebo. 119 inhibits uremia-related vascular calcifications.…”

Section: Calcimimeticsmentioning

confidence: 99%

Vascular Calcification in Chronic Renal Failure

Neven

D’Haese

2011

Circulation Research

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Accelerated atherosclerotic plaque calcification and extensive medial calcifications are common and highly detrimental complications of chronic kidney disease. Valid murine models have been developed to investigate both pathologically distinguishable complications, which allow for better insight into the cellular mechanisms underlying these vascular pathologies and evaluation of compounds that might prevent or retard the onset or progression of vascular calcification. This review describes various experimental models that have been used for the study of arterial intimal and/or medial calcification and discusses the extent to which this experimental research has contributed to our current understanding of vascular calcification, particularly in the setting of chronic renal failure. (Circ Res. 2011;108:249-264.) Key Words: animal models Ⅲ vascular calcification Ⅲ chronic renal failure C ardiovascular disease is the main cause of morbidity and mortality in patients with chronic kidney disease (CKD), accounting for approximately 50% of all deaths in patients on dialysis and in recipients of renal transplants. 1 A large-scale prospective population-based study showed that renal function was inversely associated with cardiovascular and allcause mortality. 2 Vascular calcification is the major cause of cardiovascular disease in patients with CKD as it contributes to myocardial ischemia, impaired myocardial function, valvular insufficiency, arrhythmias and stroke and is shown to be a strong independent predictor of mortality in the general 3,4 as well as in the dialysis population. [5][6][7] In patients with endstage renal disease, the risk of death increases with the number of vascular sites affected by calcification in the aorta and the carotid and femoral arteries. 5 The high prevalence of vascular calcification is already reported in early stages of CKD 8,9 and in young dialysis patients. 10,11 Atherosclerotic plaque burden in the intimal layer is higher and these lesions are also more heavily calcified in CKD patients compared to the normal population. 12-14 Although intimal calcification is associated with cardiovascular mortality, 6 it remains controversial whether calcification of advanced atherosclerotic lesions stabilizes plaque vulnerability [15][16][17] or rather contributes to rupture of the fibrous cap, 18,19 leading to thrombotic events and myocardial infarction. Interestingly, Ehara et al 20 nicely showed that the pattern of calcification in the intimal plaque is of importance: small, frequent, spotty calcifications are more often found in patients with an acute myocardial infarction or with unstable angina pectoris, whereas the presence of extensive calcifications was highest in those with stable angina pectoris. Recent investigations add new insights to this observation and indicate that, in contrast to spacious calcified areas, sparse microcalcifications produce local stress, 21 activate macrophages to secrete inflammatory mediators 22 and induce apoptosis of vascular smooth muscle cells, 23...

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“…Cinacalcet, a calcimimetic, makes it easier to achieve consistent control of multiple metabolic disordered parameters by acting directly on the calcium-sensing receptors of the parathyroid gland, which is the core of SHPT pathophysiology [23][24][25][26][27][28][29][30][31] . Several interventional [32][33][34][35][36][37][38][39] and observational studies 17,31,[40][41][42] have demonstrated improved control of biomarkers with cinacalcet.…”

Section: Introductionmentioning

confidence: 99%

“…Long-term treatment with cinacalcet (range: 1-3.5 years) maintains reductions in PTH, Ca, P, and Ca Â P, with no evidence of decreasing effectiveness over time 38,43,44 . Several phase IV studies have demonstrated cinacalcet efficacy on biochemical markers [23][24][25][26] and volume coronary artery calcification (CAC) scores, which are a surrogate marker of cardiovascular disease 25,26 . Lastly, a retrospective analysis of combined phase 3 and phase 2 studies showed an effect on mortality, cardiovascular events, fractures, and parathyroidectomies 39 .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of cinacalcet in secondary hyperparathyroidism in the United States

Boer

Lalla

Belozeroff

2012

Journal of Medical Economics

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Study design and subject baseline characteristics in the ADVANCE Study: effects of cinacalcet on vascular calcification in haemodialysis patients

Abstract: Subjects enrolled in ADVANCE have extensive CAC at baseline. The ADVANCE Study should help determine whether cinacalcet attenuates progression of vascular calcification.

Cited by 39 publications

References 30 publications

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Vascular Calcification in Chronic Renal Failure

Cost-effectiveness of cinacalcet in secondary hyperparathyroidism in the United States

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