The dualistic role of vitamin D in vascular calcifications

Razzaque, Mohammed S.

doi:10.1038/ki.2010.432

Cited by 131 publications

(87 citation statements)

References 78 publications

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“…Elevated serum calcium is known to be a factor promoting vascular calcification [26]. Moreover, vascular calcification is an important pathological condition that affects survival prognosis [27].…”

Section: Discussionmentioning

confidence: 99%

Relationship between serum calcium level at dialysis initiation and subsequent prognosis

et al. 2017

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Background: In patients on maintenance dialysis, increased serum calcium levels are known to be associated with a poor prognosis. However, it is not known whether serum calcium levels at dialysis initiation have an impact on subsequent prognosis. Methods: The subjects were patients who were newly initiated dialysis at the 17 Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) group centers. The study included 1524 patients who were at least 20 years old, had CKD, and provided written consent. We excluded one patient whose serum adjusted calcium was not assessed and six patients whose outcomes were unknown. Thus, we enrolled 1517 subjects into the study. The patients were divided into the following five groups: (1) G1 with a serum adjusted calcium level <7.0 mg/dL, (2) G2 with 7.0 to <8.0 mg/dL, (3) G3 with 8.0 to <9.0 mg/dL, (4) G4 with 9.0 to <10.0 mg/dL, and (5) G5 with ≥10.0 mg/dL. The study outcomes included: (1) comparisons of all-cause mortality rates in the five groups; (2) extraction of factors influencing all-cause mortality. Results: There were 268 deaths during the follow-up period (G1, 9 cases; G2, 30 cases; G3, 91 cases; G4, 110 cases; G5, 28 cases). Significant differences were observed between the five groups' cumulative survival rates (Logrank test p = 0.005) by using Kaplan-Meier method. There were significant differences in the incidence of either aortic or cardiac valve calcification among the five groups (aortic calcification: p = 0.006, cardiac valve calcification: p = 0.008). Moreover, lower Barthel Index, which evaluated activities of daily living, were associated with higher serum adjusted calcium levels (p < 0.001). Multivariate Cox proportional hazard analysis using the stepwise method indicated that increasing serum adjusted calcium was associated with all-cause mortality (every 1 mg/dL increase, HR = 1.267, 95% CI = 1.092 − 1.470, p = 0.002). In addition, high mortality was associated with advanced age, male gender, low systolic blood pressure, history of cardiovascular disease, and no prior use of calcium carbonate. Conclusions: Serum adjusted calcium levels at dialysis initiation were demonstrated to be associated with all-cause mortality after dialysis initiation.

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Section: Discussionmentioning

confidence: 99%

Relationship between serum calcium level at dialysis initiation and subsequent prognosis

et al. 2017

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“…9 Observational studies have shown that high dietary vitamin K 2 intake is associated with a reduced risk of coronary vascular disease and VC. 10,11 The second vitamin exerting multiple functions including a role in the calcification process is vitamin D.…”

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confidence: 99%

Effect of vitamin K2 on progression of atherosclerosis and vascular calcification in nondialyzed patients with chronic kidney disease stages 3–5

Kurnatowska¹,

Grzelak²,

Masajtis-Zagajewska³

et al. 2015

Polish Archives of Internal Medicine

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“…The rarity of vitamin D toxicity in general and the privileged survival benefits offered by VDRAs administered ISSN: 2380-0585 in small doses even in cases suffering hyperparathyroidism and/ or increased calcium and phosphorus levels supports this concept. Some studies reported the association of low vitamin D serum level with extensive VC [142]. Vitamin D inhibits renin activity, inflammation, suppresses stimulators of VC and stimulates inhibitors of VC in the uremic milieu [143].…”

Section: Management Of Non-traditional Risk Factorsmentioning

confidence: 99%

Arterial Calcification in Chronic Kidney Disease: Whom? When? and How to Handle?

2016

J Urol Nephrol

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Chronic kidney disease (CKD) patients have the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the mortalities, with cardiovascular calcifications affecting the majority of those CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 (FGF23) and Klotho were incriminated in the pathogenesis of vascular calcification (VC) through different mechanisms including their effect on endothelium and arterial wall smooth muscle cells. In addition, deficient Klotho gene expression is a constant feature in CKD patients. This deficiency, not only promotes vascular pathology, but also has a role in the progression of the CKD. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, diagnostic tools, the ideal timing to prevent or to withhold the progression of VC and the different medications and medical procedures that can help to prolong the survival of CKD patients. IntroductionThe problematic increase of cardiovascular morbidity and mortality is behind the increased interest in VC among CKD patients. VC is a strong predictor of increased cardiovascular mortality among CKD patients. However, almost all of the clinical studies that have tried to manipulate the various risk factors for VC in dialysis patients have failed to show a significant impact on patient survival. On the other hand, when pre-dialysis patients underwent similar studies, there was a significant decrease in cardiovascular and overall mortality rates, as well as a comparable effect on VC progress rate. These results point toward the importance of early intervention. The ideal timing and dynamics of this intervention will be thoroughly discussed. VC In CKD PatientsThe prevalence of VC among pre-dialysis CKD G3-5 patients is 79% as reported in a recent study [1]. It might approach 100% in patients starting dialysis [2]. Upto 3-4 fold increase in VC has been reported in the earliest phases of CKD [3].VC in CKD can affect the tunica intima and/or the tunica media layers. Intimal calcification is mainly a feature of atherosclerosis [4]. Medial calcification is restricted to CKD and is encountered even at young ages [5,6]. Hemodialysis (HD) patients have higher calcification scores than both peritoneal dialysis (PD) and CKD G4 patients. More heavily calcified patients were significantly older and mostly male [7]. In HD patients, coronary calcification progresses steadily [8]. High serum phosphate concentration was a strong independent risk factor only in non-diabetic patients. Diabetic patients lack similar associations [9]. Patients starting dialysis at the age of 25-29 years have an expected survival 33 years less than the general populous. Arterial calcification is one of the predictors of this increased cardiovascular mortality [10].The prevalence of coronary artery calcification (CAC) in kidney transplant recipients (KTRs) is higher (61-75%) than that assessed in CKD G3, [11,12] and lower than tha...

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The dualistic role of vitamin D in vascular calcifications

Cited by 131 publications

References 78 publications

Relationship between serum calcium level at dialysis initiation and subsequent prognosis

Relationship between serum calcium level at dialysis initiation and subsequent prognosis

Effect of vitamin K2 on progression of atherosclerosis and vascular calcification in nondialyzed patients with chronic kidney disease stages 3–5

Arterial Calcification in Chronic Kidney Disease: Whom? When? and How to Handle?

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