Vascular calcifications, vertebral fractures and mortality in haemodialysis patients

Abstract

Background. Vascular calcifications and the bone fractures caused by abnormal bone fragility, also called osteoporotic fractures, are frequent complications associated with chronic kidney diseases (CKD). The aim of this study was to investigate the association between vascular calcifications, osteoporotic bone fractures and survival in haemodialysis (HD) patients.Methods. A total of 193 HD patients were followed up to 2 years. Vascular calcifications and osteoporotic vertebral fractures (quoted just as vertebral fractures in the text) were assessed by thoracic, lumbar spine, pelvic and hand X-rays and graded according to their severity. Clinical, biochemical and therapeutic data gathered during the total time spent on HD were collected.Results. The prevalence of aortic calcifications was higher in HD patients than in a random-based general population (79% versus 37.5%, P < 0.001). Total time on any renal replacement therapy (RRT) and diabetes were positively associated with a higher prevalence of vascular calcifications. In addition to these factors, time on HD was also positively associated with the severity of vascular calcifications, and higher haemoglobin levels were associated with a lower prevalence of severe vascular calcifications in large and medium calibre arteries. The prevalence of vertebral fractures in HD patients was similar to that of the general population (26.5% versus 24.1%). Age and time on HD showed a positive and statistically significant association with the prevalence of vertebral fractures. Vascular calcifications in the medium calibre arteries were associated with a higher rate of prevalent vertebral fractures. In women, severe vascular calcifications and vertebral fractures were positively associated with mortality [RR = 3.2 (1.0–10.0) and RR = 4.8 (1.7–13.4), respectively].Conclusions. Positive associations between vascular calcifications, vertebral fractures and mortality have been found in patients on HD.

MICS, an easily ignored contributor to arterial calcification in CKD patients

“…In an interesting clinical study, Park et al (83) found that age and hypertension were independent risk factors for the classification of CAC scores that represented the degree of AC (83). In CKD patients followed up to 2 years, it was shown that age, diabetes and smoking were significantly associated with a higher prevalence of AC (86). However, in recent years, the nontraditional risk factors, e.g., oxidative stress, inflammation, malnutrition, fibroblast growth factor 23 (FGF-23), and Klotho, are gradually arousing interest (16) because the traditional risk factors linked to AC are often correlated with these deregulated nontraditional risk factors in CKD.…”

MicroRNAs 29b, 133b, and 211 Regulate Vascular Smooth Muscle Calcification Mediated by High Phosphorus

“…Moreover, vascular calcification is frequently associated to bone mass disorders, which suggests that factors involved in the regulation of both entities could be linked. 1,2 Vascular smooth muscle cells (VSMCs) have the same mesenchymal origin as osteoblasts, and they are able, in the presence of several stimuli, including uremia, to transdifferentiate into osteoblastic cells in response to signals coming from the internal milieu, extracellular matrix components, and biochemical and physical factors. 3,4 This phenotypic modulation is tightly regulated and involves the loss of expression of several muscle-related proteins of the VSMCs and the gain of expression of bone-related proteins accompanied by macroscopic structural changes, such as calcifications.…”

Calcium in Chronic Kidney Disease

“…These changes in normal phosphate homeostasis lead in part to the manifestations of the entity known as CKD-mineral bone disorder (CKD-MBD) (1). Epidemiologic data have identified an association between the hyperphosphatemia of CKD-MBD and patient-based outcomes of vascular calcification, myocardial dysfunction, and mortality (2)(3)(4)(5).…”