MO563HIGH DIALYSATE MAGNESIUM AND CORONARY ARTERY CALCIFICATION IN MAINTENANCE HEMODIALYSIS PATIENTS*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Praopilad Srisuwarn ◽  
Arkom Nongnuch ◽  
Sethanant Sethakarun ◽  
Sutipong Jongjirasiri ◽  
Chanika Sritara ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Vascular Calcification ◽  
Coronary Artery Calcification ◽  
Serum Magnesium ◽  
Laboratory Data ◽  
Magnesium Concentration ◽  
Maintenance Hemodialysis ◽  
Agatston Score ◽  
The Difference ◽  
Severe Calcification

Abstract Background and Aims Cardiovascular calcification is highly prevalent among patients with end-stage renal disease (ESRD). Low normal serum magnesium has been linked to a more severe degree of vascular calcification and a decrease in patient survival. An inhibitory effect of extracellular magnesium on osteogenic transformation of vascular smooth muscle cells and the upregulation of anti-calcification protein have been confirmed in vitro. Increased dialysate magnesium concentration has also been shown to lower calcification propensity of the serum of maintenance hemodialysis (HD) patients. Method This study is an investigator initiated, single-blinded, parallel-group, matched case-control clinical trial that investigated the effect of high dialysate magnesium concentration for 24 weeks on the progression of coronary artery calcification (CAC) in maintenance HD patients. The changes in laboratory data and bone mineral density (BMD) were also examined. Seventy-six ESRD patients underwent CAC screening by multi-slice computed tomography and BMD measurement by dual-x-ray absorptiometry. Only patients with Agatston score>300 were included. They were matched according to the initial CAC score that fell within 20% of one another. Twenty patients were assigned to high dialysate magnesium concentration of 1.75 mEq/L and the matched controls were kept on standard dialysate magnesium concentration of 0.7 mEq/L. CAC and BMD measurements were repeated after 24 weeks. Laboratory data were obtained prior to dialysis at study entry, 8-week intervals during the study and 2 weeks after the study ended. Results There were no significant differences in age, sex, BMI, underlying diseases, dialysis vintage, medications, baseline CAC scores and BMD. The median baseline CAC Agatston score (Volume score) were 1923 (720) and 1672 (785) in the standard and high dialysate groups, respectively. At the end of the study, a significant increase in the CAC score was observed in both groups. Because majority of the included patients had severe calcification burden at baseline, patients were categorized into 2 subgroups using the median baseline CAC Agatston (1600) and Volume scores (700) as cut-offs. Among patients with CAC Agatston score <=1600, CAC score increased significantly in the standard dialysate magnesium group (P<0.01) but was stable in the high dialysate magnesium group (P=0.33). Among patients with CAC Agatston score >1600, the severity of CAC worsened in both groups. The progression of CAC was analyzed by the difference between the follow-up and the baseline square root transformed Agatston and Volume scores. In subgroup of patients with less severe calcification, more patients in the standard dialysate magnesium group progressed compared to the high dialysate magnesium group (P=0.03). In subgroup of patients with more severe calcification, the number of progressors were comparable among the 2 groups. Serum and ionized magnesium levels increased substantially during the study and returned to baseline after the return to standard dialysate magnesium concentration. The highest predialysis serum magnesium was 3.8 mg/dL. Most patients who received high dialysate magnesium reported the disappearance of symptoms of muscle cramps (P=0.01) and requested the high dialysate magnesium be continued after the end of the study. There were no significant changes in serum calcium, phosphate or PTH levels. The decline in BMD was observed in both groups but the difference did not reach statistical significance. Conclusion High dialysate magnesium was well tolerated and could ameliorate the progression of CAC in maintenance HD patients with mild to moderate vascular calcification.

scholarly journals Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

2018 ◽  
Vol 48 (5) ◽  
pp. 369-377 ◽  
Author(s):  
Thijs.T Jansz ◽  
Franka E. van Reekum ◽  
Akin Özyilmaz ◽  
Pim A. de Jong ◽  
Franciscus T.J. Boereboom ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Coronary Artery ◽  
Vascular Calcification ◽  
Mixed Models ◽  
Coronary Artery Calcification ◽  
Matrix Gla Protein ◽  
Tobit Regression ◽  
Cross Sectional ◽  
Fetuin A ◽  
The Difference

Background: Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in peritoneal dialysis than in hemodialysis is currently unknown. Therefore, we compared coronary artery calcification (CAC), its progression, and calcification biomarkers between patients on hemodialysis and peritoneal dialysis. Methods: We measured CAC in 134 patients who had been treated exclusively with hemodialysis (n = 94) or peritoneal dialysis (n = 40) and were transplantation candidates. In 57 of them (34 on hemodialysis and 23 on peritoneal dialysis), we also measured CAC progression annually up to 3 years and the inactive species of desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, osteoprotegerin. We compared CAC cross-sectionally with Tobit regression. CAC progression was compared in 2 ways: with linear mixed models as the difference in square root transformed volume score per year (ΔCAC SQRV) and with Tobit mixed models. We adjusted for potential confounders. Results: In the cross-sectional cohort, CAC volume scores were 92 mm3 in hemodialysis and 492 mm3 in peritoneal dialysis (adjusted difference 436 mm3; 95% CI –47 to 919; p = 0.08). In the longitudinal cohort, peritoneal dialysis was associated with significantly more CAC progression defined as ΔCAC SQRV (adjusted difference 1.20; 95% CI 0.09 to 2.31; p = 0.03), but not with Tobit mixed models (adjusted difference in CAC score increase per year 106 mm3; 95% CI –140 to 352; p = 0.40). Peritoneal dialysis was associated with higher osteoprotegerin (adjusted p = 0.02) but not with dp-ucMGP or fetuin-A. Conclusions: Peritoneal dialysis is not associated with less CAC or CAC progression than hemodialysis, and perhaps with even more progression. This indicates that vascular calcification does not develop less in peritoneal dialysis than in hemodialysis.

scholarly journals Plasma F2-Isoprostanes and Coronary Artery Calcification: The CARDIA Study

2005 ◽  
Vol 51 (1) ◽  
pp. 125-131 ◽  
Author(s):  
Myron Gross ◽  
Michael Steffes ◽  
David R Jacobs ◽  
Xinhua Yu ◽  
Linda Lewis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Early Development ◽  
Coronary Artery Calcification ◽  
Continuous Variable ◽  
Oxidation Products ◽  
Gas Chromatography Mass Spectrometry ◽  
Agatston Score ◽  
Reactive Protein ◽  
Increased Risk ◽  
Coronary Artery Atherosclerosis

Abstract Background: Oxidation of lipids in lipoproteins and cells may initiate and enhance the early development of cardiovascular disease. Method and Results: We assayed F2-isoprostanes, oxidation products of arachidonic acid, by gas chromatography–mass spectrometry in a biracial cohort of 2850 young healthy adult men and women. Coronary artery calcification (CAC), a component of coronary artery atherosclerosis, was detectable in 10% of the cohort and appeared to be in its initial stages (Agatston scores <20 in 47% and <100 in 83% of CAC-positive participants). After adjusting for sex, clinical site, age, and race, the presence of any CAC was 24% more likely among those with high vs low concentrations of F2-isoprostanes [odds ratio (OR) = 1.24 per 92.2 pmol/L (32.7 ng/L; 1 SD of F2-isoprostanes); 95% confidence interval (CI), 1.09–1.41]. The OR was only slightly attenuated [1.18 per 92.2 pmol/L (32.7 ng/L); CI, 1.02–1.38] after further adjustment for body mass index, smoking, serum lipids, C-reactive protein, antioxidant supplementation use, diabetes, and blood pressure. As a continuous variable, the Agatston score increased by 6.9% per 92.2 pmol/L (32.7 ng/L) of F2-isoprostane concentration (P <0.01). Whereas CAC prevalence was lower in women than men, mean (SD), F2-isoprostanes were higher in women {190 (108.9) pmol/L [67.4 (38.6) ng/L]} than in men {140.4 (55.6) pmol/L [49.8 (19.7) ng/L]}. Nevertheless, F2-isoprostanes were associated with an increased risk of CAC in both sexes. Conclusion: This association between increased concentrations of circulating F2-isoprostanes and CAC in young healthy adults supports the hypothesis that oxidative damage is involved in the early development of atherosclerosis.

P5339Association between high-sensitive troponin I and subclinical coronary atherosclerosis in well-controlled HIV-infected adults

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Vassara ◽  
S Siwamogsatham ◽  
W Buddhari ◽  
M Tumkosit ◽  
C Ketloy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Coronary Atherosclerosis ◽  
Troponin I ◽  
Cardiac Computed Tomography ◽  
Agatston Score ◽  
Cross Sectional ◽  
Potential Biomarker ◽  
High Sensitive Troponin

Abstract Background and objectives Patients with human immunodeficiency virus (HIV) infection live longer and the prevalence of coronary heart disease is increasing among them. High-sensitive troponin I (hs-TnI) is associated with coronary artery calcification as determined by non-contrast cardiac computed tomography (CT) in general population without established cardiovascular disease (CVD). Nevertheless, the relationship in well-controlled HIV-infected patients has not been validated. Design and methods A cross-sectional study among HIV-infected adults aged >50 years free from known CVDs. All subjects underwent non-contrast cardiac CT and blood test for serum hs-TnI was concomitantly performed. Relationship between Agatston score, a parameter used to quantify coronary artery calcification and serum hs-TnI level was analysed using spearman correlation and logistic regression models. Results A total of 338 HIV-infected adults (median age 54 years, 62% men) were included. All of them were in antiretroviral therapy with a median 18 years of exposure. The median CD4 cell count was 614 cell/mm3, 98% were virologically suppressed. Hs-TnI was correlated with coronary artery calcification with the correlation coefficient of 0.287 (p<0.0001). Multivariated logistic regression analysis demonstrated that serum hs-TnI concentration was associated with an increased odd of coronary artery calcification (Agatston score>0) (OR 1.64; 95% CI, 1.05–2.56, p=0.029). To detect coronary artery calcification, using the hs-TnI in addition to Thai CV risk score slightly increased the ROCAUC from 0.6827 to 0.692 (p=0.45). Distribution of CAC score over hs-TnI Conclusion Among well-controlled HIV-infected patients without established CVDs, hs-TnI concentration was associated with coronary artery calcification. This could be a potential biomarker for an early risk stratification of subclinical coronary atherosclerosis in this population. The association with long-term adverse cardiovascular outcome needs to be validated in the future study.

Uncarboxylated matrix Gla protein (ucMGP) is associated with coronary artery calcification in haemodialysis patients

2009 ◽  
Vol 101 (02) ◽  
pp. 359-366 ◽  
Author(s):  
Cees Vermeer ◽  
Melanie Stenger ◽  
Georg Mühlenbruch ◽  
Andreas Mahnken ◽  
Ulrich Gladziwa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Vascular Calcification ◽  
Coronary Artery Calcification ◽  
High Sensitivity ◽  
Matrix Gla Protein ◽  
Reactive Protein ◽  
Dialysis Vintage ◽  
The Mean ◽  
Hs Crp ◽  
Apparently Healthy

SummaryMatrix γ-carboxyglutamate (Gla) protein (MGP) is a potent local inhibitor of cardiovascular calcification and accumulates at areas of calcification in its uncarboxylated form (ucMGP). We previously found significantly lower circulating ucMGP levels in patients with a high vascular calcification burden. Here we report on the potential of circulating ucMGP to serve as a biomarker for vascular calcification in haemodialysis (HD) patients. Circulating ucMGP levels were measured with an ELISA-based assay in 40 HD patients who underwent multi-slice computed tomography (MSCT) scanning to quantify the extent of coronary artery calcification (CAC). The mean ucMGP level in HD patients (193 ± 65 nM) was significantly lower as compared to apparently healthy subjects of the same age (441 ± 97 nM; p < 0.001) and patients with rheumatoid arthritis (RA) without CAC (560 ± 140 nM; p < 0.001). Additionally, ucMGP levels correlated inversely with CAC scores (r = –0.41; p = 0.009), and this correlation persisted after adjustment for age, dialysis vintage and high-sensitivity C-reactive protein (hs-CRP). Since circulating ucMGP levels are significantly and inversely correlated with the extent of CAC in HD patients, ucMGP may become a tool for identifying HD patients with a high probability of cardiovascular calcification.

Study of the Total Serum Concentration of Serrum Ionized Magnesium in Children and Adolescents from Sibiu Area

2019 ◽  
Vol 69 (12) ◽  
pp. 3389-3392 ◽  
Author(s):  
Elisabeta Antonescu ◽  
Gabriela Bota ◽  
Bogdan Serb ◽  
Diter Atasie ◽  
Cristina Dahm Tataru ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Reference Range ◽  
Serum Magnesium ◽  
Age Groups ◽  
Reference Intervals ◽  
Magnesium Concentration ◽  
Total Serum ◽  
Reference Ranges ◽  
Insulin Metabolism ◽  
The Difference

Magnesium is an essential nutrient for the living organisms and plays an important part in the prevention and treatment of many diseases. It is an enzymatic cofactor for more than 300 reactions. Magnesium is essential for regulating blood pressure, muscle contraction, cardiac excitability, insulin metabolism, vasomotor tonus. Studying the way in which serum magnesium concentration varies in children and adolescents in the Sibiu area according to the reference intervals we especially set for this area. The study is a retrospective one, using approximately 4900 data from the archives of the Medical Analysis Laboratory within the Sibiu Pediatric Clinical Hospital. Serum magnesium was dosed using the Konelab Prime 30i analyser. The data from the literature was used to compare the results. The reference ranges obtained in the current study were similar to the literature studied. The percentage of patients with magnesium concentration outside the reference ranges was roughly equal for all age groups. The difference was between 1 month and 2 year-old children with very few deviations from the reference range. The results of our study reflect more accurately the real reference range for the population in the Sibiu area, helping clinicians to establish a diagnosis as quickly and accurate as possible. These results were not significantly different from the literature studied.

Abstract P363: Ectopic Adiposity is Associated With Abdominal Aorto-Illiac but Not Coronary Artery Calcification Independent of Total Body Adiposity in African Ancestry Men

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Allison L Kuipers ◽  
Joseph M Zmuda ◽  
J Jeffrey Carr ◽  
James G Terry ◽  
Sangeeta Nair ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Coronary Artery ◽  
Vascular Disease ◽  
Vascular Calcification ◽  
Body Fat ◽  
Coronary Artery Calcification ◽  
African Ancestry ◽  
Total Body Fat ◽  
Total Body

Objective: While ectopic adiposity is considered a risk factor for many chronic diseases, including cardiovascular disease, the extent to which this association is independent of total adiposity is yet to be established. Vascular calcification, which is associated with greater adiposity, is a subclinical marker of cardiovascular disease that may have varying etiology and clinical implications in different vascular beds. Therefore, our objective was to assess the potential independent associations of total, regional and ectopic adiposity measures with abdominal aorto-iliac calcification (AAC) and coronary artery calcification (CAC). Methods: Detailed health history, clinical exam, dual x-ray absorptiometry and computed tomography (CT) scans were obtained in 798 African ancestry men aged ≥40 years (mean(SD): 62.0(8.6)years) recruited without regard to health status from the Tobago Heart Health Study. Vascular calcification was measured by CT in the abdomen (AAC) and chest (CAC). Calcification was scored using the Agatston method and a score ≥10 was considered to be a prevalent calcification. Severity of calcification was modeled using continuous Agatston score in those with any calcification. Multivariable logistic and linear regression models were used to assess the cross-sectional association of adiposity measures with vascular calcification prevalence and severity. All models were adjusted for age, hypertension, diabetes, dyslipidemia, smoking, alcohol intake and sedentary lifestyle. In addition, models of ectopic adiposity (abdominal visceral adipose tissue, liver attenuation and calf skeletal muscle fat) were adjusted for total body fat. Results: AAC was present in 63% and CAC was present in 29% of men. After adjustment for traditional cardiovascular risk factors, 1SD greater total, trunk, or abdominal subcutaneous adiposity was associated with 1.3-1.5-fold increased odds of AAC (all p<0.05). After additional adjustment for total body fat, 1SD lower liver attenuation (indicative of greater liver adiposity) or 1SD greater skeletal muscle fat were each associated with a 1.2-1.3-fold increased odds of AAC. In fully adjusted models, only greater BMI or waist circumference was associated with increased odds of CAC (OR 1.2, p<0.05 for both). In fully adjusted linear models of calcification severity, no significant association was observed between any adiposity measure and AAC or CAC. Conclusions: Independent of total adiposity, measures of ectopic adiposity were associated with greater AAC, but not CAC, prevalence in African ancestry men. These results highlight potential differences in the adiposity-vascular disease relationship that may vary by ectopic fat depot and vascular bed location. Future vascular disease research should explore potential underlying biologic mechanisms for these findings.

scholarly journals The Value of Big Endothelin-1 in the Assessment of the Severity of Coronary Artery Calcification

2018 ◽  
Vol 24 (7) ◽  
pp. 1042-1049 ◽  
Author(s):  
Fang Wang ◽  
Tiewei Li ◽  
Xiangfeng Cong ◽  
Zhihui Hou ◽  
Bin Lu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Laboratory Data ◽  
Calcium Score ◽  
Enzyme Linked Immunosorbent Assay ◽  
Roc Curve Analysis ◽  
Preliminary Screening ◽  
Endothelin 1 ◽  
All Cause Mortality

Progression of coronary artery calcification (CAC) was significantly associated with all-cause mortality, and high coronary artery calcium score (CACS) portends a particularly high risk of cardiovascular events. But how often one should rescan is still an unanswered question. Preliminary screening by testing circulating biomarker may be an alternative before repeat computed tomography (CT) scan. The aim of this study was to investigate the value of big endothelin-1 (bigET-1), the precursor of endothelin-1 (ET-1), in predicting the severity of CAC. A total of 428 consecutively patients who performed coronary computed tomography angiography (CCTA) due to chest pain in Fuwai Hospital were included in the study. The clinical characteristics, CACS, and laboratory data were collected, and plasma bigET-1 was detected by enzyme-linked immunosorbent assay (ELISA). The bigET-1 was positively correlated with the CACS ( r = .232, P < .001), and the prevalence of CACS >400 increased significantly in the highest bigET-1 tertile than the lowest tertile. Multivariate analysis showed that bigET-1was the independent predictor of the presence of CACS >400 (odds ratio [OR] = 1.721, 95% confidence interval [CI], 1.002-2.956, P = .049). The receiver operating characteristic (ROC) curve analysis showed that the optimal cutoff value of bigET-1 for predicting CACS >400 was 0.38 pmol/L, with a sensitivity of 59% and specificity of 68% (area under curve [AUC] = 0.65, 95% CI, 0.58-0.72, P < .001). The present study demonstrated that the circulating bigET-1 was valuable in the assessment of the severity of CAC.

Sign in / Sign up

Export Citation Format

Share Document