Parathyroidectomy Influences Coronary Artery Calcium Score in Asymptomatic Hemodialysis Patients with Secondary Hyperparathyroidism

2019 ◽  
Vol 51 (1) ◽  
pp. 65-73
Author(s):  
Qiang Ma ◽  
Dechun Su ◽  
Fen Liu ◽  
Haidong Xing ◽  
Xue Han ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Secondary Hyperparathyroidism ◽  
Calcium Score ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Progression Rate ◽  
Square Root ◽  
Mean Square ◽  
Asymptomatic Patients

Background: Successful parathyroidectomy (PTX) with stable postoperative parathyroid hormone (PTH) levels is associated with the stabilization of coronary artery calcification score (CACS) in patients with severe secondary hyperparathyroidism (SHPT) undergoing hemodialysis. To use computed tomography (CT) to evaluate the influence of PTX on CACS in asymptomatic patients. Methods: This study was performed with institutional review board approval. Written consent was obtained from each patient. Forty-eight patients (mean age ± SD 54.50 ± 13.14 years; range 33–77 years) undergoing maintenance hemodialysis who underwent PTX and 56 patients (mean age 55.28 ± 12.32 years; range 35–76 years) who did not undergo PTX received prospective follow-up for 2 years. CACS was quantitatively performed using the Agatston method after CT scan. The differences between baseline and end-of-study PTX parameters were analyzed with the paired Student t test. Results: For patients who underwent PTX, mean square root of CACS did not increase from 23.16 ± 18.58 to 23.68 ± 18.16 (t = 1.846, p = 0.072) from baseline to follow-up. In patients who did not undergo PTX, mean square root of CACS increased from 20.21 ± 16.47 to 28.72 ± 20.95 (t = 10.110, p < 0.001) from baseline to follow-up. In addition, the median annual progression rate of CACS was lower among PTX patients (4.89%), compared with the marked annual progression rate of CACS in non-PTX patients (52.81%; t = 11.264, p < 0.001). Conclusion: Dysregulation of calcium and phosphate metabolism caused by SHPT may result in significant CAC progression in asymptomatic hemodialysis patients. Low PTH state after PTX may stabilize CAC progression in hemodialysis patients.

MO800EFFICACY AND SAFETY OF CINACALCET IN CHINESE MAINTAINANCE HEMODIALYSIS PATIENTS WITH DIFFERENT STAGES OF SECONDARY HYPERPARATHYROIDISM: RESULTS OF ACTIVE STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Active Study Group
Keyword(s):  
Cohort Study ◽  
Secondary Hyperparathyroidism ◽  
Real World ◽  
Phase 1 ◽  
Fibroblast Growth Factor 23 ◽  
Public Health Problem ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Number Of Patients

Abstract Background and Aims Secondary hyperparathyroidism (SHPT), as a common complication in advanced chronic kidney disease (CKD) has become a global public health problem. Published literatures showed higher risk of bone fracture, cardiovascular events and all-cause mortality was associated with uncontrolled SHPT in patients with CKD. Cinacalcet, a calcimimetic agent was reported to reduce intact parathyroid hormone (iPTH) levels in patients with SHPT. However, there is no large-cohort study and stratified analysis of cinacalcet based on the level of iPTH in China. The ACTIVE study was designed to test the efficacy and safety of cinacalcet in treating Chinese maintenance hemodialysis patients with mild-to-severe SHPT, as well as to investigate the benefit of long-term, continuous medication with cinacalcet in the real-world setting. Method ACTIVE study was a phase IV, open-label, multicenter clinical trial including two phases: Phase 1 was a cohort study with 32 weeks’ follow-up. Phase 2 was a real-world study of 20 additional weeks in which patients who completed the cohort study decided independently whether to continue taking cinacalcet at their own cost. Eligible maintenance hemodialysis (MHD) patients with baseline iPTH ≥300 pg/mL from April 2017 to September 2019 in 23 centers in China were treated with cinacalcet orally. Patients were grouped based on their iPTH level as mild (300-600 pg/mL), moderate (600-900 pg/mL) or severe (≥900 pg/mL) SHPT. Results 911 patients were screened and of 750 eligible patients, 275 were identified as mild, 224 were considered as moderate and left 251 were grouped as severe SHPT. The number of people who completed all 52-week follow-up in the mild, moderate and severe SHPT groups were 184 (66.91%), 164 (73.21%), and 166 (66.14%), respectively(Fig 1). The baseline and interim analysis results was published on 2020 EDTA. The number of patients achieving iPTH target (150-300 pg/mL) was 85 (31.02%) in mild group, 56 (25.00%) in moderate group and 27 (10.76%) patients in severe group at 20-week visit, and the proportion of patients achieving iPTH target was 33.94% (n=93), 24.11% (n=54) and 13.55% (n=34) at 32-week visit. The trends of the proportion of patients achieving iPTH target increased in all 3 different groups (Fig 2). The number of patients who reached both targets of serum calcium (Ca2+) and serum phosphorus (P) in the mild, moderate and severe SHPT group was 61 (22.26%), 42 (18.75%), 37 (14.74%) at 20-week visit, and 44 (16.06%), 34 (15.18%), 41 (16.33%) at 32-week visit, respectively. At the end of the 20th and the 32nd week of treatment, serum Ca2+×P and fibroblast growth factor-23 (FGF-23) decreased significantly compared with their baseline values (Table 1). In the extension 32-52 weeks study, the corresponding proportion of patients who achieved iPTH target in the three SHPT groups was 11.41%, 6.06%, and 4.81%, respectively. The safety analysis showed the most common treatment-related AE were hypocalcemia, hyperlipidemia and loss of appetite. This study is sponsored by Kyowa Kirin China Pharmaceutical Co., Ltd. Conclusion Oral cinacalcet HCl was effective and safe in reducing iPTH in patients receiving HD with mild-to-severe SHPT.

scholarly journals Secondary Hyperparathyroidism and Hypertension: An Intriguing Couple

2020 ◽  
Vol 9 (3) ◽  
pp. 629 ◽  
Author(s):  
Mariadelina Simeoni ◽  
Alessandra F. Perna ◽  
Giorgio Fuiano
Keyword(s):  
Clinical Trials ◽  
Cardiovascular Risk ◽  
Mortality Rate ◽  
Secondary Hyperparathyroidism ◽  
Major Complication ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
High Cardiovascular Risk ◽  
High Prevalence

Secondary hyperparathyroidism (SHPTH) is a major complication in patients on maintenance hemodialysis burdened with high cardiovascular risk. Hypertension is also a high prevalence complication contributing to an increase in the mortality rate in hemodialysis patients. A possible association between SHPTH and hypertension has been widely reported in the literature and several pathogenetic mechanisms have been described. There is evidence that the decrease of plasma iPTH levels are correlated with hypertension correction in hemodialysis patients undergoing parathyroidectomy and oral calcimimetics administration. We have observed a similar behaviour also in a patient on chronic hemodialysis treated with Etelcalcetide. Even if this is an isolated observation, it could stimulate future investigation, possibly in dedicated clinical trials.

scholarly journals Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Albuquerque ◽  
Pedro de Araújo Gonçalves ◽  
Hugo Marques ◽  
António Ferreira ◽  
Pedro Freitas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Cardiac Death ◽  
Anomalous Origin ◽  
Cardiac Symptoms ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
The Right

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

scholarly journals P1493CORRELATION BETWEEN END-DIALYSIS OVER-WEIGHT IN INITIAL STAGE OF HEMODIALYSIS AND PROGNOSIS IN INCIDENT HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ping Zhang ◽  
Ying Wang ◽  
Xi Yao ◽  
Shaohua Chen ◽  
Chunping Xu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiovascular Mortality ◽  
Multivariate Regression ◽  
Independent Risk Factor ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Interdialytic Weight Gain ◽  
The Relationship

Abstract Background and Aims The volume factor of maintenance hemodialysis patients is closely related to the prognosis. We hypothesized that the excess weight after dialysis (end-dialysis over-weight, edOW) is an important factor of volume impact survival in hemodialysis (HD) patients. The purpose of this study was to analyze the relationship between edOW and long-term prognosis of patients with maintenance hemodialysis. Method This retrospective study observed incident hemodialysis patients who treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017, three times a week for at least one year. The end point of follow-up was death, abdominal dialysis, kidney transplantation, transfer or until April 30, 2018. The general data of the patients included age, gender, BMI, primary renal disease, CVD, first hemodialysis access, albumin(Alb), Haemoglobin(Hb), blood pressure, heart rate, ultrafiltration rate(UFR), interdialytic weight gain IDWG, end -dialysis overweight (edOW). Cox multivariate regression was used to analyze the relationship between edow and all-cause mortality and cardiovascular mortality. Results Totally 469 patients male, 64% were enrolled, with an average age of 56.9 ± 17.1 years. During the follow-up period, 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.7%. The mean value of edow was 0.28 ± 0.02 kg. Kaplan-Meier(Log-rank test) survival analysis showed that the long-term survival rate of the group with edow ≤ 0.28kg was better than that of the group with edow &gt; 0.28kg (P = 0.042), and the cardiovascular mortality of the group with edow &gt; 0.28kg was significantly higher than that of the group with edow ≤ 0.28kg (P = 0.001). Cox multivariate regression analysis showed that edow was an independent risk factor for all-cause death in hemodialysis patients (P = 0.025, AhR = 1.541, 95% CI 1.057-2.249), and also an independent risk factor for CVD death in hemodialysis patients (P = 0.007, AhR = 1.929, 95% CI 1.198-3.107). Conclusion EdOW is an independent risk factor of long-term all-cause and cardiovascular death in hemodialysis patients.

scholarly journals P976 Can calcium score predict the appropriate treatment for high risk patients? (a 5 years follow up study)

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Stanciu ◽  
M Gurzun ◽  
S Dumitrescu ◽  
F Naftanaila ◽  
A Spanu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Bypass Graft ◽  
Calcium Score ◽  
Agatston Score ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

Abstract Coronary artery calcium score (CAC) measures the calcium contained in the artery wall and it is evaluated using multi-slice cardiac CT and CAC represents a useful tool for appreciating the burden of coronary atherosclerosis and for determining the risk for cardiovascular events. The purpose of this study is that CAC can be use for guiding treatment strategy in patients classified as high risk based on Framingham score . We prospectively enrolled 64 pts (79% male), 62,7+/-5 year, between 2002-2017. All included patients were considered high risk based on EuroSCORE model. A multislice heart CT scan was performed for every patient with CAC score determination quantified with the Agatston score and expressed as Agatston Units (AU). The patients were divided in 3 groups according to the treatment that they received during the 5 years follow up: optimal medical treatment for coronary artery disease (OMT) – 35.9% (23), percutaneous coronary angioplasty (PCA) – 29.7% (19) and coronary artery bypass graft (CABG) – 34.4%. The CAC score for pts treated by OMT vs CABG +/_ PCA were compared using the ROC curves. CAC score was statistically significantly superior in CABG+ PCA patients versus OMT (AUC: 0.96, p &lt; 0.001 vs AUC 0.42, p = 0.212). Also, a comparison of CAC score score for CABG vs OMT revealed the same results (AUC: 0.96, p&lt; 0.001 vs AUC: 0.42, p = 0.264). OMT vs CABG + PCA presented a cut-off value of 382 AU with a specificity of 90% and a sensitivity of 95%. OMT vs CABG presented a cut-off value of 530 AU with a specificity of 89% and a sensitivity of 95%. In conclusion, CAC score has a good predictability and sensitivity in determining the outcome and can be a promising tool to guide therapy in high risk patients, mainly regarding medical vs surgical treatment for coronary artery disease.

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