B Vitamins and the Risk of Total Mortality and Cardiovascular Disease in End-Stage Renal Disease

♦ Objective To analyze the late cardiovascular outcome of end-stage renal disease (ESRD) in children. ♦ Design A nation-wide long-term follow-up study. Determinants of outcomes and causes of death were retrospectively assessed. Patients underwent assessment of overall health state, B- and M-mode ultrasound of the carotid arteries, and echocardiography for cross-sectional analysis. ♦ Results We analyzed the medical course of all 249 adult Dutch patients with ESRD onset between 1972 and 1992 at age 0 – 14 years, and who were born before 1979. Of the 187 living patients, 140 participated in the cross-sectional part of the study. The standardized mortality rate was 31.0. Overall 5-, 10-, and 20-year survival after ESRD onset was 87%, 82%, and 78%, respectively. Cardiovascular disease accounted for most deaths (41%). In the whole group, left ventricular hypertrophy (LVH), aortic valve calcification, and arterial wall stiffening were highly prevalent. LVH was associated with hypertension at time of assessment. Aortic valve calcification was strongly associated with a long total duration of peritoneal dialysis (β = 0.33, p < 0.001). Arterial wall pathology was not associated with current treatment modality. ♦ Conclusions As in adults, cardiovascular disease is the most important cause of death in children with ESRD. Stricter reduction of volume overload, prevention of high serum calcium–phosphate product, and more vigorous treatment of hypertension are important targets to improve cardiovascular survival in children with ESRD.

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Serum magnesium, mortality, and cardiovascular disease in chronic kidney disease and end-stage renal disease patients: a systematic review and meta-analysis

Journal of Nephrology ◽

10.1007/s40620-019-00601-6 ◽

2019 ◽

Vol 32 (5) ◽

pp. 791-802 ◽

Cited By ~ 14

Author(s):

Jiachuan Xiong ◽

Ting He ◽

Min Wang ◽

Ling Nie ◽

Ying Zhang ◽

...

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Meta Analysis ◽

Serum Magnesium ◽

Stage Renal Disease ◽

End Stage

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Assessing Plasma Total Homocysteine in Patients with End-Stage Renal Disease

Peritoneal Dialysis International ◽

10.1177/089686080702700502 ◽

2007 ◽

Vol 27 (5) ◽

pp. 476-488 ◽

Cited By ~ 8

Author(s):

Bradley L. Urquhart ◽

Andrew A. House

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Renal Disease ◽

End Stage Renal Disease ◽

Elevated Plasma ◽

Plasma Thcy ◽

Total Homocysteine ◽

Stage Renal Disease ◽

End Stage ◽

Plasma Total Homocysteine

Elevated plasma total homocysteine (tHcy) is a risk factor for cardiovascular disease; however, in light of several recent randomized trials, the issue of causality has been cast into doubt. Patients with end-stage renal disease are particularly interesting as they consistently have elevated tHcy and their leading causes of morbidity and mortality are related to cardiovascular disease. In the present article, we review the early evidence for the homocysteine theory of atherosclerosis, homocysteine metabolism, mechanisms of toxicity, and pertinent available clinical investigations. Where appropriate, the sparse evidence of homocysteine in peritoneal dialysis is reviewed. We conclude by addressing the difficulties associated with lowering plasma tHcy in patients with end-stage renal disease and suggest some novel methods for lowering tHcy in this resistant population. Finally, to address the issue of causality, we recommend that clinicians and scientists await the results of the FAVORIT trial before abandoning homocysteine as a modifiable risk factor for cardiovascular disease, as this study has recruited patients from a population with consistently elevated plasma tHcy who are known to respond to vitamin therapy.

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