Vascular calcification by conventional X-ray and mortality in a cohort of predominantly African descent hemodialysis patients

Background/objective: There is a lack of studies describing the prevalence of vascular calcification (VC) and its association with mortality in maintenance hemodialysis (MHD) patients of African descent. We investigated if a VC score based on the number of calcified vascular beds was associated with mortality in MHD patients. Methods: We analyzed data from 211 MHD patients enrolled from January 2010 to January 2011 in the prospective cohort study, “The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO),” developed in Salvador, BA, Brazil. VC was evaluated using radiographs of the hands, abdomen, hip, and chest; the score was calculated by the number of calcified sites as 0 (absence of calcification), 1 (one calcified site), 2 (two sites), 3 (⩾3 sites). We used Cox’s regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of associations between VC and mortality with adjustments for age and comorbidities. Results: VC was detected in 114 (54.0%) patients; 37 (17.5%) with a VC score = 1; 21 (10%) with VC score = 2 and 56 (26.5%) with VC score = 3. Compared with VC score = 0, the adjusted hazard of death was 2.67 (95% CI: 1.12, 6.33) for patients with VC score = 1; HR = 2.89 (95% CI: 0.95, 7.63) for VC score = 2; and HR = 3.27 (95% CI: 1.47, 7.28) for VC score = 3. Conclusion: The present study in an African descent MHD population provides support for the VC score based on conventional radiography as a prediction tool for the clinical practice. As shown, the VC score was monotonically and independently associated with mortality.

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Secondary Hyperparathyroidism and Hypertension: An Intriguing Couple

Journal of Clinical Medicine ◽

10.3390/jcm9030629 ◽

2020 ◽

Vol 9 (3) ◽

pp. 629 ◽

Cited By ~ 1

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.

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Arteriosclerosis in Dialysis Patients

The International Journal of Artificial Organs ◽

10.1177/039139889601901104 ◽

1996 ◽

Vol 19 (11) ◽

pp. 638-644 ◽

Cited By ~ 25

Author(s):

J. Bommer ◽

E. Strohbeck ◽

J. Goerich ◽

M. Bahner ◽

I. Zuna

Keyword(s):

Calcium Phosphate ◽

Hdl Cholesterol ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Maintenance Hemodialysis ◽

Time Interval ◽

Dialysis Patients ◽

Cross Sectional ◽

Vldl Cholesterol

Arteriosclerosis is a constant problem in long-term hemodialysis patients. Computer tomography of the abdominal aorta allows a well-defined and reproducible evaluation of aortosclerosis. In the cross-sectional study, aortosclerosis was significantly accelerated in 84 chronic hemodialysis patients and was comparable to the results found in 20-year older control patients without renal disease. The increase of aortosclerosis correlated significantly with age of the patient, smoking, and duration of dialysis therapy. Furthermore, increased VLDL cholesterol and decreased HDL cholesterol seem to enhance aortosclerosis in our dialysis patients. In the longitudinal study (two CT scans with a time interval of 87 ± 62.7 months) in 36 dialysis patients, progressed aortosclerosis correlated significantly with the long duration of hypertriglyceridemia, VLDL cholesterol, uric acid, and calcium phosphate products. Progression of aortosclerosis was reduced in parathyroidectomized patients. The study suggests that premature aortosclerosis is found in dialysis patients. In addition to the common risk factor of aortosclerosis, disturbed calcium phosphate and parathyroid hormone metabolism seem to enhance aortosclerosis in patients under maintenance hemodialysis.

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P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1593 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Nevi Pasko ◽

Ariana Strakosha ◽

Arieta Dedej ◽

Loredana Kapidani ◽

Fjona Nasto ◽

...

Keyword(s):

Risk Factors ◽

Serum Albumin ◽

Serum Triglyceride ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Maintenance Hemodialysis ◽

C Reactive Protein ◽

Reactive Protein ◽

Arterial Complications ◽

The Impact

Abstract Background and Aims Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers. Method The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements. Results A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it. Conclusion In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.

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Evaluation of Body Composition in Hemodialysis Thai Patients: Comparison between Two Models of Bioelectrical Impedance Analyzer and Dual-Energy X-Ray Absorptiometry

Journal of Nutrition and Metabolism ◽

10.1155/2018/4537623 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Kulapong Jayanama ◽

Supanee Putadechakun ◽

Praopilad Srisuwarn ◽

Sakda Arj-Ong Vallibhakara ◽

Prapimporn Chattranukulchai Shantavasinkul ◽

...

Keyword(s):

Body Composition ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Hemodialysis Patients ◽

Dual Energy ◽

Fat Free Mass ◽

Maintenance Hemodialysis ◽

Cross Sectional ◽

X Ray ◽

Inbody 720

Background. Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with multifrequency technique is a practical and reliable tool. Objective. This cross-sectional study was aimed to compare the agreement of BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors. Methods. Body composition was measured by 2 BIA methods (InBody S10 and InBody 720) and DXA after a hemodialysis session. A total of 69 measurements were included. Pearson’s correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively. Results. The correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r=0.95, fat-free mass index (FFMI): r=0.78) and also between DXA and InBody 720 (FMI: r=0.96, FFMI: r=0.81). Comparing to DXA, the means of each body composition measured by InBody S10 method were not significantly different in each gender, but differences were found in FM, %FM, and FMI measured by InBody 720. Conclusions. In maintenance hemodialysis patients, the measurement of body composition with DXA and both BIA methods had highly significant correlations; practically, BIA method could be used as an instrument to follow FM and FFM and to measure the edematous stage. Further studies with large populations are warranted.

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Effects of lanthanum carbonate on vascular calcification in elderly maintenance hemodialysis patients

Journal of Huazhong University of Science and Technology [Medical Sciences] ◽

10.1007/s11596-015-1461-y ◽

2015 ◽

Vol 35 (4) ◽

pp. 508-513 ◽

Cited By ~ 3

Author(s):

Xiao-hui Wang ◽

Xin Zhang ◽

Chang-jun Mu ◽

Yong He ◽

Qing-ping Peng ◽

...

Keyword(s):

Vascular Calcification ◽

Hemodialysis Patients ◽

Lanthanum Carbonate ◽

Maintenance Hemodialysis ◽

Maintenance Hemodialysis Patients

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MP534IS PULSE WAVE VELOCITY THE BEST PREDICTOR OF VASCULAR CALCIFICATION IN CHRONIC HEMODIALYSIS PATIENTS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw196.13 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i518-i518 ◽

Cited By ~ 1

Author(s):

Silva Breznik ◽

Robert Ekart ◽

Breda Pečovnik Balon

Keyword(s):

Pulse Wave Velocity ◽

Wave Velocity ◽

Vascular Calcification ◽

Pulse Wave ◽

Hemodialysis Patients ◽

Chronic Hemodialysis

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Tinzaparin Provides Lower Lipid Profiles in Maintenance Hemodialysis Patients: A Cross-Sectional Observational Study

The Scientific World JOURNAL ◽

10.1155/2014/486781 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9

Author(s):

Ming-Hsien Tsai ◽

Yu-Wei Fang ◽

Jyh-Gang Leu

Keyword(s):

Multivariate Analysis ◽

Total Cholesterol ◽

Univariate Analysis ◽

Serum Triglyceride ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Maintenance Hemodialysis ◽

Diabetic Patients ◽

Significant Difference ◽

The Impact

As a low-molecular-weight heparin, tinzaparin has effectively been used as an anticoagulant during hemodialysis sessions. However, the impact of different heparin types on dyslipidemia is still controversial. In our study, 434 chronic hemodialysis patients were evaluated. The mean age was 65 ± 13. Forty-eight patients (11%) and 386 patients (89%) were in the tinzaparin and unfractionated heparin (UFH) groups, respectively. Triglyceride had significant difference between the two groups (P=0.001) but total cholesterol, HDL, or LDL did not. In the univariate analysis, the triglyceride level was significantly associated with tinzaparin use [β: −39.9, 95% confidence interval (CI): −76.7 to −3.0], and this association remained following the multivariate analysis (β: −40.8, 95% CI: −75.1 to −6.5). The difference in serum total cholesterol level between tinzaparin and UFH became significant (β: −13, 95% CI: −24.5 to −1.56) after adjustment in the multivariate analysis. Moreover, in a subgroup analysis, male diabetic patients showed lower serum triglyceride levels with the use of tinzaparin, while older, nondiabetic, male patients showed significant advantages in total cholesterol levels with the use of tinzaparin. Based on our findings, tinzaparin shows a significant association with a lower lipid profile in patients with chronic hemodialysis when compared to UFH.

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