Hyperphosphatemia in chronic kidney disease

Hyperphosphatemia in renal pathology is a key factor for developing mineral and bone disorders. It can develop even in the early stages of renal function decline and predict the formation of vascular calcification and an increased risk for developing cardiovascular complications in patients with chronic kidney disease, especially in those, who receive program hemodialysis. The use of calcium-free phosphate-binding agents that are not associated with the risk for developing hypercalcemia can slow the development of vascular calcification, reduce the incidence of adverse cardiovascular events and mortality in patients with chronic kidney disease.

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Oxidative Balance and Inflammation in Hemodialysis Patients: Biomarkers of Cardiovascular Risk?

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/8567275 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Daniele La Russa ◽

Daniela Pellegrino ◽

Alberto Montesanto ◽

Paolo Gigliotti ◽

Anna Perri ◽

...

Keyword(s):

Oxidative Stress ◽

Chronic Kidney Disease ◽

Renal Function ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Events ◽

Cardiovascular Complications ◽

Hemodialysis Patients ◽

Healthy Population ◽

Oxidative Balance

During chronic kidney disease, the progressive deterioration of renal function induces several biological/clinical dysfunctions, including enhancement of synthesis of inflammation/oxidative stress mediators. Impaired renal function is an independent cardiovascular risk factor; indeed, cardiovascular complications dominate the landscape of both chronic kidney disease and end-stage renal disease. The aim of this study is to explore the correlation between the global oxidative balance in hemodialysis patients and both inflammatory markers and cardiovascular events. Using photometric tests, this study explored plasmatic oxidative balance in 97 hemodialysis patients compared to a healthy population. In the hemodialysis patients, we showed that oxidative stress values were significantly lower than in controls while effectiveness in the antioxidant barrier was significantly increased in the hemodialysis group. Furthermore, we highlighted a strong correlation between oxidative index and blood levels of C-reactive protein. When patients were divided into two groups based on previous cardiovascular events, we found that subjects with previous cardiovascular events had higher values of both oxidative stress and antioxidant barrier than patients without cardiovascular events. Our results indicated that in hemodialysis patients, the clinical and prognostic significance of oxidative status is very different from general population. As cardiovascular complications represent a strong negative factor for survival of hemodialysis patients, the research of new cardiovascular risk biomarkers in these patients takes on particular importance in order to translate them into clinical practice/primary care.

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Combination of biomarkers of vascular calcification and sTWEAK to predict cardiovascular events in chronic kidney disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2018.01.011 ◽

2018 ◽

Vol 270 ◽

pp. 13-20 ◽

Cited By ~ 7

Author(s):

Milica Bozic ◽

Nerea Méndez-Barbero ◽

Carmen Gutiérrez-Muñoz ◽

Angels Betriu ◽

Jesús Egido ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Vascular Calcification ◽

Cardiovascular Events

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Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications – A National Population-Based Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0136508 ◽

2015 ◽

Vol 10 (9) ◽

pp. e0136508 ◽

Cited By ~ 43

Author(s):

Hsien-Yi Chiu ◽

Hui-Ling Huang ◽

Chien-Hsun Li ◽

Hung-An Chen ◽

Chia-Lun Yeh ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cardiovascular Complications ◽

Population Based ◽

National Population ◽

Increased Risk

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Association of Serum Phosphate and Related Factors in ESRD-Related Vascular Calcification

International Journal of Nephrology ◽

10.4061/2011/939613 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Cai-Mei Zheng ◽

Kuo-Cheng Lu ◽

Chia-Chao Wu ◽

Yung-Ho Hsu ◽

Yuh-Feng Lin

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Vascular Calcification ◽

Cardiovascular Complications ◽

Serum Phosphate ◽

Related Factors ◽

Therapeutic Prevention ◽

Esrd Patients

Vascular calcification is common in ESRD patients and is important in increasing mortality from cardiovascular complications in these patients. Hyperphosphatemia related to chronic kidney disease is increasingly known as major stimulus for vascular calcification. Hyperphosphatemia and vascular calcification become popular discussion among nephrologist environment more than five decades, and many researches have been evolved. Risk factors for calcification are nowadays focused for the therapeutic prevention of vascular calcification with the hope of reducing cardiovascular complications.

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Correlation Between Soluble Klotho and Vascular Calcification in Chronic Kidney Disease: A Meta-Analysis and Systematic Review

Frontiers in Physiology ◽

10.3389/fphys.2021.711904 ◽

2021 ◽

Vol 12 ◽

Author(s):

QiFeng Liu ◽

LiXia Yu ◽

XiaoYa Yin ◽

JianMing Ye ◽

ShaSha Li

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Publication Bias ◽

Vascular Calcification ◽

Meta Analysis ◽

Linear Regression Analysis ◽

Significant Heterogeneity ◽

Multivariate Linear Regression Analysis ◽

Inverse Association ◽

Increased Risk

Background: The correlation between soluble Klotho (sKlotho) level and vascular calcification (VC) in patients with chronic kidney disease (CKD) remains controversial. Using meta-analysis, we aimed to address this controversy and assess the feasibility of applying sKlotho as a biomarker for VC.Methods: Medical electronic databases were thoroughly searched for eligible publications on the association between sKlotho level and VC in CKD patients. Effectors, including correlation coefficients (r), odds ratios (ORs), hazard ratio (HR) or β-values, and 95% confidence intervals (CIs) were extracted and combined according to study design or effector calculation method. Pooled effectors were generated using both random-effects models and fixed-effects models according to I2-value. Origin of heterogeneity was explored by sensitivity analysis and subgroup analysis.Results: Ten studies with 1,204 participants from a total of 1,199 publications were eligible and included in this meta-analysis. The combined correlation coefficient (r) was [−0.33 (−0.62, −0.04)] with significant heterogeneity (I2 = 89%, p < 0.001) based on Spearman correlation analysis, and this significant association was also demonstrated in subgroups. There was no evidence of publication bias. The combined OR was [3.27 (1.70, 6.30)] with no evidence of heterogeneity (I2 = 0%, p = 0.48) when sKlotho was treated as a categorical variable or [1.05 (1.01, 1.09)] with moderate heterogeneity (I2 = 63%, p = 0.10) when sKlotho was treated as a continuous variable based on multivariate logistic regression. No significant association was observed and the pooled OR was [0.29 (0.01, 11.15)] with high heterogeneity (I2 = 96%, p < 0.001) according to multivariate linear regression analysis. There was an inverse association between sKlotho and parathyroid hormone levels. The combined coefficient (r) was [−0.20 (−0.40, −0.01)] with significant heterogeneity (I2 = 86%, p < 0.001), and without obvious publication bias. No significant association was found between sKlotho and calcium or phosphate levels.Conclusion: There exists a significant association between decreased sKlotho level and increased risk of VC in CKD patients. This raises the possibility of applying sKlotho as a biomarker for VC in CKD populations. Large, prospective, well-designed studies or interventional clinical trials are required to validate our findings.

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Increased Risk of Cardiovascular Complications in Chronic Kidney Disease: A Possible Role of Leptin

Current Pharmaceutical Design ◽

10.2174/13816128113199990013 ◽

2014 ◽

Vol 20 (4) ◽

pp. 666-674 ◽

Cited By ~ 4

Author(s):

Agnieszka Korolczuk ◽

Jaroslaw Dudka

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Complications ◽

Increased Risk

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The role of bone metabolism regulators sclerotin and osteoprotegerin in the development of cardiovascular complications in the late stages of chronic kidney disease

Nephrology (Saint-Petersburg) ◽

10.36485/1561-6274-2021-25-6-63-70 ◽

2021 ◽

Vol 25 (6) ◽

pp. 63-70

Author(s):

F. U. Dzgoeva ◽

O. V. Remizov ◽

V. Kh. Botsieva ◽

N. G. Malakhova ◽

Z. R. Ikoeva ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Blood Serum ◽

Bone Metabolism ◽

Vascular Calcification ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Enzyme Linked Immunosorbent Assay ◽

Commercial Kits

BACKGROUND. Cardiovascular complications caused by vascular calcification in chronic kidney disease (CKD) are closely related to disorders of bone and mineral metabolism, the mechanisms of which require further study.THE AIM: to clarify the role of the regulatory proteins of bone metabolism of sclerostin and osteoprotegerin in the processes of vascular calcification and the development of cardiovascular complications in CKD.PATIENTS AND METHODS. 110 patients with stage 3-5D CKD (67 men) were examined. Median age is 47.0 (23.0-68.0) years. Osteoprotegerin (OPG), sclerostin, intact parathyroid hormone (IPTG), troponin I in blood serum were determined using commercial kits "Enzyme-linked Immunosorbent Assay Kit for Sclerostin" ("Cloud-Clone Corp.", USA) and commercial kits "ELISA kit" ("Biomedica" (Austria) by enzyme immunoassay (ELISA). Echocardiography with Dopplerography was performed on the device "ALOKA 4000" ("Toshiba", Japan). The left ventricular myocardial mass index (LVMI) and peak systolic blood flow velocity in the aortic arch (Vps, peak systolic velocity) were determined to quantify hemodynamic changes indirectly indicating the state of the aortic vascular wall.RESULTS. Analysis of the ratios of the calculated glomerular filtration rate (EGFR), IMLJ, Vps, OPG, and sclerostin showed that a decrease in excretory kidney function is accompanied by an increase in the concentrations of OPG and sclerostin in the blood serum. At the same time, there is an increase in IMLJ and Vps. During the correlation analysis, it was shown that the level of OPG was positively correlated with the level of sclerostin and negatively with the level of iPTG.CONCLUSION. In our study, we obtained data confirming the interactive interaction between the vascular and bone systems. Morphogenetic proteins-inhibitors of bone metabolism (sclerostin and OPG) play a significant role in the defeat of the cardiovascular system in patients with CKD, as they promotes the development of vascular calcification.

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MO465PROGNOSTIC IMPLICATION OF URINARY POTASSIUM EXCRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab090.0027 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Daisuke Mori ◽

Shinjiro Tamai ◽

Maho Tokuchi ◽

Natsumi Inoue ◽

Hideaki Kawai ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Potassium ◽

Cardiovascular Events ◽

Renal Outcome ◽

Potassium Excretion ◽

Ckd Progression ◽

Increased Risk ◽

Urinary Potassium ◽

All Cause Mortality

Abstract Background and Aims Plasma potassium levels are impacted by decreased kidney function and are known to be associated with increased mortality, adverse cardiovascular events and adverse kidney events. However, the prognostic implication of urinary potassium is unclear. Method We conducted an observational study of 1102 patients with chronic kidney disease (CKD) who were hospitalized between 2010 and 2018. The expected primary outcomes were all-cause mortality, adverse cardiovascular events and CKD progression. CKD progression was defined as a 30% increase in serum creatinine, the initiation of maintenance dialysis or the need for kidney transplantation. The Cox proportional hazards model was used to analyse the association between urinary potassium excretion and adverse clinical outcomes after adjustment for potential confounders. Results At baseline, 66% of the patients were men, with a median age of 72 years (interquartile range or IQR, 64–79 years); 61% of the patients were diabetic, and 54% of them were hypertensive. The median values for estimated glomerular filtration rate (eGFR) was 12 mL/min/1.73m2 (IQR, 8–18), serum potassium 4.5 mmol/L (IQR, 4.1–5.1) and urinary potassium/creatinine ratio (UK/Cr) 27 mmol/gCr (IQR, 20–38). Over a median follow-up period of 2.6 years (IQR 0.2–4.5), the number of all-cause deaths was 87. There were 171 cases of cardiovascular events and 860 cases of CKD progression. After adjusting for the eGFR, serum potassium level, proteinuria, renin–angiotensin system inhibitors, diuretics and other potential confounders, UK/Cr was found to be neither significantly associated with all-cause mortality nor with adverse cardiovascular events. However, a low UK/Cr was associated with an increased risk of CKD progression (adjusted hazard ratio [95% confidence interval] for the first, second and third quartiles, compared with the fourth quartile, were as follows: 2.09 [1.43-3.06], 1.33 [0.96-1.86] and 1.05 [0.75-1.46]) Conclusion A low UK/Cr might be an independent risk factor for poor renal outcome.

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