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

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
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.

scholarly journals THU0300 RISK FACTORS FOR COMPLICATIONS AND REFRACTORY COURSE IN PATIENTS WITH ANCA-ASSOCIATED SYSTEMIC VASCULITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 378.2-378
Author(s):  
A. Chudinov ◽  
I. Belyaeva ◽  
M. Pervakova ◽  
V. Mazurov ◽  
O. Inamova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Induction Therapy ◽  
Granulomatosis With Polyangiitis ◽  
Disease Risk ◽  
Systemic Vasculitis ◽  
Cardiovascular Complications ◽  
Infectious Complications ◽  
Eosinophilic Granulomatosis With Polyangiitis

Background:ANCA-associated systemic vasculitis (AAV) is characterized by a high incidence of complications and high mortality. The most significant complications during the first 3 years of the disease are infectious and cardiovascular. Development of chronic kidney disease also impairs the prognosis of AAV. Refractory to induction therapy can significantly increase the severity of organ lesions in patients with AAV.Objectives:The aim of this study was to determine risk factors for complications and refractory course in patients with AAV.Methods:Patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were observed during the first 3 years of the disease and included in this study between 2010 and 2018. Most common infectious complications requiring inpatient treatment were pneumonia, mycosis, sepsis, purulent arthritis, purulent otitis media. Cardiovascular complications included pulmonary thromboembolism, myocardial infarction, ischemic stroke, venous thrombosis.Results:In total 209 (165 [79%] female and mean age 51.8 ± 13.2 years) AAV patients (94 GPA; 46 MPA; and 69 EGPA) were included in the analysis. Risk factors for infectious complications were BVAS level at the beginning of induction therapy > 25 (OR – 2.92, 95% CI (1.53;5.45) p<0.001), usage of prednisone in doses more than 60 mg / day at the induction of remission (OR – 2.76, 95% CI (1.45;5.29) p=0.003), usage of prednisone in doses ≥ 10 mg / day after 6 months of induction therapy (OR – 2.60, 95% CI (1.38;4.93) p=0.003), ANCA-PR3 positivity (OR – 2.25, 95% CI (1.13;4.46) p=0.017) and presence of diabetes mellitus in the AAV onset (OR – 1.77, 95% CI (1.14;3.45) p=0.038). Patients with AAV had following risk factors for cardiovascular complications: male (OR – 2.28, 95% CI (1.33;3.88) p=0.002), BVAS level > 25 (OR – 2.1, 95% CI (1.11;3.16) p=0.008) and presence of coronary artery disease in the AAV onset (OR – 2.2, 95% CI (1.18;4.10) p=0.015). ANCA positivity (OR – 5.62, 95% CI (2.1;14.9) p<0.001), presence of rapidly progressive glomerulonephritis in the first 3 months from onset AAV (OR – 5.02, 95% CI (3.42;7.35) p<0.001) and over 60 years of age (OR – 2.17, 95% CI (1.38;3.44) p=0.001) were risk factors of development of chronic kidney disease. Risk factors for refractory to induction therapy in patients with AAV were ANCA-PR3 positivity (OR – 3.13, 95% CI (1.63;6.02) p<0.001), BVAS level > 25 (OR – 2.63, 95% CI (1.74;4.34) p<0.001), initiation of therapy after 4 months from the onset of clinical manifestations (OR – 2.17, 95% CI (1.26;3.91) p=0.005). We additionally defined that identification of pathological phenotypes of alpha-1-antitrypsin was risk factors for refractory course in patients with GPA manifestations (OR – 2.66, 95% CI (1.12;6.33) p=0.048).Conclusion:Our study has shown that high disease activity, ANCA positivity and comorbid pathology increase risk of serious complications. Early administration of immunosuppressive therapy, adequate steroid dosing and use of risk factors for complications and refractory course in clinical practice can significantly improve the prognosis of AAV.Disclosure of Interests:None declared

scholarly journals Cardiorenal syndrome in patients with chronic kidney disease and diabetes mellitus

2013 ◽  
Vol 16 (3) ◽  
pp. 90-96
Author(s):  
Irina Mikhailovna Kutyrina ◽  
Tatiana Evgen'evna Rudenko ◽  
Svetlana Alekseevna Savel'eva ◽  
Mikhail Yur'evich Shvetsov ◽  
Marina Vladimirovna Shestakova
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiorenal Syndrome ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Related Factors ◽  
Myocardial Remodelling ◽  
History Of

AIM: Combination of cardiovascular and renal disease is currently viewed as a unified cardiorenal syndrome (CRS). The aim of our study was to assess the CRS prevalence and risk factors associated with left ventricular hypertrophy (LVH) in patients with pre-dialysis stages of chronic kidney disease (CKD) of various etiology. MATERIALS AND METHODS: We enrolled 172 patients with CKD to participate in this study. First group consisted of 83 patients with nondiabetic CKD at 2nd through 4th stage (mean age 46-15 years, 51% male and 29% female). Mean glomerular filtration rate (GFR) was 37.2 ml/min (33.9-41.4 with 95% CI); creatinine plasma clearance was 2.9 mg/dl (2.6-3.2). Second group consisted of 89 patients with type 2 diabetes mellitus (T2DM) and CKD at 1st?2nd stage (40% male and 60% female) with albuminuria (mean age 57.3-7.1 years). Duration of diabetes in this sampling was 10.4-7.1 years. All patients underwent standard clinical examination, supplemented with echocardiography to evaluate the influence of general and CKD-related risk factors for LVH. RESULTS: LVH was diagnosed in 37.3% of non-diabetic patients with CKD at 2nd through 4th stage. Aside from classic cardiovascular riskfactors (including age, gender, arterial hypertension, family history of cardiovascular diseases, hypercholesterolemia), we observed theimpact of kidney-related factors (anemia, plasma creatinine, disturbance of calcium-phosphorus metabolism). CKD progression wasassociated with elevation in the incidence of concentric and eccentric LVH). Patients with T2DM were diagnosed with LVH in 36% ofcases. Increased myocardial mass correlated with plasma levels of uric acid, HbA1c, obesity and albuminuria. There was also a firmassociation between diabetic nephropathy, left ventricular myocardial remodelling and a history of cardiovascular events. CONCLUSION: In patients with diabetes mellitus and CKD cardiorenal syndrome develops at pre-dialysis stages due to both classic and kidney-related cardiovascular risk factors.

scholarly journals Hyperphosphatemia in chronic kidney disease

2019 ◽  
pp. 78-85
Author(s):  
S. A. Martynov ◽  
M. Sh. Shamkhalova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Cardiovascular Events ◽  
Cardiovascular Complications ◽  
Phosphate Binding ◽  
Renal Function Decline ◽  
Increased Risk ◽  
Binding Agents ◽  
Key Factor

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.

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

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.

Fractional excretion of phosphorus and vascular calcification in stage 3 chronic kidney disease

2018 ◽  
Vol 67 (3) ◽  
pp. 674-680 ◽  
Author(s):  
Manuel Jiménez Villodres ◽  
Guillermo García Gutiérrez ◽  
Patricia García Frías ◽  
José Rioja Villodres ◽  
Mónica Martín Velázquez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Risk Factors ◽  
Vascular Calcification ◽  
Fractional Excretion ◽  
X Rays ◽  
Abdominal Radiography ◽  
Vascular Comorbidity

The role of renal excretion of Pi in relation to vascular calcification (VC) in patients in the early stages of chronic kidney disease (CKD) is controversial. Thus, we determine the relation between fractional excretion of phosphorus (FEP) and VC, measured using two methods in a cross-sectional study of patients with stage 3 CKD. We recorded demographic data, anthropometry, comorbidities and active treatment. We measured 24-hour urine FEP and, in serum, measured fibroblast growth factor 23 (FGF23), α-Klotho, intact parathyroid hormone (iPTH), calcium and phosphorus. VC was measured by lateral abdominal radiography (Kauppila index (KI)) and CT of the abdominal aorta (measured in Agatston units). In 57% of subjects, abnormal VC was present when measured using CT, and in only 17% using lateral abdominal radiography. Factors associated with VC using CT were age, cardiovascular risk factors, vascular comorbidity, microalbuminuria and levels of FGF23, phosphorus and calcium x phosphorus product (CaxP); although only age (OR 1.25, 95% CI 1.11 to 1.41), smoking (OR 21.2, CI 4.4 to 100) and CaxP (OR 1.21, CI 1.06 to 1.37) maintained the association in a multivariate analysis. By contrast, only age (OR 1.35, 95% CI 1.07 to 1.74), CaxP (OR 1.14, CI 1.13 to 1.92) and FEP (OR 1.07,95% CI 1004 to 1.14) were associated with abnormal VC in the lateral abdominal radiography. In conclusion, in patients with stage 3 CKD, the detection of VC by abdominal CT is more sensitive than conventional X-rays. Moreover, CaxP is associated with cardiovascular risk factors and vascular comorbidity; quantification of FEPi in these patients provides additional clinical information in advanced VC detected by KI.

High-serum phosphate and parathyroid hormone distinctly regulate bone loss and vascular calcification in experimental chronic kidney disease

2018 ◽  
Vol 34 (6) ◽  
pp. 934-941 ◽  
Author(s):  
Natalia Carrillo-López ◽  
Sara Panizo ◽  
Cristina Alonso-Montes ◽  
Laura Martínez-Arias ◽  
Noelia Avello ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Bone Loss ◽  
Vascular Calcification ◽  
High Serum ◽  
Serum Phosphate

scholarly journals Assessment of Risk Factors for Cardiovascular Complications in Patients with Chronic Kidney Disease (CKD) Stage III-V before Dialysis

2014 ◽  
Vol 9 (1) ◽  
pp. 25-32
Author(s):  
MK Khan ◽  
HU Rashid ◽  
S Yesmine ◽  
IH Mahmoo ◽  
SMA Habib ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Small Sample ◽  
Stage Iii ◽  
Ckd Stage

Background: Chronic Kidney Disease is a major public health and clinical problem throughout the world including Bangladesh. The prevalence of cardiovascular complications is much higher in patients with CKD regardless of stages than normal population. Considering this view, a cross sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, with an aim to assessing the cardiovascular complications & associated risk factors among the patients with chronic kidney disease (CKD) stage III-V before dialysis. Methods: A total of 109 patients were selected consecutively who had a diagnosis of CKD and an estimated GFR of less than 60 ml/min/1.73m2 of stages III to V and who had not received any form of renal replacement therapy, during a period of June 2006 to July 2007. Results: The study included 63 males and 46 females with age ranging from 18 to 65 years having a mean age 45.5±12.2 years. Left ventricular failure, left ventricular hypertrophy (by ECG and echocardiography), cardiomegally by X-ray were identified as significant cardiovascular complications among the patients of CKD stage V (p<0.05). However , logistic regression analysis revealed that hypertension and CKD stages appeared to be the important predictors of cardiovascular complications p<0.05). Data analysis found that hypertension, smoking and anemia appeared to be important risk factors for cardiovascular complications in CKD patients (p<0.05) by bi-variate analysis. Conclusion: Though the study findings did not generalize the CKD patients in Bangladesh due to small sample size, however, heart failure and left ventricular hypertrophy significantly appeared to be the main cardiovascular complications in CKD stage V compared to other two stages (stage III and IV)(p<0.05). Anemia, hypertension were identified as important risk factors (p<0.05). DOI: http://dx.doi.org/10.3329/uhj.v9i1.19508 University Heart Journal Vol. 9, No. 1, January 2013; 25-32

MO208ASSOCIATION OF SERUM BETA-2 MICROGLOBULIN LEVEL WITH DIFFERENT CARDIAC AND METABOLIC RISK FACTORS IN CKD PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nazia Arfin Siddiqui ◽  
M Sahadat Hossain ◽  
Babrul Alam ◽  
S R Chaudhury ◽  
Maa Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Phosphate ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Abstract Background and Aims Serum β M is a middle molecule uremic toxin that accumulates in serum and deposits at various tissues in chronic kidney disease (CKD), especially more in dialysis patients. The βâ M is generally considered as a predictor of cardiovascular morbidity and mortality and this is more investigated in dialysis group. However its relationship with several cardiac and metabolic risk factors in all stages of CKD is still under evaluation. This study was undertaken to evaluate the association of plasma βâ M level in different stages of chronic kidney disease patients with different cardiac, renal and metabolic risk factors that can predict future cardiovascular events Method This cross-sectional study was conducted by selecting consecutive 132 CKD subjects of stages 1-5D including both patients not requiring dialysis and those on maintenance hemodialysis. Their demographic, clinical and laboratory data were recorded in a data sheet. Fasting blood samples in dialysis non requiring subjects and predialysis samples in hemodialysis group (G5D) were taken for testin in laboratory for CBC, serum βâ M, hCRP, iPTH, lipid profile, creatinine, uric acid and serum albumin as cardiac, renal and metabolic risk markers. Urine sample was taken from predialysis patients for chemical test and ACR. The CKD staging were done by MDRD criteria. Additional 25 no CKD subject was taken as healthy referents. Results Primarily Beta-2 microglobulin was higher in CKD patients than in healthy group (13.53 ± 14.74 vs. 1.81 ± 0.47, mg/l; p&lt;.001). The levels were gradually rising with the advancing stages of CKD (G1&2-3.46 ± 2.39, G3-3.66 ± 1.08, G4-6.51 ± 2.20, G5-11.43 ± 2.98 and G5D-41.79 ± 8.58, mg/l). A Beta-2 microglobulin cut-off of &gt;7.7 vs. &lt; 7.7 mg/l showed significantly increased Systolic BP (136 ±22 vs. 123 ± 22, mmHg), diastolic BP (80 ± 12 vs. 75 ± 8.96, mmHg),( p&lt;0.01); CRP (6.83 ± 6.03 vs. 4.39 ± 5.35, mg/l)( p&lt;0.007); serum phosphate (4.84 ± 1.79 vs. 3.85 ±.92,mg/dl)( p&lt;0.001); uric acid (5.89 ± 1.41 vs. 5.01 ± 1.57,mg/dl)( p&lt;0.01); TG (189± 103 vs. 155 ± 88, mg/dl),( p&lt;0.04); and PTH (239.83 ± 186.50 vs. 90.52 ± 81.77, pg/ml), ( p&lt;0.001) indicating higher cardio metabolic risks in higher group. Similarly renal parameters were also more altered in high Beta-2 microalbumin group for serum creatinine (6.89 ± 3.54 vs. 1.58 ± .81, mg/dl) (p&lt;0.001) and ACR (824 ± 917 vs. 320 ± 753, mg/g),( p&lt;0.001). B-2 microglobulin also positively correlated with systolic blood pressure (r=.295, p&lt;.001), serum creatinine (r=.879, p&lt;.001), serum phosphate (r=.175, p =.047), serum iPTH (r=.403, p&lt;.001) , hCRP ( r=.193, p =.050) , Triglycerides (r=.196, p =.023) and urine ACR in CKD patients. Conclusion Beta-2 microglobulin level was significantly higher in CKD with an increasing pattern towards advancing stages. The higher levels positively correlated with cardio renal and metabolic risk factors. Hence measuring Beta-2 microglobulin regularly can help to take preventive measures early to manage patients at risk.

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