nach oben

Erschienen in:

13.02.2018 | Nephrology - Original Paper

Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study

verfasst von: Nada Dimkovic, Georg Schlieper, Aleksandar Jankovic, Zivka Djuric, Marcus Ketteler, Tatjana Damjanovic, Petar Djuric, Jelena Marinkovic, Zoran Radojcic, Natasa Markovic, Jürgen Floege

Erschienen in: International Urology and Nephrology | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment.

Methods

We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6–160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q).

Results

Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 ± 47 months (Q1), 87 ± 51 month (Q2), 66 ± 48 (Q3) and 54 ± 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles.

Conclusion

Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies.

Schlieper G, Brandenburg V, Djuric Z et al (2009) Risk factors for cardiovascular calcifications in nondiabetic Caucasian haemodialysis patients. Kidney Blood Press Res 32:161–168CrossRefPubMed

Ketteler M, Schlieper G, Floege J (2006) Calcification and cardiovascular health: new insights into an old phenomenon. Hypertension 47:1027–1034CrossRefPubMed

Lanzer P, Boehm M, Sorribas V et al (2014) Medial vascular calcification revisited: review and perspectives. Eur Heart J 35:1515–1525CrossRefPubMedPubMedCentral

Brandenburg VM, Sinha S, Specht P et al (2014) Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease mineral and bone disorder. Pediatr Nephrol 29:2289–2298CrossRefPubMed

Raggi P, Boulay A, Scott CT et al (2002) Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 39:695–701CrossRefPubMed

London G, Covic A, Goldsmith D et al (2011) Arterial aging and arterial disease: interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease. Kidney Int Suppl 1:10–12CrossRef

Yoon HE, Chung S, Whang HC, Shin YR et al (2012) Abdominal aortic calcification is associated with diastolic dysfunction, mortality, and nonfatal cardiovascular events in maintenance hemodialysis patients. J Korean Med Sci 27(8):870–875. https://doi.org/10.3346/jkms.2012.27.8.870 CrossRefPubMedPubMedCentral

Kwon HY, Lee OH, Kim MJ et al (2014) The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients. Kidney Res Clin Pract 33(2):95–102. https://doi.org/10.1016/j.krcp.2014.04.003 CrossRefPubMedPubMedCentral

Inoue H, Shimizu S, Watanabe K et al (2017) Impact of trajectories of abdominal aortic calcification over 2 years on subsequent mortality: a 10-year longitudinal study. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfx253

10.

Schlieper G, Krüger T, Djuric Z et al (2008) Vascular access calcification predict mortality in hemodialysis patients. Kidney Int 74(12):1582–1587. https://doi.org/10.1038/ki.2008.458 CrossRefPubMed

11.

Hong D, Wu S, Pu L et al (2013) Abdominal aortic calcification is not superior over other vascular calcification in predicting mortality in hemodialysis patients: a retrospective observational study. BMC Nephrol 14:120. https://doi.org/10.1186/1471-2369-14-120 CrossRefPubMedPubMedCentral

12.

Adragao T, Pires A, Lucas C et al (2004) A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant 19:1480–1488CrossRefPubMed

13.

Damjanovic T, Djuric Z, Markovic N, Dimković S, Radojcic Z, Dimkovic N (2009) Screening of vascular calcifications in patients with end-stage renal diseases. Gen Physiol Biophys 28:277–283PubMed

14.

Ix JH, Shlipak MG, Brandenburg VM et al (2006) Association between human fetuin-A and the metabolic syndrome: data from the heart and soul study. Circulation 113:1760–1767CrossRefPubMedPubMedCentral

15.

Schurgers LJ, Teunissen KJ, Knapen MH et al (2005) Novel conformation-specific antibodies against matrix gamma-carboxyglutamic acid (Gla) protein: undercarboxylated matrix Gla protein as marker for vascular calcification. Arterioscler Thromb Vasc Biol 25:1629–1633CrossRefPubMed

16.

Schlieper G (2014) Vascular calcification in chronic kidney disease: not all arteries are created equal. Kidney Int 85:501–503CrossRefPubMed

17.

Floege J, Gillespie IA, Kronenberg F et al (2015) Development and validation of a predictive morality risk score from a European hemodialysis cohort. Kidney Int 87(5):996–1008CrossRefPubMedPubMedCentral

18.

Anker SD, Gillespie IA, Eckardt KU, On behalf the ARO Steering Committee (collaborators) et al (2016) Development and validation of cardiovascular risk scores for hemodialysis patients. Int J Cardiol 216:68–77CrossRefPubMed

19.

Haydar AA, Covic A, Colhoun H, Rubens M, Goldsmith DJ (2004) Coronary artery calcification and aortic pulse wave velocity in chronic kidney disease patients. Kidney Int 65:1790–1794CrossRefPubMed

20.

Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM (2001) Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 38:938–942CrossRefPubMed

21.

Zoccali C, London G (2015) Con: vascular calcification is a surrogate marker, but not the cause of ongoing vascular disease, and it is not a treatment target in chronic kidney disease. Nephrol Dial Transplant 30:352–357CrossRefPubMed

22.

Brandenburg VM, Sinha S, Specht P, Kettelr M (2014) Calcific uraemic arteriolopathy: a rare disease with a potentially high impact on chronic kidney disease-mineral and bone disorder. Pediatr Nephrol 29(12):2289–2298. https://doi.org/10.1007/s00467-013-2746-7 CrossRefPubMed

23.

Bover J, Evenepoel P, Urena’Tores P et al (2015) Pro: cardiovascular calcifications are clinically relevant. Nephrol Dial Transplant 30(3):345–351. https://doi.org/10.1093/ndt/gfv020 CrossRefPubMed

24.

Ketteler M, Rothe K, Kruger T et al (2011) Mechanisms and treatment of extraosseous calcification in chronic kidney disease. Nat Rev Nephrol 7:509–5016CrossRefPubMed

25.

Schafer C, Heiss A, Schwarz A et al (2003) The serum protein alpha 2-Heremans–Schmid glycoprotein/fetuin-A is a systemically acting inhibitor of ectopic calcification. J Clin Invest 112:357–366CrossRefPubMedPubMedCentral

26.

Dautova Y, Kozlova D, Skepper JN et al (2014) Fetuin-A and albumin alter cytotoxic effects of calcium phosphate nanoparticles on human vascular smooth muscle cells. PLoS ONE 9(5):e97565. https://doi.org/10.1371/journal.pone.0097565 eCollection 2014 CrossRefPubMedPubMedCentral

27.

Ketteler M, Bongartz P, Westenfeld R et al (2003) Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet 361(9360):827–833CrossRefPubMed

28.

Ix JH, Chertow GM, Shlipak MG et al (2007) Association of fetuin-A with mitral annular calcification and aortic stenosis among persons with coronary heart disease: data from the heart and soul study. Circulation 115:2533–2539CrossRefPubMedPubMedCentral

29.

Moe SM, Reslerova M, Ketteler M et al (2005) Role of calcification inhibitors in the pathogenesis of vascular calcification in chronic kidney disease (CKD). Kidney Int 67:2295–2304CrossRefPubMed

30.

Cranenburg EC, Brandenburg VM, Vermeer C et al (2009) Uncarboxylated matrix Gla protein (ucMGP) is associated with coronary artery calcification in haemodialysis patients. Thromb Haemost 101:359–366PubMed

31.

Schlieper G, Westenfeld R, Krüger T et al (2011) Circulating nonphosphorylated carboxylated matrix Gla protein predicts survival in ESRD patients. J Am Soc Nephrol 22:387–395CrossRefPubMedPubMedCentral

32.

Kapustin AN, Davies JD, Reynolds JL et al (2011) Calcium regulates key components of vascular smooth muscle cells-derived matrix vesicles to enhance mineralization. Circ Res 109:e1–e12CrossRefPubMed

33.

Hofbauer LC, Schoppet M (2001) Osteoprotegerin: a link between osteoporosis and arterial calcification? Lancet 358:257–259CrossRefPubMed

34.

Eknoyan G, Beck GJ, Cheung AK et al (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347(25):2010–2019CrossRefPubMed

35.

Schlieper G, Brandenburg V, Djuric Z et al (2007) Is there a correlation between C-reactive protein and calcification inhibitors with cardiovascular parameters and risk factors in hemodialysis patients? Dtsch Med Wochenschr 132:1820–1824CrossRefPubMed

36.

Floege J, Kim J, Ireland E et al (2011) Serum iPTH, calcium and phosphate, and the risk of mortality in a European hemodialysis population. Nephrol Dial Transplant 26:1948–1955CrossRefPubMed

37.

Davenport A (2015) Will incremental hemodialysis preserve residual renal function and improve patient survival? Semin Dial 28(1):16–19. https://doi.org/10.1111/sdi.12320 CrossRefPubMed

Titel: Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study
verfasst von: Nada Dimkovic
Georg Schlieper
Aleksandar Jankovic
Zivka Djuric
Marcus Ketteler
Tatjana Damjanovic
Petar Djuric
Jelena Marinkovic
Zoran Radojcic
Natasa Markovic
Jürgen Floege
Publikationsdatum: 13.02.2018
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 5/2018
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-018-1821-1

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

25.04.2024 | Hypotonie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study

Abstract

Purpose

Methods

Results

Conclusion

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2018

Implementation and evaluation of structured nephrology morbidity and mortality conferences: a quality education report

Cigarette smoking and risk of albuminuria in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies

Research progress of percutaneous nephrolithotomy

Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters

Vitamin D supplementation improves endothelial dysfunction in patients with non-dialysis chronic kidney disease

The role of zinc in urinary stone disease

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Update Innere Medizin