Differences in Risk Factors and Prevalence of Vascular Calcification between Pre-Dialysis and Hemodialysis Balkan Nephropathy Patients.

Nenad Petković,Siniša Ristić,Radmil Marić,Ljubica Djukanović,Jelena Marinković,Marijana Kovačević

doi:10.3390/medicina54010004

Nenad Petković, Siniša Ristić + Show 4 more

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https://doi.org/10.3390/medicina54010004

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Abstract

Aims: The aim of this study was to compare the risk factors and prevalence of vascular calcification (VC) in pre-dialysis and hemodialysis (HD) patients with Balkan endemic nephropathy (BEN) or other kidney diseases (non-BEN). Materials and Methods: The study involved 115 patients, 32 pre-dialysis and 83 HD patients, separated into groups of BEN and non-BEN patients. In addition to interviews, objective examinations and laboratory analyses, VC was assessed using Adragao score. Results: Patients with BEN were significantly older in both groups, while pre-dialysis BEN patients had significantly lower systolic blood pressure, serum cholesterol and phosphorus levels, but higher urinary excretion of phosphorus than non-BEN patients. These differences were lost in HD groups. In pre-dialysis patients, prevalence of VC was lower in BEN than in non-BEN group and mean VC score differed significantly between them (2.8 (1.7) vs. 4.6 (1.8); p = 0.009). No significant difference in VC score was found between BEN and non-BEN patients on HD. Multivariate analysis showed that in pre-dialysis patients VC score >4 was associated with lower iPTH and higher serum cholesterol level, but in the HD group with higher serum triglyceride level and longer HD vintage. Conclusions: Lower prevalence of risk factors for VC in the BEN than non-BEN patients was found in pre-dialysis but not in HD group and this was reflected in the prevalence and severity of VC in the groups. Prevalence of VC and mean VC score were significantly lower in pre-dialysis BEN than in non-BEN patients but not for those on HD.

Highlights

Balkan endemic nephropathy (BEN) is a familial, slow progressive tubule-interstitial disease characterized by tubular proteinuria, mild hypertension and in the advanced stage by severe anemia [1].For BEN patients, data on chronic kidney disease-mineral and bone disorder (CKD-MBD) as well as findings concerning vascular calcification (VC) are scarce and insufficient [2,3,4]
We showed that in pre-dialysis patients, a VC score of >4 was associated with lower intact parathyroid hormone (iPTH) and higher serum cholesterol levels, but in the HD group, it was associated with lower iPTH and higher serum cholesterol levels, but in the HD group, it was associated with a higher serum triglyceride level and longer HD vintage (Table 3)
Several risk factors for VC were less prominent in pre-dialysis BEN than in non-BEN patients but such differences were not found between BEN and non-BEN patients on HD

Summary

Introduction

Balkan endemic nephropathy (BEN) is a familial, slow progressive tubule-interstitial disease characterized by tubular proteinuria, mild hypertension and in the advanced stage by severe anemia [1].For BEN patients, data on chronic kidney disease-mineral and bone disorder (CKD-MBD) as well as findings concerning vascular calcification (VC) are scarce and insufficient [2,3,4]. Hyperphosphatemia, one of the main pathogenic factors of VC (as proven in many studies over the past decades [5,6]), has been found more rarely in BEN than in other chronic kidney diseases [2]. It was proposed that the prevalence of VC is lower in BEN than in other kidney diseases. Our previous study showed that pre-dialysis BEN patients had a significantly lower VC score than patients with other kidney diseases, but it was not examined in BEN patients on regular hemodialysis (HD). Medicina 2018, 54, 4; doi:10.3390/medicina54010004 www.mdpi.com/journal/medicina patients was examined with the aim to compare the risk factors and prevalence of VC in pre-dialysis and HD patients with BEN and those with other kidney diseases (non-BEN)

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