Predicting the risk of severe myocardial infarction in patientswith chronic 5D-stage kidneydisease and mineral-bone disorders

Abstract

BACKGROUND. The increasing prevalence of chronic kidney disease is a global trend as well in general as in terminal kidney failure in particular. Of great interest is the analysis of the impact of mineral and bone disorders on the risk of cardiovascular complications and, first of all, acute myocardial infarction (AMI ). THE AIM: to assess the impact of bone mineral disorders on the risk of AMI in patients with stage 5D chronic kidney disease. PATIENTS AND METHODS. It was conducted a prospective (three-year) cohort study of 85 patients with CKD S5D treated with programmed hemodialysis. At the first stage, it were reg­istered the risk factors and clinical manifestations of CKD 5 St, as well as indicators that characterized bone mineral disorders (levels of blood inorganic phosphate, calcium, parathyroid hormone, 1,25(OH)D, fibroblast growth factor (FGF-23), a-Klotho). Signs of calcification of the heart valves and aortic wall were also determined. The second stage involved a re-examination of patients after 3.1±0.1 years, as well as registration of endpoints, which were identified as cases of fatal and non-fatal AMI. RESULTS. After 3 years of follow-up, the following endpoints were registered: nonfatal AMI - 6 cases, fatal AMI-4 cases. The risk of AMI increased in the presence of initial persistent hyperphosphatemia and 1,25(OH)D3 deficiency, as well as calcifica­tion of heart valves and high FGF-23 values, but only in combination with hyperphosphatemia and 1,25(OH)D3 deficiency. Hyperparathyroidism also increased the risk of AMI in conditions of a deficit of 1,25(OH)D3. The risk of nonfatal AMI cases was also increased by the presence of aortic calcification and its severity. The risk of AMI increases in the presence of initial persistent hyperphosphatemia and a deficit of 1.25 (OH)D3, as well as CCS, high FGF-23 values, but only in combination with hyperphosphatemia and a deficit of 1.25(OH)D3. Hyperparathyroidism also increases the risk of AMI in conditions of a deficit of 1.25(OH)D3. The risk of nonfatal cases of AMI also increases the presence of aortic calcification and its severity. CONCLU­SION. The risk of AMI increases in the presence of initial persistent hyperphosphatemia and a deficit of 1,25(OH)D3, as well as calcification of the heart valves, high FGF-23 values, but only in combination with hyperphosphatemia and a deficit of 1,25(OH) D3. Hyperparathyroidism also increases the risk of AMI in conditions of a deficit of 1.25(OH)D3. The risk of nonfatal cases of AMI also increases the presence of aortic calcification.