Prevalence Of Vascular Calcification Research Articles

Comparative Analysis of Vascular Calcification Risk Factors in Pre-Hemodialysis and Prevalent Hemodialysis Adult Patients: Insights into Calcification Biomarker Associations and Implications for Intervention Strategies in Chronic Kidney Disease.

This retrospective study aimed to compare risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with calcification biomarkers. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF 23, fetuin-A, sclerostin, and VC scores (Adragao method). Prevalence of VC was similar in both groups, but HD patients had more frequent VC scores ≥ 6. Pre-HD patients were older, with higher prevalence of hypertension and less frequent use of calcium phosphate binders. Both groups showed similar patterns of hyperphosphatemia, low vitamin D, and iPTH. Fetuin-A and sclerostin levels were higher in pre-HD, while FGF 23 was elevated in HD patients. Higher VC risk in pre-HD patients was associated with male gender, older age, lower fetuin-A and higher sclerostin, lower ferritin, and no vitamin D treatment, while in HD patients with higher sclerostin, FGF 23 and urea, and lower iPTH. Conclusion: Biomarkers could be measurable indicators of biological processes underlying VC in CKD patients that may serve as a potential guide for considering personalized therapeutic approaches. Further studies are needed to elucidate the underlying pathways.

Biomimetic Grapefruit-Derived Extracellular Vesicles for Safe and Targeted Delivery of Sodium Thiosulfate against Vascular Calcification.

As the prevalence of vascular calcification (VC), a strong contributor to cardiovascular morbidity and mortality, continues to increase, the need for pharmacologic therapies becomes urgent. Sodium thiosulfate (STS) is a clinically approved drug for therapy against VC; however, its efficacy is hampered by poor bioavailability and severe adverse effects. Plant-derived extracellular vesicles have provided options for VC treatment since they can be used as biomimetic drug carriers with higher biosafety and targeting abilities than artificial carriers. Inspired by natural grapefruit-derived extracellular vesicles (EVs), we fabricated a biomimetic nanocarrier comprising EVs loaded with STS and further modified with hydroxyapatite crystal binding peptide (ESTP) for VC-targeted delivery of STS. In vitro, the ESTP nanodrug exhibited excellent cellular uptake capacity by calcified vascular smooth muscle cells (VSMCs) and subsequently inhibited VSMCs calcification. In the VC mice model, the ESTP nanodrug showed preferentially the highest accumulation in the calcified arteries compared to other treatment groups. Mechanistically, the ESTP nanodrug significantly prevented VC via driving M2 macrophage polarization, reducing inflammation, and suppressing bone-vascular axis as demonstrated by inhibiting osteogenic phenotype trans-differentiation of VSMCs while enhancing bone quality. In addition, the ESTP nanodrug did not induce hemolysis or cause any damage to other organs. These results suggest that the ESTP nanodrug can prove to be a promising agent against VC without the concern of systemic toxicity.

Associated factors of osteoporosis and vascular calcification in patients awaiting kidney transplantation

IntroductionPretransplant osteoporosis and vascular calcification probably increase the risk of fractures and cardiovascular events after kidney transplantation. In the present study, we investigated the related risk factors of osteoporosis and vascular calcification among end-stage renal disease (ESRD) patients awaiting kidney transplantation.MethodsA total of 221 ESRD patients (age, 43.4 ± 14.3 years; 125 males and 96 females; median dialysis duration, 61.0 m) awaiting kidney transplantation were enrolled in this cross-sectional study. Serum levels of bone turnover markers and intact parathyroid hormone (iPTH) were analyzed from fasting morning blood samples. Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD). Vascular calcification was evaluated by lateral abdominal radiography and plain radiographic films of the pelvis and hands.ResultsThe osteoporosis prevalence was 27.6% in this cohort of kidney transplantation candidates, and the prevalence of vascular calcification was 51.1%. The related factors for osteoporosis and vascular calcification were similar and included older age, longer dialysis duration, parathyroid hyperplasia, and higher levels of iPTH and bone turnover markers. In the multivariable regression model, age and iPTH were independent risk predictors of both vascular calcification and osteoporosis. There were strong, positive correlations between iPTH and all bone turnover markers. The moderate and severe hyperparathyroidism (iPTH 600–1499 pg/ml and iPTH 1500 pg/ml) were related to reduced serum albumin and hemoglobin levels.ConclusionThe involvement of high iPTH levels in vascular calcification, osteoporosis, and malnutrition indicated the need of treating hyperparathyroidism early in patients awaiting kidney transplantation. Prospective studies are needed to further examine the utility of bone turnover markers.

Dietary lycopene is negatively associated with abdominal aortic calcification in US adults: a cross-sectional study

Background Vascular calcification (VC) is one of the complications of chronic kidney disease (CKD) patients. Previous studies have confirmed that oxidative stress (OS) plays an important role in developing VC and that antioxidants have anti-VC effects. Objectives Our study aimed to determine the relationship between the intake of antioxidants from dietary sources and the prevalence of VC, especially in the CKD population. Methods This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2013–2014). Participants were noninstitutionalized adults >40 years of age. Diet-derived antioxidants were obtained from the first 24-h dietary recall interviews. The abdominal aortic calcification (AAC) score was measured by a DXA scan. We divided the AAC scores into three groups: no calcification (AAC =0), mild to moderate calcification (0< AAC ≤6), and severe calcification (AAC >6). Results A total of 2897 participants were included in the main analysis. Our results showed that vitamin B6, α-tocopherol, and lycopene were associated with severe AAC in unadjusted models (odds ratio (OR): 0.81, 95% confidence interval (CI): 0.72–0.91, p = 0.001; OR: 0.97, 95% CI: 0.95–0.99, p = 0.008; OR: 0.98, 95% CI: 0.96–0.99, p = 0.01, respectively). However, only dietary lycopene was associated with severe AAC after adjusting covariates based on clinical and statistical significance. Per 1 mg higher intake of diet-derived lycopene per day, the odds of having severe AAC were 2% lower in the fully adjusted model (OR: 0.98, 95% CI: 0.95–0.999, p = 0.04). Moreover, in subgroup analysis, diet-derived antioxidant was not associated with AAC in patients with CKD. Conclusion: Our findings indicate that a higher intake of diet-derived lycopene was independently associated with lower odds of having severe AAC in humans. Therefore, a high intake of diet-derived lycopene may help prevent severe AAC.

Prevalence and risk factors for vascular calcification based on the ankle-brachial index in the general population: a cross-sectional study

BackgroundTo investigate the prevalence of vascular calcification based on the ankle‐brachial index (ABI) value and analyse the risk factors for vascular calcification in the general population.MethodsA cross-sectional study was conducted to collect clinical, laboratory, and lifestyle data in individuals aged 30–70 recruited from the physical examination centre. The automatic arteriosclerosis detector was used to measure the ABI. Difference tests, correlation analyses, and multivariate logistic regression analyses were performed to identify risk factors for vascular calcification.ResultsThe overall prevalence of vascular calcification was 24.39% in 1033 subjects. The prevalence of vascular calcification in males was much higher than that in females (27.80% vs. 17.49%, P < 0.001). The differences in age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), hypertension, and fatty liver disease were statistically significant in males (P < 0.05). The differences between serum uric acid (UA), total cholesterol (TC), TG, low-density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR), alcohol consumption, exercise, and postmenopausal status were statistically significant in females (P < 0.05). Increased age (odds ratio (OR) = 1.028, 95% confidence interval (CI) 1.008–1.049, P = 0.007), increased BMI (OR = 1.238, 95% CI 1.147–1.337, P < 0.001) and elevated DBP (OR = 2.563, 95% CI 1.262–5.205, P = 0.009) were independent risk factors for vascular calcification in males after adjusting for confounding factors. Increased BMI (OR = 1.159, 95% CI 1.029–1.304, P = 0.015), elevated UA (OR = 1.545, 95% CI 1.077–2.216, P = 0.018), elevated LDL-C (OR = 1.044, 95% CI 1.060–1.027, P < 0.001), and a lack of exercise (OR = 2.402, 95% CI 1.073–5.373, P = 0.033) were independent risk factors for vascular calcification in females.ConclusionsThe prevalence of vascular calcification based on the ABI value is also high in the general population of our centre. Increased age, BMI, and elevated DBP are independent risk factors for vascular calcification in males. Increased BMI, UA, LDL-C, and a lack of exercise are independent risk factors for vascular calcification in females. Attention should be given to strengthening the prevention and control of vascular calcification in the general population.

Clinical and laboratory markers of calcifying atherosclerosis

Despite the achievements in the detection of calcium deposits in the walls of blood vessels, there is practically no data on the relationship of calcification of the coronary arteries with clinical and laboratory indicators of calcification in the blood, and the mechanisms of this process have not been fully established. The aim of the work was to establish the relationship between the severity of vascular calcification and clinical and laboratory markers of vascular calcification to improve the effectiveness of the diagnosis of diseases of the cardiovascular system and optimize therapy. The data obtained during the study indicate a high prevalence of vascular calcification in patients with atherosclerosis. Estimates of the calcium index and traditional risk factors are not always sufficient to predict cardiovascular complications. Thus, the identification of specific laboratory markers of calcification and predisposition to calcinosis is very relevant at the present time. Studies have shown that atherosclerosis with vascular calcification is combined with the development of chronic systemic inflammation and inflammation of the vascular wall. At the same time, there are elevated levels of C-reactive protein, endothelin, homocysteine, lipid metabolism indicators, and reduced levels of fetuin-A in the blood, which allows us to recommend these laboratory indicators to prevent cardiovascular complications.

MO453SERUM AND VASCULAR FIBROBLAST GROWTH FACTOR 23 (FGF23) ARE ASSOCIATED WITH VASCULAR CALCIFICATION

Abstract Background and Aims Mineral metabolism imbalances and inflammation are related to the development of vascular calcification (VC). Fibroblast growth factor-23 (FGF23) is the main regulator of phosphate homeostasis and various studies have shown the existence of an association between elevated levels of FGF23 and the appearance of cardiovascular disease (CVD). We conducted a case-control study to test the hypothesis that serum and vascular levels of FGF23 are associated with the presence of VC. In addition, we determined the influence of inflammation in these levels. Method One hundred and thirty-three patients diagnosed with clinical atherosclerotic disease undergoing elective vascular surgery, and 20 cadaveric organ donors with no medical history of CVD, were included in this study. Serum levels of intact FGF23 (iFGF23), together with tumor necrosis factor-alpha (TNFα), interleukin (IL)10, were determined by ELISA. Vascular fragments of aorta, carotid and femoral arteries were obtained for assaying the gene expression of FGF23, TNF, IL10 and RUNX2 by qPCR. Immunohistochemical procedures were employed to determine vascular protein levels of FGF23, TNFα and IL10. VC was diagnosed by imaging techniques and confirmed by histological procedures including von Kossa staining. Results Case group presented a higher prevalence of hypertension, hypercholesterolemia and reduced estimated glomerular filtration rate, with no differences regarding other parameters. Serum iFGF23 and TNFα/IL10 ratio were higher in the case group (P&amp;lt;0.01 and P&amp;lt;0.001, respectively). Vascular expression of FGF23 was detected in 58.6% of CVD patients vs 35% of donors, with mean expression levels significantly higher in the first group (P&amp;lt;0.01). Vascular expression of TNF/IL10 was also increased (P&amp;lt;0.001) in CVD patients. FGF23 immunoreactivity was detected in 84% of CVD patients and only in 35% of controls. Immunoreactivity for FGF23 and TNFα/IL10 ratio were significantly higher in CVD patients (P&amp;lt;0.001 and P&amp;lt;0.0001, respectively). Stratified analysis according to serum iFGF23 levels showed a higher prevalence of VC in the upper tertiles. Patients with VC presented increased levels of all the FGF23 variables including serum [1.5 (1.2-1.6) vs. 1.4 (0.9-1.5) pg/mL, P&amp;lt;0.01], vascular mRNA [26.1 (14.3-67.4) vs. 18.8 (8.8-312.9) log AU, P&amp;lt;0.01] and vascular immunoreactivity [4.6 (3.8-4.9) vs. 3.7 (3.1-4.1) log µm2, P&amp;lt;0.05]. Moreover, FGF23 immunoreactivity was detected in 92.3% of fragments with VC and only in 53.6% of those without VC. Serum TNFα/IL10 and RUNX2 mRNA levels were also higher in this group (P&amp;lt;0.01 for both). Correlation analysis showed associations of serum iFGF23 with serum TNFα (r=0.375, P&amp;lt;0.001), neutrophil/lymphocyte (r=0.142, P&amp;lt;0.05), vascular RUNX2 mRNA (r=0.55, P&amp;lt;0.05), and vascular FGF23 immunoreactivity (r=0.281, P&amp;lt;0.05) in the CVD group. Vascular FGF23 expression correlated with RUNX2 mRNA (r=0.315, P&amp;lt;0.05) and FGF23 immunoreactivity (r=0.254, P&amp;lt;0.05). Multiple regression analysis showed that iFGF23 levels were determined by UAE, HDL, FGe, calcium and TNFα levels (adjusted R2= 0.473, P&amp;lt;0.0001) and that vascular FGF23 mRNA expression was determined by TNFα, PCR, glucose and age (adjusted R2= 0.795, P&amp;lt;0.0001). Multivariate logistic regression, with VC as dependent variable, showed that both iFGF23 and vascular mRNA constitute independent risk factors for the existence of VC [OR (95% CI): 1.05 and 1.12, P&amp;lt;0.05 for both]. Conclusion Patients with atherosclerosis and VC present significantly higher serum concentrations of FGF23, as well as higher immunoreactivity and gene expression levels in the vascular wall compared to patients without VC. Moreover, both serum and vascular mRNA levels of FGF23 are associated with the inflammatory status. Whether the increase in systemic and vascular FGF23 can directly promote or favor the calcifying process in the vascular bed is currently an issue under discussion.

Abstract 14548: Coronary and Aortic Calcification Are Common in Men With Recurrent Prostate Cancer Undergoing PET/CT Imaging

Background: Men who receive androgen deprivation therapy for prostate cancer may be at increased risk for cardiovascular events. Vascular calcification is predictive of coronary events in the general population. The prevalence of vascular calcification in men with prostate cancer is not known. Methods: 211 consecutive patients who underwent 18F-fluciclovine positron emission tomography (PET) /computed tomography (CT) at Washington University School of Medicine for recurrent prostate cancer were retrospectively identified. Clinical, demographic, and cardiac biomarker data were obtained from the medical record. Coronary and aortic calcification were qualitatively assessed on non-gated CT scans using standardized scoring systems. Results: Among 211 men with recurrent prostate cancer, median age was 69 (IQR 64, 75) years. Cardiovascular comorbidities were common (70% hypertension, 65% hyperlipidemia, 20% diabetes mellitus, 47% current or former smoking). 21% carried a clinical diagnosis of coronary artery disease while 6% had peripheral vascular disease. On CT imaging, 147 patients (70%) had coronary artery calcification of whom 29 (20%) had severe calcification. Additionally, 189 patients (90%) had aortic calcification on CT imaging of whom 48 (25%) had severe thoracic aortic calcification and 109 (58%) had severe calcification at the aortoiliac bifurcation. Conclusions: Coronary and peripheral vascular calcification are common on PET/CT imaging in men with prostate cancer. Vascular calcification on CT imaging may have utility for cardiovascular risk stratification and guiding implementation of cardiovascular therapies in men receiving androgen deprivation therapy.

Vitamin K deficiency: an emerging player in the pathogenesis of vascular calcification and an iatrogenic consequence of therapies in advanced renal disease.

Vascular calcification is a known complication of chronic kidney disease (CKD). The prevalence of vascular calcification in patients with non-dialysis-dependent CKD stages 3-5 has been shown to be as high as 79% (20). Vascular calcification has been associated with increased risk for mortality, hospital admissions, and cardiovascular disease (6, 20, 50, 55). Alterations in mineral and bone metabolism play a pivotal role in the pathogenesis of vascular calcification in CKD. As CKD progresses, levels of fibroblast growth factor-23, parathyroid hormone, and serum phosphorus increase and levels of 1,25-(OH)2 vitamin D decrease. These imbalances have been linked to the development of vascular calcification. More recently, additional factors have been found to play a role in vascular calcification. Matrix G1a protein (MGP) in its carboxylated form (cMGP) is a potent inhibitor of vascular calcification. Importantly, carboxylation of MGP is dependent on the cofactor vitamin K. In patients with CKD, vitamin K deficiency is prevalent and is exacerbated by warfarin, which is frequently used for anticoagulation. Insufficient bioavailability of vitamin K reduces the amount of cMGP available, and, therefore, it may lead to increased risk of vascular calcification. In vitro studies have shown that in the setting of a high-phosphate environment and vitamin K antagonism, human aortic valve interstitial cells become calcified. In this article, we discuss the pathophysiological consequence of vitamin K deficiency in the setting of altered mineral and bone metabolism, its prevalence, and clinical implications in patients with CKD.

Evaluation of the association of Wnt signaling with coronary artery calcification in patients on dialysis with severe secondary hyperparathyroidism

BackgroundPatients with end-stage renal disease have a higher risk of death from cardiovascular events, which can be mainly attributed to coronary artery calcification (CAC). Wnt signaling is involved in vascular development and may play a role in vascular calcification. This study aimed to evaluate CAC prevalence in patients on dialysis with severe secondary hyperparathyroidism (SHPT) and identify CAC risk factors.MethodsThe study is a retrospective analysis of the severe hyperparathyroidism registration study that prospectively recruited patients on dialysis with severe SHPT who were candidates for parathyroidectomy, from October 2013 to May 2015. CAC and bone mineral density (BMD) were measured. Demographic and clinical data including calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone, Dickkopf-related protein 1 (DKK1), and sclerostin levels were analyzed. CAC scores were reported in Agatston units (AU).ResultsA total of 61 patients were included in this study. No CAC, mild CAC (<100 AU), moderate CAC (>100 AU), and severe CAC (>400 AU) were observed in 4.9%, 11.4%, 14.8%, and 68.9% of patients, respectively. DKK1 and sclerostin were not associated with CAC. In univariate analysis, CAC was significantly correlated with age, sex (male), total cholesterol, and intravenous pulse calcitriol (p<0.05). CAC was not inversely correlated with the BMD, T scores, or Z scores of the femoral neck (p>0.05). In multivariate analysis, the stepwise forward multiple linear regression revealed that CAC was associated with age, male sex and intravenous pulse calcitriol (p<0.05). Furthermore, serum sclerostin was positively correlated with the BMD of the femoral neck but negatively associated with intact parathyroid hormone (p<0.05). Serum sclerostin was significantly associated with severely low bone mass with Z-scores<-2.5 of the femoral neck, even when adjusted for serum intact parathyroid hormone, vitamin D status, dialysis pattern, sex, and DKK-1 (p<0.05).ConclusionsThe patients on dialysis with severe SHPT have a high prevalence of vascular calcification. Although the Wnt signaling pathway could play a role in hyperparathyroid bone disease, CAC may be mainly due to the treatment modality rather than the Wnt signaling pathway associated bone metabolism in patients on dialysis with severe SHPT.

Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Objective: To investigate the occurrence of vascular calcification (VC) in different types of arteries in patients with maintenance peritoneal dialysis (PD) patients and its influencing factors. Methods: This study enrolled PD patients with stable status who has received PD treatment for more than 6 months in Peking University People’s Hospital. We used plain X-ray films of abdomen, pelvis, and hands to quantitatively evaluate VC of large artery (abdominal aorta, iliac artery), medium artery (femoral artery, radial artery), and small artery (finger arteries). Two radiologists read and scored radiographs blindly. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time-average laboratory indices including parameters of calcium phosphorus metabolism, serum albumin, PD adequacy were collected. A logistic regression model was used to estimate the influencing factors of different sites of VC. Results: (1) 154 PD patients were enrolled in this study: seventy-eight males, mean age was 60.4 ± 13.9 years, and median PD duration was 24 (16.39) months. The major primary disease was diabetic nephropathy (39%). (2) Among the 154 PD patients, the proportion of calcification of large artery was the highest (found in 100 patients, accounting for 64.9%); then the medium artery (66, 42.9%); and 15 of small artery, accounting for 9.7%. (3) Logistic regression showed that older age, longer dialysis duration, lower baseline serum intact parathyroid hormone (iPTH), and higher CCI scores were independent risk factors of large artery calcification (p < 0.05), and higher CCI scores, higher baseline serum triglycerides (TG), lower baseline serum iPTH, and time-average iPTH were independent risk factors of medium and small arteries. Conclusions: In PD patients, the occurrence of large artery calcification was higher than others. Among different sites of VC, the abdominal aortic calcification was most likely to occur, and the proportion of small artery calcification was low. Calcification of medium and small arteries can exist alone without calcification of large artery. Large artery calcification was more likely to occur in patients with older age, longer dialysis duration, lower baseline serum iPTH levels and higher CCI scores. Patients with higher CCI scores, higher baseline TG and lower baseline iPTH, and time-average iPTH were more likely to develop small and medium artery calcification.

Vascular calcification in patients with chronic kidney disease on dialysis in the Kingdom of Saudi Arabia: A cross-sectional study.

The study aimed to provide a unique nationwide data and a valuable update on the current situation of vascular calcification (VC) among chronic kidney disease (CKD) patients in the Kingdom of Saudi Arabia. The study included all patients diagnosed with CKD over a period of one year and six months from September 2015 to February 2017 and underwent dialysis. All analyses were done using IBM-SPSS. Of the 842 enrolled patients, 836 (99.3%) constituted the descriptive population. The mean age of patients was 51.8 ± 15.4 years. A total of 759 (90.8%) patients had cardiovascular risk factors. The prevalence of VC in patients with CKD is 40.8%. In the multivariate analysis, prognostic factors for VC were physical inactivity with odd ratio 2.87 [95% confidence interval (CI): (1.89-4.63), P < 0.01], history of ischemic heart disease 2.34 [95% CI: (1.30-4.22), P < 0.01], dyslipidemia 1.56 [95% CI: (1.01-2.40), P = 0.04], and older age 1.06 [95% CI: (1.05-1.07), P <0.01]. At inclusion, the mean ± standard deviation for high-density lipoprotein cholesterol, low cholesterol, total cholesterol, and triglycerides was 41 ± 30, 79.7 ± 29.9, 144.2 ± 38.5, and 143.4 ± 95.3 mg/dL, respectively. This study reports useful information about the prevalence of VCs in CKD stage 5D in a Middle Eastern country as the Kingdom of Saudi Arabia. Furthermore, it offers information on the predictors or associated factors of a VC in CKD patients.

Vascular calcification in patients with large-vessel vasculitis compared to patients with hyperlipidemia

ObjectiveCalcification of the coronary arteries, aorta, and branch vessels can occur in both large-vessel vasculitis (LVV) and atherosclerosis. The study objective was to determine the location and amount of vascular calcification in patients with LVV versus hyperlipidemia (HLD) and to identify risk factors associated with vascular calcification in LVV. MethodsPatients with giant cell arteritis (GCA), Takayasu's arteritis (TAK), and HLD underwent non-contrast computed tomography of the aorta and branch vessels. Vascular calcification in 14 specific arterial territories (4 segments of the aorta, 9 branch arteries, and the coronary arteries) was quantified throughout the large arteries by a cumulative Agatston score. Multivariate linear regression analyses were used to identify associations between traditional and disease-specific risk factors and total Agatston score. ResultsA total of 88 subjects, including GCA (n = 29); TAK (n = 22); and HLD (n = 37), participated. Prevalence of vascular calcification in the aorta and branch vessels significantly differed in the coronary arteries (HLD = 67%, GCA = 35%, TAK = 9%, p < 0.01). Total Agatston scores were higher in GCA (median 3260, range 25–18,138) versus HLD (460, 19–17,215) (p < 0.01) but did not significantly differ between GCA and TAK (1944, 52–47,520) (p = 0.53). In multivariable regression analysis, age, type of vasculitis, and prednisone use was associated with vascular calcification in LVV. ConclusionThe prevalence of coronary artery calcification is lower in LVV compared to HLD, but the amount of total vascular calcification throughout the large arteries is greater in LVV. Both traditional and disease-specific risk factors are associated with vascular calcification in LVV.

EVALUATION OF THE VASCULAR CALCIFICATIONS AND BONE MINERAL DISORDER OF THE ERC IN HEMODIALYSIS

Introduction: Vascular calcifications are part of the systemic disorders of bone mineral metabolism in chronic kidney disease (CKD) and represent one of the main causes of mortality.&nbsp; Objective: To determine the clinical characteristics, prevalence of vascular calcifications and biochemical alterations of the bone mineral disorder in patients with CKD in hemodialysis therapy. Methods: Analytical, cross-sectional and non-experimental study. The prevalence of vascular calcifications (abdominal aorta) was determined according to the validated score (Kaupilla). The association of qualitative variables was used the Pearson Chi-Square. Results: The population included (n: 49), 65% of the patients were incidents in hemodialysis (&gt; 6 months) with a mean hemodialysis time of 2.8 years. The not incident or new patients on hemodialysis (&lt;6 months) was 35%. The average age was 62.1 years, 53% female and 47% male. 67% reached some degree of vascular calcification (Kaupilla score greater than 1) and 45% presented a score higher than 3 (score associated with cardiovascular risk) and that was predominant in the incident population on hemodialysis. 55% had at least one of the biochemical alterations of bone mineral disease (hypercalcemia, hyperphosphatemia or hyperparathyroidism). The association between the biochemical alterations of the bone mineral disorder and the vascular calcification index was not found in this study. Conclusion: Most patients on hemodialysis present some degree of vascular calcification, so it is important to recognize and prevent vascular calcifications because of the cardiovascular risk that it has. Key words: Vascular calcifications; Kaupilla score; Chronic kidney disease. (source: MeSH NLM) DOI:&nbsp; 10.25176/RFMH.v18.n3.1590

Predictors of coronary calcification in Indian hemodialysis patients.

Several biomolecules potentially serve as promoters or inhibitors of calcification in dialysis patients which include fetuin A, matrix gla protein, osteopontin, osteoprotegerin, etc. The primary aim was to compare the biomarkers of coronary artery calcification (CAC) and to study its role as predictors of CAC in hemodialysis (HD) patients. Of 126 patients undergoing chronic HD, 100 patients completed the study. Blood samples were drawn for serum creatinine, electrolytes, calcium, phosphorus, Vitamin D3, parathyroid hormone (PTH), lipid profile, high sensitivity C-reactive protein, ferritin, fetuin A, and fibroblast growth factor-23 (FGF-23). Non-contrast Computed Tomography scan of the coronary arteries was conducted on all participants. Participants who were positive for CAC (P group) were compared with those negative for CAC (N group) using two sample t-test. Multiple logistic regression analysis was conducted to determine the predictors of CAC. The prevalence of vascular calcification (VC) was 60% with higher prevalence seen in males (71%), older age group, patients with dialysis vintage >5 years (27%), and diabetic population (62%). Mean serum phosphorus was significantly higher (P <0.001) and fetuin A (P <0.001) was significantly lower in the P group. Age (OR: 1.2, P = 0.004), serum phosphorus (OR: 1.8, P = 0.024), and fetuin A (OR: 0.0006, P = 0.001) were found as predictors of CAC. CAC was more prevalent in males, patients with higher age group and in those with longer dialysis vintage and diabetic population. Participants with CAC exhibited significantly high phosphorus and low fetuin A levels. Age, phosphorus level, and fetuin A were found to be predictors of CAC in dialysis patients. FGF-23 could not predict CAC.

Serum sclerostin values are associated with abdominal aortic calcification and predict cardiovascular events in patients with chronic kidney disease stages 3-5D.

The purpose of this study was to investigate the possible association of circulating concentrations of sclerostin with abdominal aortic calcification (AAC) and cardiovascular outcomes in patients with chronic kidney disease stage 3-5. One hundred and sixty-one patients with CKD3-5D were enrolled. The patients were divided into two groups according to the presence of AAC: an AAC group (n = 99) and a non-AAC group (n = 62). The concentration of serum sclerostin was measured using an enzyme-linked immunosorbent assay (ELISA). AAC was evaluated using abdominal lateral X-ray examination. The follow-up intervals ranged from 7 to 29 months (median 16 months), and cardiovascular events (CVEs) were recorded. The prevalence of vascular calcification (VC) was 61.5% (99/161). Serum sclerostin was significantly higher in an AAC group than in a non-AAC group (P < 0.001), but the concentration in the moderate-to-severe AAC group was lower than in the mild AAC group (P < 0.001). Binary logistic regression analysis revealed that high serum sclerostin, high serum calcium, diabetes, and old age were independently correlated with AAC. Patients with higher sclerostin values had a reduced risk of major cardiovascular events (log-rank test, P = 0.001). Serum sclerostin values are associated with the presence of AAC, but are lower when AAC is moderate to severe. Higher values are predictive of reduced short-term cardiovascular events. Taken together, these results suggest that sclerostin may have a role in the development of or the response to vascular calcification.

Correlations of Plasma Desphosphorylated Uncarboxylated Matrix Gla Protein with Vascular Calcification and Vascular Stiffness in Chronic Kidney Disease

Background: Matrix Gla protein (MGP) is a potent inhibitor of vascular calcification and needs vitamin K-dependent carboxylation for its activity. High levels of desphosphorylated uncarboxylated MGP (dp-ucMGP) were significantly associated with vitamin K deficiency and vascular calcification. This study was conducted to explore the correlations of plasma dp-ucMGP with vascular calcification and vascular stiffness in chronic kidney disease (CKD) patients. Methods: This cross-sectional study enrolled 83 CKD stages 3-5 patients. Vascular calcification score was determined by calcific lesions in the abdominal aorta (AAC) shown by lateral lumbar film; vascular stiffness was assessed by cardio-ankle vascular index (CAVI) and pulse wave velocity, while plasma dp-ucMGP levels were measured using ELISA method. Multivariate regression analyses were used to select factors that were independently associated with vascular calcification and vascular stiffness. Results: The mean age was 62.9 ± 13.9 years. CKD stages 3, 4, and 5 constituted 51.8, 13.3, and 34.9%, respectively. The median of plasma dp-ucMGP levels in CKD stages 3, 4, and 5 were 586 (452-888), 870 (594-1,591), and 1,050 (518-1,298) pmol/L, respectively. The prevalence of vascular calcification (AAC score ≥1) was 63.4% and that of vascular stiffness (CAVI ≥9) was 46.3%. Vascular calcification was correlated with vascular stiffness (r² = 0.50, p < 0.001). Multivariate logistic regression analysis models to predict vascular calcification showed that age and plasma dp-ucMGP levels were significantly correlated with vascular calcification (OR 1.21; 95% CI 1.09-1.33; p < 0.001 and OR 1.002; 95% CI 1.001-1.004; p = 0.004, respectively). In contrast, there was no association between plasma dp-ucMGP levels and vascular stiffness. Conclusions: Plasma dp-ucMGP levels increase according to the severity of CKD. Plasma dp-ucMGP was positively associated with vascular calcification and might be utilized as an early marker for vascular calcification in CKD patients.

Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease.

Background:Mineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods:Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients’ entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.Results:Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min−1.1.73 m−2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions:In Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

Atrial fibrillation and low vitamin D levels are associated with severe vascular calcifications in hemodialysis patients

Vascular calcifications (VCs) and fractures are major complications of chronic kidney disease. Hemodialysis patients have a high prevalence of atrial fibrillation (AF) and an increased risk of thromboembolism, which should be prevented with warfarin, a drug potentially causing increased risk of VCs and fractures. Aim of this study is evaluating, in hemodialysis patients with and without AF, the prevalence of VCs and fractures, as well as identifying the associated risk factors. A total of 314 hemodialysis patients were recruited, 101 with documented AF and 213 without AF. Comorbidities, chronic kidney disease mineral and bone disorder blood tests and therapies were collected. Vertebral quantitative morphometry was carried out centrally for the detection of fractures, defined as vertebral body reduction by ≥20%. In the same radiograph, the length of aortic calcification was also measured. Logistic regression models were applied for evaluating the independent predictors of presence of VCs and vertebral fractures. In our population VCs were very common (>85%). Severe VCs (>10cm) were more common in patients with AF (76%) than in patients without (33%). Vertebral fractures were present in 54% of patients. Multivariable analysis showed that AF (OR 5.41, 95% CI 2.30-12.73) and 25(OH) vitamin D <20ng/mL (OR 2.05, 95% CI 1.10-3.83) were independent predictors of VCs. Age (OR 1.04/year, 95% CI 1.01-1.07) and male gender (OR 1.76, 95% CI 1.07-2.90) predicted vertebral fractures. Hemodialysis patients had an elevated prevalence of severe VCs, especially when affected by AF. Low vitamin D levels were strongly associated with severe VCs. Prevalence of vertebral fractures was also remarkably high and associated with older age and male gender.

The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis: a cross-sectional observational study.

This multicenter international cross-sectional observational study characterized vascular and valvular calcification burden and correlations with pulse pressure, diabetes, hypertension, and cardiovascular diseases in prevalent hemodialysis patients. We enrolled 275 consecutive adults with end-stage renal disease on maintenance hemodialysis for ⩾3 months. Coprimary endpoints were prevalences of: (1) echocardiographic calcification in mitral valve, aortic valve or mitral annulus; (2) aortoiliac tree vascular calcifications by plain lateral lumbar X-ray. Correlations among calcification sites and with demographics and comorbidities were determined. Pulse pressures were determined. Subjects' mean ± standard deviation (SD) age was 56 ± 15.9 years; mean (SD) dialysis duration was 4.5 ± 4.3 years. Overall, 100% of echocardiographically imaged patients (n = 243) had calcification in aortic valve, mitral valve, or mitral annulus; 77.8% of X-rayed patients (n = 248) had abdominal aortic calcification. Radiographic abdominal aortic calcification score correlated significantly with calcification of aortic valve (p < 0.0001) and mitral annulus (p = 0.0001) but not mitral valve. Aortic valve, mitral valve, and mitral annulus calcification correlated significantly among themselves (p < 0.0001). Moderate/severe aortic valve calcification was significantly more prevalent in patients aged ⩾65 years than <65 years, men than women, and Whites than African Americans. Pulse pressure correlated significantly with vascular calcification score (p = 0.0049) but not with valvular calcification at any site. Vascular and valvular calcification are highly prevalent in the hemodialysis population. Peripheral vascular calcification correlates significantly with elevated pulse pressure and can be assessed easily using lateral lumbar X-ray. Further studies investigating the interaction between pulse pressure and development or progression of vascular calcification are of interest.