Coronary artery calcification (CAC) is associated with cardiovascular disease (CVD). CAC might contain calcium oxalate, and a high serum oxalate (SOx) concentration is associated with cardiovascular mortality in dialysis patients. We assessed the associations between SOx and CAC or cardiovascular events in Japanese hemodialysis patients. In 2011, 77 hemodialysis patients underwent multi-detector spiral computed tomography, and Agatston CAC score was calculated. Serum samples were collected and frozen in 2011, and SOx concentrations were retrospectively measured in 2021. Also, new-onset CVD events in 2011–2021 were recorded. The association between SOx concentration and CAC score ≥ 1,000, and new-onset CVD events were examined by logistic regression, Kaplan–Meier, and Cox proportional hazard models, respectively. Median SOx concentration and CAC score were 266.9 (229.5–318.5) µmol/L and 912.5 (123.7–2944), respectively. CAC score was associated with SOx (adjusted odds ratio [OR] 1.01, 95% confidence interval [CI], 1.00–1.02). The number of new-onset CVD events was significantly higher in patients with SOx ≥ median value (hazard ratio [HR] 2.71, 95%CI 1.26–6.16). New-onset CVD events was associated with SOx ≥ median value (adjusted HR 2.10, 95%CI, 0.90–4.91). SOx was associated with CAC score and new-onset CVD events in Japanese hemodialysis patients.

Keywords： hepatitis C virus (HCV), hemodialysis (HD), liver fibrosis, magnetic resonance elastography (MRE), Mac 2 binding protein glycosylation isomer (M2BPGi) 〈Abstract〉 Liver fibrosis (LF) progresses more slowly after the elimination of the hepatitis C virus (HCV) by antiviral therapy. Liver biopsy is the gold standard for evaluating LF； however, it is invasive and can cause procedure related complications. Therefore, non invasive LF parameters are desired. Magnetic resonance elastography (MRE) is as accurate at assessing LF as liver biopsy. Mac 2 binding protein glycosylation isomer (M2BPGi) was reported to

BACKGROUND AND AIMS Guidelines of KDOQI for dialysis patients on blood-pressure (BP) targets proposed blow 140/90 mmHg at predialysis and < 130/80 mmHg at postdialysis. On the other hand, in dialysis patients, many reports have shown an association between predialysis hypotension and poor prognosis. Moreover, it has been reported that low systolic blood-pressure (SBP) is associated with poor prognosis in non-dialysis patients with heart failure. Therefore, predialysis BP controlled according to KDOQI guideline should worsen survival rate in dialysis patients, especially with any cardiac disease. This time, we investigated the difference on cardiovascular survival-rate between the group complied with KDOQI guidelines and the group complied with them for diastolic blood-pressure alone, by using Yoshikawa clinic dialysis-database (YCD). METHOD A total of 455 dialysis patients (264 males and 176 females) registered in YCD enrolled in this study from April 2006 on. From these patients, we extracted two groups, group G, strictly lowering on systolic and diastolic blood-pressure and group D, lowering on diastolic blood-pressure (DBP) alone, in accordance with antihypertensive guidelines. According to calculated propensity score on group G, patients were extracted by 1: 1 matching from each group. Their survival analysis was estimated by Kaplan–Meier method, and a log-rank test was used to examine the differences between the cardiovascular survival curves. The prognostic factors for cardiovascular mortality were extracted from background factors, including blood-pressure level, using Cox regression model. RESULTS In 455 patients, mean predialysis SBP and DBP were 143.3 mmHg and 73.1 mmHg, respectively. 141 patients were extracted as group G and 219 were as group D. According to calculated propensity-score, 116 pairs (group Gp and Dp) were extracted from group G and D. There was no significant difference in matching covariates except predialysis blood-pressure between the two groups. During mean-observational period of 5.8 years, 111 patients died, among that 59 were cardiovascular death (CVD). The survival curve on cardiovascular mortality in the group Gp showed significantly poor prognosis. In multivariate analysis of Cox proportional hazard model, SBP < 140 mmHg was extracted as a prognostic factor for CVD, and the hazard ratio was 1.892. On the other hand, in group Dp, non-cardiovascular prognosis was poor, especially in those < 70 years old. CONCLUSION Blood-pressure control in maintenance dialysis-patients based on current antihypertensive guidelines (KDOQI) should worsen their cardiovascular prognosis. Therefore, it is necessary to set SBP control for each case. This study is a cohort study with a single institution, and a prospective study with multiple institutions will be needed in the future.

BACKGROUND AND AIMS Oxalate is an organic acid found in abundance in plants and can also be synthesized as a terminal metabolite by the organic acid metabolism systems in humans. As a major excretion pathway of oxalate is urine, serum oxalate (SOx) concentration elevates in end-stage renal disease (ESRD) patients and causes calcium oxalate deposition to tissues. We previously reported that calcium oxalate might be one of the major components of coronary artery calcification (CAC) in ESRD patients; however, the association between SOx and CAC is unknown. This study aimed to demonstrate the relationship between SOx and CAC in haemodialysis patients. METHOD A total of 77 patients undergoing maintenance haemodialysis at a single facility who underwent an atherosclerosis check-up from 2011 to 2012 were enrolled and measured SOx retrospectively in 2021. Of those, 17 extremely outlying SOx patients were excluded, and 60 patients including 42 males were analysed. The median age was 64 (35–85) years, and median dialysis duration was 87.5 (17.1–410) months. Gender, Agastston's CAC score, major artery calcification volume, laboratory data and medications around the atherosclerosis check-up date and new-onset cardiovascular disease (CVD) events and deaths during the 10-year observation period were recorded. A CVD event is defined as an admission due to non-fatal myocardial infarction, coronary artery disease or heart failure. SOx level was measured by the commercial colorimetric oxalate assay kit, and the normal SOx level was 181 µmol/L. RESULTS The median SOx was 267 (221–563) µmol/L and new-onset CVD events, all-cause deaths occurred in 28 (47%) and 22 (37%) patients, respectively. In univariate analysis, SOx was associated with males (r = 0.27, P = 0.03), serum albumin (r = –0.25, P = 0.05), uric acid (r = 0.29, P = 0.02), phosphate (r = 0.26, P = 0.04), alkaline phosphatase (r = –0.28, P = 0.03), lanthanum carbonate (r = 0.32, P = 0.01), major artery calcification volume (r = 0.28, P = 0.03) and CAC score (r = 0.29, P = 0.02). In multivariate regression analysis, SOx was associated with lanthanum carbonate (F = 5.96, P = 0.02) and CAC score (F = 4.47, P = 0.03, Table 1). Receiver operating characteristic curve showed SOx = 269.5 µmol/L was the best cut-off for predicting CVD events. We divided subjects into two groups by this cut-off SOx value and revealed SOx was associated with new-onset CVD events (N = 60, P = 0.01) even after adjusted by age under 75 years (N = 52, P = 0.03) or both age under 75 years and CAC score under 1000 (N = 28, P = 0.04) by the Kaplan–Meier method (Fig. 1). CONCLUSION SOx was associated with CAC score, lanthanum carbonate and CVD events in ESRD patients undergoing haemodialysis.