Abdominal aortic calcification can predict all-cause mortality and CV events in dialysis patients: A systematic review and meta-analysis

Niu, Qingyu; Hong, Ye; Lee, Chien-Hsing; Men, Chuncui; Zhao, Hongxia; Zuo, Li

doi:10.1371/journal.pone.0204526

Cited by 28 publications

(24 citation statements)

References 34 publications

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“…Second, sKlotho emerged as an inhibitory factor for vascular calcification (VC). VC is a known risk factor affecting adverse outcomes in MHD patients [ 28 – 30 ]. Klotho is also expressed in vascular tissue, and Klotho deficiency in mice caused severe calcification in vascular and soft tissues [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Soluble Klotho Level with Adverse Outcomes in Patients on Maintenance Hemodialysis

Liu

Jiang

et al. 2020

Disease Markers

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Background. The predictive value of soluble Klotho (sKlotho) for adverse outcomes in patients on maintenance hemodialysis (MHD) is controversial. In this study, we aimed to clarify the potential association of sKlotho levels with adverse outcomes in this patient population. Materials. A total of 211 patients on MHD were identified and stratified according to the median sKlotho level. Patients were followed up for adverse outcomes including cardiovascular (CV) morbidity and all-cause mortality. Results. During the 36-month follow-up, 75 patients [51 CV events (including 16 CV deaths) and 40 deaths] experienced adverse outcomes. After stratification according to median sKlotho level, patients with a lower sKlotho level had a greater risk of CV events (38.2% vs. 19.5%, p = 0.006 ), all-cause mortality (28.4% vs. 11.6%, p = 0.003 ), and combined adverse outcomes (51.0% vs. 24.2%, p < 0.001 ). Similar observations were made from analyses using Kaplan-Meier survival curves. Cox regression analysis showed that a low sKlotho level was strongly correlated with CV morbidity [1.942 (1.030–3.661), p = 0.040 )], all-cause mortality [2.073 (1.023–4.203), p = 0.043 ], and combined adverse outcomes [1.818 (1.092–3.026), p = 0.021 ] in fully adjusted models. Conclusions. The sKlotho level was an independent predictive factor of adverse outcomes including CV morbidity and mortality in patients on MHD.

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Section: Discussionmentioning

confidence: 99%

Association of Soluble Klotho Level with Adverse Outcomes in Patients on Maintenance Hemodialysis

Liu

Jiang

et al. 2020

Disease Markers

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“…Of note, in the CORD study “19% of patients had no visible calcification in their abdominal aorta, even though some of them were > 80 years of age”. Despite the implication that “the ‘non-calcified’ patients have some typical biochemical and/or genetic features that protect them from calcification” and the strong prognostication role of abdominal aortic calcification as a simple clinical tool for mortality[ 26 ], there is actually scientific paucity regarding in-depth investigation of the pathophysiology and clinical management of the “non-calcifiers”. The non–stratification of the calcification propensity could also potentially annulate therapeutic strategies, for example manipulation of serum magnesium[ 27 ], or pharmaceutical parathyroidectomy by cinacalcet, as in the EVOLVE trial[ 28 ].…”

Section: Present Examples Of Guideline-driven Clinical Practicementioning

confidence: 99%

Emperor’s syndrome in the COVID-19 era: Time for patient-centered nephrology?

Bacharaki¹,

Diamandopoulos²

2021

WJN

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The coronavirus disease-19 (COVID-19) pandemic has been a wake-up call in which has forced us to react worldwide. Health policies and practices have attracted particular attention in terms of human and financial cost. Before COVID-19, chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension, the two now being the major risk factors for COVID-19 infection and adverse outcome. In contrast to the urgent need for action, the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality. Ironically and paradoxically in a field lacking robust clinical trials, clinical practice is driven by guidelines-based medicine on weak evidence. The Emperor’s syndrome, referring to Hans Christian Andersen’s fairy tale, has been described in medicine as voluntary blindness to an obvious truth, being a weak evidence-based therapeutic intervention or weak health care. A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors. COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.

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“…Cardiovascular death has long been the leading cause of death in chronic kidney disease (CKD) patients [ 1 , 2 ]. Coronary artery calcification (CAC) is an important factor that increase the risk of cardiovascular disease, which is a common pathological manifestation due to mineral and bone disorder in CKD patients [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of dialysis modalities on the progression of coronary artery calcification in dialysis patients

et al. 2020

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Background: Hemodialysis (HD) tend to have more hemodynamic changes than peritoneal dialysis (PD), which aggravates inflammation and oxidative stress. Whether HD and PD have different effects on the progression of vascular calcification? Therefore, we produced a study to explore the relationship of dialysis modalities and coronary artery calcification (CAC) progression. Methods: This was a prospective cohort study. CT scans were performed at enrollment and 2 years later for each patient. Demographic and clinical data were collected. Tobit regression was used to compare delta CAC score between HD and PD patients. Results: (1) 155 patients were enrolled, including 69 HD and 86 PD patients. (2) The baseline CAC scores were 97 (1, 744) in HD and 95 (0, 324) in PD; the follow-up CAC scores were 343 (6, 1379) in HD and 293 (18, 997) in PD. There were no significant differences in baseline, follow-up and delta CAC scores between 2 groups (P > 0.05). (3) In Tobit regression, after adjusted for variables, there was no significant difference of CAC progression in HD and PD groups (P > 0.05). (4) Logistic regression showed that older age, diabetes and higher time-averaged serum phosphate (P) were associated with faster progression of CAC (P < 0.05), but there was no evidence that HD was associated with faster CAC progression compared with PD (P = 0.879). Conclusions: There was no evidence that different dialysis modalities have different effect on CAC progression. Old age, DM and higher time-averaged P were associated with fast CAC progression.

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Abdominal aortic calcification can predict all-cause mortality and CV events in dialysis patients: A systematic review and meta-analysis

Cited by 28 publications

References 34 publications

Association of Soluble Klotho Level with Adverse Outcomes in Patients on Maintenance Hemodialysis

Association of Soluble Klotho Level with Adverse Outcomes in Patients on Maintenance Hemodialysis

Emperor’s syndrome in the COVID-19 era: Time for patient-centered nephrology?

The effects of dialysis modalities on the progression of coronary artery calcification in dialysis patients

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