Accelerated Progression of Calcific Aortic Stenosis in Dialysis Patients

Perkovic, Vlado; Hunt, David; Griffin, Siân; Plessis, M du; Becker, Gavin J.

doi:10.1046/j.1440-1797.2002.00007-1-106.x

Cited by 12 publications

(20 citation statements)

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“…CVD, fractures, and mortality are its major outcomes. Increased PTH may diminish cardiac contractility, induce ventricular hypertrophy (37,38), and enhance coronary risk (39) and cardiovascular calcification (40,41). PTH also plays a role in disturbances in the autonomic nervous system-both sympathetic and § P,0.05, *P,0.001.…”

Section: Discussionmentioning

confidence: 99%

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Zhang

Sun

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Lower heart rate variability implies increased risk of cardiovascular disease. This study aimed to evaluate the relationship between mineral metabolism and heart rate variability and longitudinal changes of heart rate variability after parathyroidectomy in stage 5 CKD patients.Design, setting, participants, & measurements This cross-sectional study included 118 stage 5 CKD patients, 87 controls, and a prospective study in two subgroups classified as successful (n=17) and unsuccessful (n=4) parathyroidectomy follow-up enrolled from March of 2011 to December of 2012. Blood examination and 24-hour Holter for heart rate variability were measured.Results Most heart rate variability indices were lower in stage 5 CKD patients. In multivariate stepwise regression models, serum intact parathyroid hormone was correlated with mean normal-to-normal R-R intervals, mean heart rate, and very low frequency, serum calcium was correlated with SD of 5-minute average of normal R-R intervals, and serum phosphorus was correlated with very low frequency and low frequency/high frequency. Compared with baseline, the successful parathyroidectomy subgroup had significant improvements in mean normal-to-normal R-R intervals, mean heart rate, SD of normal-to-normal R-R intervals, SD of 5-minute average of normal R-R intervals, very low frequency, high frequency, and low frequency/high frequency. There was no significant change of heart rate variability in patients after unsuccessful parathyroidectomy.Conclusions Disorders of mineral metabolism are associated with decreased heart rate variability in stage 5 CKD. Successful parathyroidectomy may contribute to reverse this cardiovascular disease risk in severe secondary hyperparathyroidism patients.

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Section: Discussionmentioning

confidence: 99%

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Zhang

Sun

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Increased vascular calcification in CKD patients is reported to be associated with both overall and cardiovascular-related morbidity and mortality. [1][2][3][4][5][6] Accumulating evidence suggests that vascular calcification resembles developmental bone mineralization, with the production of "bone" proteins by vascular smooth muscle cells (VSMCs), such as osteopontin (OPN) and type-I collagen. [7][8][9][10][11] Furthermore, a recent study [12] demonstrates that the addition of uremic serum to cultured VSMCs accelerated mineralization and up-regulated the expression of osteopontin and core binding factor-a1 (CBF-a1), a transcription factor that is important for osteoblast differentiation and bone matrix protein expression.…”

Section: Introductionmentioning

confidence: 99%

Advanced Oxidation Protein Products Induce Vascular Calcification by Promoting Osteoblastic Trans-Differentiation of Smooth Muscle Cells via Oxidative Stress and ERK Pathway

et al. 2009

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Vascular calcification is an actively regulated process similar to bone formation. Advanced oxidation protein products (AOPPs) have been demonstrated to be novel markers of oxidantmediated protein damage. The present study investigated the role of AOPPs in inducing osteoblastic trans-differentiation and calcification of smooth muscle cells in vitro. We found that AOPPs directly increased the calcium deposition and expression of core binding factor-a1 (CBF-a1) and osteopontin (OPN) and significantly decreased SM-a-actin expression in human aortic smooth muscle cells (HASMCs). AOPPs increased intracellular oxidative stress, which was inhibited by vitamin E. Vitamin E also inhibited AOPP-induced calcium content and osteoblast differentiation of HASMCs. Furthermore, the inhibitor of ERK significantly suppressed the effects of AOPPs on calcification and osteoblast marker expression. These findings suggest that AOPPs induce vascular calcification by promoting osteoblast differentiation of smooth muscle cells via oxidative stress and ERK pathway.

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“…These results are consistent with those of previous findings demonstrating that AV calcification or AS was associated with elevated levels of serum calcium, phosphorus and parathyroid hormone [2,6] . However, other studies have failed to detect any evidence of an association between these mineral abnormalities and calcification of the AV or progression of AS [1,15] , suggesting that complex pathophysiological processes may exist in AS progression.…”

Section: Discussionmentioning

confidence: 96%

“…Disturbances in serum phosphorus, calcium, calcium and phosphorus products and parathyroid hormone levels have been associated with AV calcification or AS [2,4,6] but not with the progression of AS [1] . Dialysis-related amyloid (DA), which results from the accumulation of β2-microglobumin (β2MG) and its deposition as amyloid fibrils into tissue, is another potential pathologic process in the cardiovascular system of dialysis patients.…”

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confidence: 99%

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Dialysis Amyloid Deposition in the Aortic Valve and Its Association with Aortic Stenosis

Kurita

Fujii²,

Kotera

et al. 2015

Blood Purif

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Background: The relationship between dialysis amyloid (DA) deposition in the aortic valve (AV) and aortic stenosis (AS) is unknown. Methods: This was a cross-sectional study. AV specimens of dialysis patients (median vintage: 8.8 years) consecutively collected from cardiac surgeries (n = 56) or autopsies (n = 13) were examined by a board-certified pathologist blinded to clinical data. DAs were considered to be present if deposits were stained both by Congo red with apple-green birefringence under polarized light and by anti-β2-microblobulin antibody. Degree of deposition was graded as follows: Amyloid (-), no deposit; Amyloid (1+), occasional small deposits; Amyloid (2+), multiple small to large deposits or a single large deposit. Calcification was defined as a calcified deposit with a diameter >1 mm in the specimen. Severe AS (sAS) was defined as a mean gradient >50 mm Hg by echocardiogram. We examined the proportion of DAs and the association between DAs and the sAS. Results: DAs were present in 71% (n = 49) of specimens and primarily co-localized with calcification. Non-dialysis related amyloid was found in one specimen. After excluding this specimen, sAS was associated with ‘Amyloid (1+) and Calcification >1 mm' and ‘Amyloid (2+) and Calcification >1 mm' (vs. ‘Amyloid (-) and Calcification ≤1 mm', odds ratios (ORs): 13.5 and 34.2, respectively). Furthermore, after adjustment for covariates, sAS was found to be associated with ‘Amyloid (2+) and Calcification >1 mm' (OR: 24.3). Conclusions: DA deposition in the AV was prevalent among dialysis patients. DA deposition with accompanying calcification might contribute to the severity of AS.

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Accelerated Progression of Calcific Aortic Stenosis in Dialysis Patients

Cited by 12 publications

References 0 publications

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Advanced Oxidation Protein Products Induce Vascular Calcification by Promoting Osteoblastic Trans-Differentiation of Smooth Muscle Cells via Oxidative Stress and ERK Pathway

Dialysis Amyloid Deposition in the Aortic Valve and Its Association with Aortic Stenosis

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