Detection of Cardiac Calcinosis in Hemodialysis Patients by Whole-Body Scintigraphy with 99m-Technetium Methylene Diphosphonate

Eguchi, Mariko; Tsuchihashi, Kazufumi; Takizawa, Hideki; Nakahara, Norifumi; Hagiwara, Makoto; Ohnishi, Hirofumi; Torii, Takaaki; Hashimoto, Akiyoshi; Marusaki, Shigeru; Nakata, Tomoaki; Ura, Nobuyuki; Shimamoto, Kazuaki

doi:10.1159/000013601

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…In our study, only single measurement of PTH level was made, which might explain the inconsistent result with Grandaliano. However, there were several studies reporting a negative association between PTH levels and cardiac calcification, calcific aortic stenosis, and peripheral vascular disease among dialysis patients, which was supporting our findings (20,36,37). The reason for the negative association might be related to deposition of calcium at extraskeletal sites, preferentially in low-bone turnover states.…”

Section: Discussionsupporting

confidence: 90%

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Chen¹,

Chang²,

Hwang³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Vascular access failure (VAF) is associated with increased morbidity and mortality in hemodialysis patients. The most common cause of VAF is stenosis at the arteriovenous anastomosis because of abnormal neointimal proliferation and extracellular matrix deposition. These two changes are also observed in the classic atheroma, which means atherosclerotic lesions and venous stenosis in VAF may share some similar pathogenic mechanisms. The ankle-brachial index (ABI) is a reliable marker for atherosclerosis. The aim of this study was to evaluate the relationship between ABI <0.9 and VAF.Design, setting, participants, & measurements: All routine hemodialysis patients in one regional hospital were included except for six patients refusing ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. The study subjects were observed from arteriovenous access creation until the first episode of VAF. The mean observation period was 42.2 ؎ 42.8 mo. The relative VAF risk was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Results: VAF episodes were recorded in 111 patients. In multivariate analysis, ABI <0.9 (hazard ratio, 1.893; P ‫؍‬ 0.039), vascular access type of arteriovenous graft (P ‫؍‬ 0.004), and serum triglyceride level (P ‫؍‬ 0.043) were positively associated with VAF, and serum parathyroid hormone level (P ‫؍‬ 0.043) was negatively associated with VAF.Conclusions: Our findings show that ABI <0.9 is significantly correlated with increased VAF. Screening hemodialysis patients by means of ABI may help to identify a high-risk group for VAF.

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Section: Discussionsupporting

confidence: 90%

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Chen¹,

Chang²,

Hwang³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…This is the first study to evaluate the consequences of isolated myocardial calcification independent of any structural alterations of the vascular system. Our results may be clinically relevant especially for understanding the cardiovascular abnormalities and risks in the dialysis population, because both vascular and myocardial calcifications are highly prevalent in this patient group (11)(12)(13)(14)(15). This potential relevance is further supported by previous observations that patients on dialysis show decreased serum fetuin-A levels and that fetuin-A deficiency in uremia is associated with impaired cardiovascular survival (9).…”

Section: Discussionsupporting

confidence: 76%

“…It has even been postulated that dystrophic calcification might contribute to cardiac dysfunction with at least the same prevalence as ischemic heart disease (10). In dialysis patients, the magnitude of cardiovascular calcification is especially high, affecting atherosclerotic plaques, arterial media, cardiac valves, and the myocardium, respectively (11)(12)(13)(14)(15). The severity of medial calcification is associated with arterial stiffness and increased pulse wave velocity (16).…”

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confidence: 99%

Myocardial Stiffness, Cardiac Remodeling, and Diastolic Dysfunction in Calcification-Prone Fetuin-A–Deficient Mice

Merx¹,

Schäfer²,

Westenfeld³

et al. 2005

Journal of the American Society of Nephrology

119

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Accelerated atherosclerosis in dialysis patients is characterized by severe vascular calcification, and the magnitude of vascular calcification is associated with increased cardiovascular mortality. Calcification-dependent arterial stiffness is considered to be a major determinant of cardiac failure in uremia. Fetuin-A/␣ 2 -Heremans-Schmid glycoprotein is an abundant serum protein with powerful calcification inhibitory properties. Fetuin-A deficiency was recently linked to cardiovascular mortality in dialysis patients. Fetuin-A knockout (fetuin-KO) mice spontaneously develop widespread soft tissue calcification, including significant myocardial calcification, whereas larger arteries are spared. Therefore, this investigation offers the unique opportunity to study the functional role of isolated myocardial calcification independent of arterial stiffness by assessing the hemodynamics of fetuin-KO mice. Cardiac output in fetuin-KO mice was lower than in wild-type mice (fetuin-KO 1.81 ؎ 0.18 versus WT 2.45 ؎ 0.29 ml/min per g; P < 0.005), and fetuin-KO mice were refractory to dobutamine stimulation. Left ventricular relaxation was significantly impaired in fetuin-KO hearts with the relaxation index reduced by 23% (P < 0.005). After ischemia, fetuin-KO hearts displayed a continuous decline in left ventricular developed pressure after the initial phase of reperfusion, resulting in 77 ؎ 15% of preischemic left ventricular developed pressure (P < 0.05 versus wild-type). In fetuin-KO mice, dystrophic cardiac calcification, with myocardial calcium contents increased 60-fold, was associated with profound induction of profibrotic TGF-␤ and downstream collagen and fibronectin mRNA synthesis. In conclusion, independent of arterial stiffness, calcification-associated "myocardial stiffness" characterized by cardiac fibrosis, diastolic dysfunction, impaired tolerance to ischemia, and catecholamine resistance thus may constitute an underestimated cardiovascular risk factor that contributes to cardiac failure in calcification-prone states. Owing to its high affinity for calcium phosphates, fetuin-A accumulates in the mineralized bone matrix, in atherosclerotic plaques, and in pathologically mineralized tissues (2,3). Mineral binding is a salient feature of fetuin-A biology, but it also binds to multiple ligands, including the fibrogenic growth factor TGF-␤, thus acting as a soluble receptor-like antagonist of TGF-␤ actions (4). Chemically, fetuin-A acts as an inhibitor of spontaneous calcium phosphate precipitation by forming soluble colloidal calciprotein particles that contain fetuin, calcium, and phosphate (5,6). On the cellular level, fetuin-A accumulates in mineralization-competent matrix vesicles associated with vascular smooth muscle cells, thus attenuating apoptosis and dystrophic calcification (7). In vivo, fetuin-A deficiency in DBA/2 mice is associated with spontaneous widespread dystrophic soft tissue calcification, especially in the kidney, lung, and heart but sparing the aorta (8). A cross-sectional study identified l...

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“…SHPT was traditionally considered as an important factor for cardiovascular morbidity and mortality of ESRD patients [ 11 ]. Though certain previous studies reported negative associations between PTH levels and CV morbidity [ 12 , 13 ], it was considered that low PTH levels represented residual confounding by nutritional status [ 14 ]. Parathyroidectomy (PTX) is the main treatment for severe SHP refractory to medical treatment.…”

Section: Introductionmentioning

confidence: 99%

The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease

Hsu

Chen

et al. 2016

PLoS ONE

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PurposeThe changes of the risk of peripheral arterial disease (PAD) in patients with end-stage renal disease after parathyroidectomy are scant.MethodsWe used a nationwide health insurance claims database to select all dialysis-dependent patients with end-stage renal disease aged 18 years and older for the study population in 2000 to 2006. Of the patients with end-stage renal disease, we selected 947 patients who had undergone parathyroidectomy as the parathyroidectomy group and frequency matched 3746 patients with end-stage renal disease by sex, age, years since the disease diagnosis, and the year of index date as the non-parathyroidectomy group. We used a multivariate Cox proportional hazards regression analysis with the use of a robust sandwich covariance matrix estimate, accounting for the intra-cluster dependence of hospitals or clinics, to measure the risk of peripheral arterial disease for the parathyroidectomy group compared with the non-parathyroidectomy group after adjusting for sex, age, premium-based income, urbanization, and comorbidity.ResultsThe mean post-op follow-up periods were 5.08 and 4.52 years for the parathyroidectomy and non-parathyroidectomy groups, respectively; the incidence density rate of PAD in the PTX group was 12.26 per 1000 person-years, significantly lower than the data in the non-PTX group (24.09 per 1000 person-years, adjusted HR = 0.66, 95% CI = 0.46–0.94).ConclusionParathyroidectomy is associated with reduced risk of peripheral arterial disease in patients with end-stage renal disease complicated with severe secondary hyperparathyroidism.

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Detection of Cardiac Calcinosis in Hemodialysis Patients by Whole-Body Scintigraphy with 99m-Technetium Methylene Diphosphonate

Cited by 10 publications

References 9 publications

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

Myocardial Stiffness, Cardiac Remodeling, and Diastolic Dysfunction in Calcification-Prone Fetuin-A–Deficient Mice

The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease

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