Progression of vascular calcification increases QT interval in haemodialysis patients

Iorio, Biagio Raffaele Di; D'Avanzo, Ernesto; Piscopo, Carmine; Grimaldi, Pellegrino; Cucciniello, Emanuele; Cillo, Nicola; Bellizzi, Vincenzo

doi:10.1093/ndt/gfl417

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…The 2017 update of the KDIGO guidelines recommending more restricted CBPB use was based on weak evidence (grade 2B) 3 consisting of 3 open-label RCTs comparing clinical outcomes between sevelamer and CBPBs with inconsistent results. The Renagel in New Dialysis (RIND) Study (United States, N = 127) 5 and INDEPENDENT (Reduce Cardiovascular Calcifications to Reduce QT Interval in Dialysis) study (Italy, N = 466) 6,27 included patients with incident HD and both reported an approximately 4-fold survival benefit (secondary end…”

Section: Discussionmentioning

confidence: 99%

“…However, both trials were limited by a low event count in the sevelamer group (11 in RIND and 28 in INDEPENDENT), leading to potential for chance findings. Furthermore, exclusion of patients with atrial fibrillation/flutter (RIND 5 ) and cardiac arrhythmia (INDEPENDENT 27 ), which are common, 28 limits their generalizability to patients with typical ESRD who have a high comorbidity burden. In addition, both trials reported insufficient balance after randomization for key covariates, such as baseline phosphorus levels 6 and atherosclerotic heart disease.…”

Section: Research Original Investigationmentioning

confidence: 99%

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Cardiovascular Outcomes of Calcium-Free vs Calcium-Based Phosphate Binders in Patients 65 Years or Older With End-stage Renal Disease Requiring Hemodialysis

et al. 2019

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IMPORTANCE Guidelines restricting use of calcium-based phosphate binders in all patients with end-stage renal disease owing to their potential contribution to increased cardiovascular risk shifted prescribing from calcium acetate toward the costlier sevelamer carbonate products. OBJECTIVE To compare cardiovascular events and mortality between patients with end-stage renal disease (ESRD) undergoing hemodialysis receiving sevelamer vs calcium acetate in real-world practice. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted using the United States Renal Data System linked to Medicare claims data (May 1, 2012, to December 31, 2013). Data analysis was performed from October 2017 to September 2018. Participants included patients 65 years or older with ESRD within 180 days after starting hemodialysis (sevelamer, 2647; calcium acetate, 2074). EXPOSURES New use of sevelamer (calcium-free phosphate binder) vs calcium acetate (calcium-based phosphate binder). MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) with 95% CIs were estimated for fatal or nonfatal cardiovascular events (myocardial infarction or ischemic stroke: primary outcome) and all-cause mortality (secondary outcome) using Cox proportional hazards regression with fine stratification on the propensity score to control for potential confounders, including phosphorus and calcium levels. RESULTS After propensity score weighting, 2639 patients initiating sevelamer treatment (1184 men [44.9%]; mean [SD] age, 75.6 [6.9] years) and 2065 patients initiating calcium acetate treatment (930 men [45.0%]; mean [SD] age, 75.5 [7.1] years) were included in the analysis. Crude incidence rates (IRs) for cardiovascular events of 458 per 1000 person-years for sevelamer and 464 per 1000 person-years for calcium acetate were observed. After propensity score fine-stratification weighting, HRs of 0.96 (95% CI, 0.84-1.10) for cardiovascular events were observed. Results were consistent within subgroups of age (<75 y: primary outcome, HR, 1.02; 95% CI, 0.85-1.24; vs Ն75 years: primary outcome, HR, 0.83; 95% CI, 0.69-1.01) and sex (primary outcome in men: HR, 1.02; 95% CI, 0.83-1.26). CONCLUSIONS AND RELEVANCE The results of the study do not suggest increased cardiovascular safety of sevelamer in the routine clinical practice of patients with ESRD compared with calcium acetate; this study's findings suggest that well-designed, long-term, randomized clinical trials are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Research Original Investigationmentioning

confidence: 99%

Cardiovascular Outcomes of Calcium-Free vs Calcium-Based Phosphate Binders in Patients 65 Years or Older With End-stage Renal Disease Requiring Hemodialysis

et al. 2019

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“…Resultados semelhantes foram encontrados por Di Iorio et al, 23 em que o intervalo QTc foi mais prolongado de modo significativo em pacientes cujo dialisato continha as mais baixas concentrações de cálcio e potássio e as mais altas concentrações de bicarbonato. Em um estudo que envolveu pacientes com DRC estágio 4 e estágio 5 em hemodiálise, Di Iorio et al 24 demonstraram que a calcificação cardíaca, medida pelo score de cálcio em tomografia computadorizada (TC score), mostrou--se um determinante independente do intervalo QT, apresentando uma relação linear e positiva, de modo que quanto maior o TC score, maior foi a dispersão do intervalo QT.…”

Section: Discussionunclassified

Electrocardiographic findings in chronic hemodialysis patients

Bignotto¹,

Kallás²,

Djouki³

et al. 2012

Jornal Brasileiro De Nefrologia

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“…We utilized data from incident hemodialysis patients recruited in the Independent study ( ClinicalTrials.gov: NCT00710788 ). A detailed description of the study protocol and cohort has already been provided [ 14 , 15 ]. Briefly, the independent study was designed to assess the impact of 2 different phosphate binder regimens (calcium-free vs. calcium-containing phosphate binder) on CV events as well as all-cause mortality.…”

Section: Methodsmentioning

confidence: 99%

Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients

Bellasi

Lullo

Russo

et al. 2021

Cells

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Background: It is estimated that chronic kidney disease (CKD) accounts globally for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Traditional as well as non-traditional CV risk factors such as vascular calcification are believed to drive this disproportionate risk burden. We aimed to investigate the association of coronary artery calcification (CAC) progression with all-cause mortality in patients new to hemodialysis (HD). Methods: Post hoc analysis of the Independent study (NCT00710788). At study inception and after 12 months of follow-up, 414 patients underwent computed tomography imaging for quantification of CAC via the Agatston methods. The square root method was used to assess CAC progression (CACP), and survival analyses were used to test its association with mortality. Results: Over a median follow-up of 36 months, 106 patients died from all causes. Expired patients were older, more likely to be diabetic or to have experienced an atherosclerotic CV event, and exhibited a significantly greater CAC burden (p = 0.002). Survival analyses confirmed an independent association of CAC burden (hazard ratio: 1.29; 95% confidence interval: 1.17–1.44) and CACP (HR: 5.16; 2.61–10.21) with all-cause mortality. CACP mitigated the risk associated with CAC burden (p = 0.002), and adjustment for calcium-free phosphate binder attenuated the strength of the link between CACP and mortality. Conclusions: CAC burden and CACP predict mortality in incident to dialysis patients. However, CACP reduced the risk associated with baseline CAC, and calcium-free phosphate binders attenuated the association of CACP and outcomes, suggesting that CACP modulation may improve survival in this population. Future endeavors are needed to confirm whether drugs or kidney transplantation may attenuate CACP and improve survival in HD patients.

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Progression of vascular calcification increases QT interval in haemodialysis patients

Cited by 4 publications

References 5 publications

Cardiovascular Outcomes of Calcium-Free vs Calcium-Based Phosphate Binders in Patients 65 Years or Older With End-stage Renal Disease Requiring Hemodialysis

Cardiovascular Outcomes of Calcium-Free vs Calcium-Based Phosphate Binders in Patients 65 Years or Older With End-stage Renal Disease Requiring Hemodialysis

Electrocardiographic findings in chronic hemodialysis patients

Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients

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