Vascular calcification and cardiovascular function in chronic kidney disease

Sigrist, Mhairi K.; Bungay, Peter M.; Taal, Maarten W.; McIntyre, Christopher W.

doi:10.1093/ndt/gfi236

Cited by 187 publications

(141 citation statements)

References 20 publications

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“…4 Previous reports have demonstrated that marked vascular calcification and stiffness predisposed hemodialysis patients to LVH and cardiac diastolic dysfunction. 21 We investigated the impact of fetuin-A and OPG serum levels, which are representative of potent vascular calcification regulators, on vascular stiffness and ventricular function.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Vascular calcification, which results in increased vascular stiffness, is a common pathological feature of hemodialysis patients 1,3 and is accompanied by left ventricular hypertrophy (LVH) and diastolic dysfunction. 4,5 Vascular calcification is an active process controlled by a balance of serum calcification inhibitors and enhancers. Fetuin-A (a2-Heremans Schmid glycoprotein) is a 62-kDa liver-derived glycoprotein and potent circulatory inhibitor of vascular calcification, which is downregulated by inflammation.…”

Section: Introductionmentioning

confidence: 99%

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The balance of fetuin-A and osteoprotegerin is independently associated with diastolic dysfunction in hemodialysis patients

et al. 2011

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Fetuin-A and osteoprotegerin (OPG) are arterial calcification regulators, which are related to cardiovascular survival in hemodialysis patients. We hypothesized that a balance of these calcification regulators might mediate the progression of left ventricular (LV) diastolic dysfunction in hemodialysis patients. We recruited 63 hemodialysis patients and measured their serum fetuin-A, OPG, arterial stiffness, aortic calcification and echocardiographic parameters, including the transmitral early diastolic velocity/tissue Doppler mitral annular early diastolic velocity ratio (E/E¢), and analyzed the relationships between these variables. Fetuin-A levels were significantly and negatively correlated with the ankle-brachial pulse wave velocity (baPWV), aortic calcification score (AOCS), left atrial volume index (LAVI), LV mass index (LVMI) and E/E¢. OPG levels and the ratio of OPG to fetuin-A levels were significantly and positively correlated with the baPWV, AOCS, LAVI and E/E¢. A stepwise multiple regression analysis revealed that E/E¢ was independently correlated with fetuin-A levels (b¼À0.334, P¼0.02), OPG levels (b¼0.367, P¼0.01) and the ratio of OPG to fetuin-A (b¼0.295, P¼0.04). Categorizing the patients according to their serum fetuin-A and OPG levels revealed that patients with low fetuin-A and high OPG levels had the highest LAVI, LVMI and E/E¢ values after adjusting for potential confounders. Serum fetuin-A levels negatively reflected, whereas OPG levels and the ratio of OPG to fetuin-A positively reflected an increase in vascular and ventricular stiffness, leading to the aggravation of diastolic dysfunction. Therefore, based on our results, the balance of the tissue calcification regulators fetuin-A and OPG could mediate the progression of LV diastolic dysfunction in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The balance of fetuin-A and osteoprotegerin is independently associated with diastolic dysfunction in hemodialysis patients

et al. 2011

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“…Multislice computerized tomography was used to quantify vascular calcification (VC) in a standardized section of the superficial femoral artery as described previously (18). Carotid-femoral pulse wave velocity (PWV) was measured using a SphygmoCor (AtCor Medical Pty, Ltd., Australia).…”

Section: Assessment Of Vascular Calcification and Pulse Wave Velocitymentioning

confidence: 99%

Circulating Endotoxemia

McIntyre

Harrison

Eldehni

et al. 2011

Clinical Journal of the American Society of Nephrology

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414

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SummaryBackground and objectives Translocated endotoxin derived from intestinal bacteria has a wide range of adverse effects on cardiovascular (CV) structure and function, driving systemic inflammation, atherosclerosis and oxidative stress. This study's aim was to investigate endotoxemia across the spectrum of chronic kidney disease (CKD).Design, setting, participants, & measurements Circulating endotoxin was measured in 249 patients comprising CKD stage 3 to 5 and a comparator cohort of hypertensive patients without significant renal impairment. Patients underwent extended CV assessment, including pulse wave velocity and vascular calcification. Hemodialysis (HD) patients also received detailed echocardiographic-based intradialytic assessments. Patients were followed up for 1 year to assess survival. ResultsCirculating endotoxemia was most notable in those with the highest CV disease burden (increasing with CKD stage), and a sharp increase was observed after initiation of HD. In HD patients, predialysis endotoxin correlated with dialysis-induced hemodynamic stress (ultrafiltration volume, relative hypotension), myocardial stunning, serum cardiac troponin T, and high-sensitivity C-reactive protein. Endotoxemia was associated with risk of mortality.Conclusions CKD patients are characteristically exposed to significant endotoxemia. In particular, HD-induced systemic circulatory stress and recurrent regional ischemia may lead to increased endotoxin translocation from the gut. Resultant endotoxemia is associated with systemic inflammation, markers of malnutrition, cardiac injury, and reduced survival. This represents a crucial missing link in understanding the pathophysiology of the grossly elevated CV disease risk in CKD patients, highlighting the potential toxicity of conventional HD and providing a novel set of potential therapeutic strategies to reduce CV mortality in CKD patients.

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“…Several studies have shown that vascular calcification is present in 30-70% of adult patients with CKD [18] , and even in approximately 15% of uremic pediatric patients [19] . Arterial aging associated with ESRD is characterized by intimal as well as medial calcification.…”

Section: Interactions Between Inflammation and Vascular Calcificationmentioning

confidence: 99%

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

Dai

Gołembiewska

Lindholm

et al. 2017

Contributions to Nephrology

151

111

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Despite marked improvements in renal replacement therapy during the last 30 years, the age-adjusted mortality rate in end-stage renal disease (ESRD) patients is still unacceptably high and comparable to that of many malignancies. Cardiovascular disease (CVD) remains the major cause of morbidity and mortality in ESRD patients. However, traditional risk factors can only partially explain the high premature cardiovascular burden in this population. Nontraditional risk factors, including persistent low-grade inflammation, are critical in the pathogenesis of atherosclerosis, vascular calcification, and other causes of CVD and may also contribute to protein-energy wasting and other complications in chronic kidney disease (CKD) patients. Inflammatory biomarkers, such as high sensitivity C-reactive protein and interleukin-6, independently predict mortality in these patients. The causes of inflammation in CKD are multifactorial and include imbalance between increased production (due to multiple sources of inflammatory stimuli such as oxidative stress, acidosis, volume overload, co-morbidities, especially infections, genetic and epigenetic influences, and the dialysis procedure) and inadequate removal (due to decreased glomerular filtration rate or in ESRD patients, inadequate dialytic clearance) of pro-inflammatory cytokines. Though there are currently no established guidelines for the treatment of low-grade inflammation in ESRD patients, several strategies have been proposed, such as lifestyle modifications, pharmacological treatment, and optimization of dialysis. Further studies on pathways involved in pathogenic processes of inflammation in ESRD, and long-term effects of anti-inflammatory interventions targeting production or removal of cytokines or both on premature CVD and clinical outcomes in this patient group are warranted.

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Vascular calcification and cardiovascular function in chronic kidney disease

Cited by 187 publications

References 20 publications

The balance of fetuin-A and osteoprotegerin is independently associated with diastolic dysfunction in hemodialysis patients

The balance of fetuin-A and osteoprotegerin is independently associated with diastolic dysfunction in hemodialysis patients

Circulating Endotoxemia

End-Stage Renal Disease, Inflammation and Cardiovascular Outcomes

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