Vascular Calcification and ESRD

Bhan, Ishir; Thadhani, Ravi

doi:10.2215/cjn.04800709

Cited by 38 publications

(31 citation statements)

References 35 publications

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“…10 Calcium deposition and large plaque burden, which are frequently found in the coronary lesions of HD patients, prevent adequate stent expansion and strut apposition to the vascular wall during stent implantation. In addition, the relatively thick and rigid stent strut design of SES might aggravate the frequency and degree of such inadequate results at implantation.…”

Section: Article P 2169mentioning

confidence: 99%

Late Failure of First-Generation Drug-Eluting Stents in Hemodialysis Patients

Kume

Uemura

2015

Circ J

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Section: Article P 2169mentioning

confidence: 99%

Late Failure of First-Generation Drug-Eluting Stents in Hemodialysis Patients

Kume

Uemura

2015

Circ J

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“…Vascular calcification is associated with increased morbidity and mortality in dialysis patients (1,2) and new therapeutic strategies are needed to tackle this challenge. Sodium thiosulfate (STS, Na 2 S 2 O 3 ⅐5H 2 O, MW 248 g) is an old drug used for decades as an antidote against cyanide poisoning (3), because STS supplements the cyanide-detoxifying enzyme rhodanese (4,5), which is part of the endogenous thiosulfate (TS) synthesis pathway (6).…”

Section: Introductionmentioning

confidence: 99%

Sodium Thiosulfate Pharmacokinetics in Hemodialysis Patients and Healthy Volunteers

Farese¹,

Stauffer²,

Kalicki³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Vascular calcification is a major cause of morbidity and mortality in dialysis patients. Human and animal studies indicate that sodium thiosulfate (STS) may prevent the progression of vascular calcifications. The pharmacokinetics of STS in hemodialysis patients has not been investigated yet.Design, setting, participants, & measurements STS was given intravenously to 10 hemodialysis patients onand off-hemodialysis. Additionally, STS was applied to 9 healthy volunteers once intravenously and once orally. Thiosulfate concentrations were measured by using a specific and sensitive HPLC method. ResultsIn volunteers and patients, mean endogenous thiosulfate baseline concentrations were 5.5 Ϯ 1.82 versus 7.1 Ϯ 2.7 mol/L. Renal clearance was high in volunteers (1.86 Ϯ 0.45 ml/min per kg) and reflected GFR. Nonrenal clearance was slightly, but not significantly, higher in volunteers (2.25 Ϯ 0.32 ml/min per kg) than in anuric patients (2.04 Ϯ 0.72 ml/min per kg). Hemodialysis clearance of STS was 2.62 Ϯ 1.01 ml/min per kg. On the basis of the nonrenal clearance and the thiosulfate steady-state serum concentrations, a mean endogenous thiosulfate generation rate of 14.6 nmol/min per kg was calculated in patients. After oral application, only 4% of STS was recovered in urine of volunteers, reflecting a low bioavailability of 7.6% (0.8% to 26%). ConclusionsGiven the low and variable bioavailability of oral STS, only intravenous STS should be prescribed today. The biologic relevance of the high hemodialysis clearance for the optimal time point of STS dosing awaits clarification of the mechanisms of action of STS.

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“…However, with the exception of arterial stiffness [4,5], it is not yet clear whether VC is a direct cause of these changes, or whether it is merely a marker of disease [30]. …”

Section: Discussionmentioning

confidence: 99%

Vascular Calcification Progression Is an Independent Predictor of Mortality in Patients on Haemodialysis

Gadrey

Mayor²,

Deléaval³

et al. 2015

Nephron

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Background: We previously reported that vascular calcification (VC) score was associated with mortality in patients on haemodialysis (HD) and that a high serum level of parathyroid hormone (PTH) and fibroblast growth factor (FGF)-23 were the only factors associated with VC progression. Aim: To assess the impact of VC progression on HD patient survival. Methods: The study cohort including 85 HD patients studied between 2006 and 2007 and between 2009 and 2010 was divided into patients with VC progression (PG+, n = 38) and no-progression (PG-, n = 47), based on VC scores measured twice at 3-year intervals (VC1 and VC2). Patients were followed during 3 additional years. Results: Kaplan-Meier analysis determined that PG+ displayed increased mortality (hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.12-4.8; p = 0.03). This result was confirmed using a Cox proportional hazards model adjusted for age, dialysis duration, the VC1 score, and the mean FGF-23 and iPTH serum levels (HR: 2.7; 95% CI: 1.12-6.6; p = 0.02). Conclusion: VC progression is associated with poor survival in patients on HD, irrespective of a patient's baseline VC score.

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Vascular Calcification and ESRD

Cited by 38 publications

References 35 publications

Late Failure of First-Generation Drug-Eluting Stents in Hemodialysis Patients

Late Failure of First-Generation Drug-Eluting Stents in Hemodialysis Patients

Sodium Thiosulfate Pharmacokinetics in Hemodialysis Patients and Healthy Volunteers

Vascular Calcification Progression Is an Independent Predictor of Mortality in Patients on Haemodialysis

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