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Revista de Nefrología, Diálisis y Trasplante

ISSN 0326-3428 (Print)
Órgano de difusión científica de la Asociación Nefrológica de Buenos Aires
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2020, Number 1

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Rev Nefrol Dial Traspl 2020; 40 (1)

Vascular calcifications and their poor association with metabolic bone disease in a hemodialysis population

Castillo VE, Atusparia FG, Reinoso TC, Ruiz CB, Roldán AL
Full text How to cite this article

Language: Spanish
References: 23
Page: 25-31
PDF size: 211.15 Kb.


Key words:

chronic kidney disease, hemodialysis, renal dialysis, vascular calcification, hyperphosphatemia, hypercalcemia, hyperparathyroidism.

ABSTRACT

Introduction: Vascular calcifications are part of the mineral bone disorder in chronic kidney disease and they are one of the main causes of mortality. There is plausibility and experimental association between metabolic disorder and vascular calcification; however, there is no enough evidence for their clinical connection. Objective: To determine the association of biochemical alterations of mineral bone disorder (calcium: ›10 mg/dL; phosphorus: ›5 mg/dL; paratohormone: ›300 pg/mL) with vascular calcifications evaluated according to the Kauppila score. Methods: An observational, cross-sectional, analytical study was performed. 97 stage V CKD patients undergoing hemodialysis were included; 69% were prevalent cases (diagnosed within ›6 months) with an average time of 5.3 years. A statistical association was established according to Pearson’s Chi2 test and logistic regression. Results: A level of vascular calcification was found with a Kauppila score of ›1 in 60.8% of patients and of ≥3 in 43.3% of them, being predominant in the prevalent dialysis population (78.6%). However, no statistical association was found with mineral bone disorder in the chi-squared bivariate analysis or the logistic regression. Conclusions: A crosssectional test of the biochemical alteration in mineral bone disorder does not allow to find an association with vascular calcifications. It is necessary to establish a prospective calciumphosphorus positive balance first to prove this association.


REFERENCES

  1. Hsu CH. Are we mismanaging calcium and phosphatemetabolism in renal failure? Am J Kidney Dis.1997;29(4):641-9.

  2. Giachelli CM. Vascular calcification mechanisms. JAm Soc Nephrol. 2004;15(12):2959-64.

  3. Watanabe R, Lemos MM, Manfredi SR, Draibe SA,Canziani ME. Impact of cardiovascular calcificationin nondialyzed patients after 24 months of follow-up.Clin J Am Soc Nephrol. 2010;5(2):189-94.

  4. Amann K. Media calcification and intima calcificationare distinct entities in chronic kidney disease. Clin JAm Soc Nephrol. 2008;3(6):1599-605.

  5. Blacher J, Guerin AP, Pannier B, Marchais SJ,London GM. Arterial calcifications, arterial stiffness,and cardiovascular risk in end-stage renal disease.Hypertension. 2001;38(4):938-42.

  6. Hruska KA, Mathew S, Lund RJ, Memon I, SaabG. The pathogenesis of vascular calcification in thechronic kidney disease mineral bone disorder: thelinks between bone and the vasculature. SeminNephrol. 2009;29(2):156-65.

  7. Neven E, De Schutter TM, De Broe ME, D’HaesePC. Cell biological and physicochemical aspects ofarterial calcification. Kidney Int. 2011;79(11):1166-77.

  8. Kalantar-Zadeh K, Kuwae N, Regidor DL, KovesdyCP, Kilpatrick RD, Shinaberger CS, et al. Survivalpredictability of time-varying indicators of bonedisease in maintenance hemodialysis patients. KidneyInt. 2006;70(4):771-80.

  9. Danese MD, Belozeroff V, Smirnakis K, Rothman KJ.Consistent control of mineral and bone disorder inincident hemodialysis patients. Clin J Am Soc Nephrol.2008;3(5):1423-9.

  10. Castillo-Velarde E, Atusparia-Flores G, Reinoso-Trabucco C, Cruz-Huertas B, Ruiz-CarrascoB, Gallegos-Flores A, et al. Evaluación de lascalcificaciones vasculares y trastorno mineral óseode la ERC en hemodiálisis. Rev Fac Med Hum.2018;18(3):39-46.

  11. Kauppila LI, Polak JF, Cupples LA, HannanMT, Kiel DP, Wilson PW. New indices to classifylocation, severity and progression of calcific lesionsin the abdominal aorta: a 25-year follow-up study.Atherosclerosis. 1997;132(2):245-50.

  12. Honkanen E, Kauppila L, Wikström B, Rensma PL,Krzesinski JM, Aasarod K, et al. Abdominal aorticcalcification in dialysis patients: results of the CORDstudy. Nephrol Dial Transplant. 2008;23(12):4009-15.

  13. Maruyama N, Higuchi T, Ono M, Oguma H,Nakamura Y, Utsunomiya K, et al. Correlationbetween aortic calcification score and biochemicalparameters in hemodialysis patients. Contrib Nephrol.2019;198:40-51.

  14. Castillo Valverde ER. Informe EMO (enfermedadmineral ósea). Lima: Colegio Médico del Perú, 2015,p. 28-30.

  15. Hill Gallant KM, Spiegel DM. Calcium balancein chronic kidney disease. Curr Osteoporos Rep.2017;15(3):214-21.

  16. Spiegel DM, Brady K. Calcium balance in normalindividuals and in patients with chronic kidneydisease on low- and high-calcium diets. Kidney Int.2012;81(11):1116-22.

  17. Craver L, Marco MP, Martínez I, Rue M, BorràsM, Martín ML, et al. Mineral metabolismparameters throughout chronic kidney disease stages1-5--achievement of K/DOQI target ranges. NephrolDial Transplant. 2007;22(4):1171-6.

  18. Talmage DW, Talmage RV. Calcium homeostasis:how bone solubility relates to all aspects of bonephysiology. J Musculoskelet Neuronal Interact.2007;7(2):108-12.

  19. Talmage RV, Mobley HT. The concentration of freecalcium in plasma is set by the extracellular actionof noncollagenous proteins and hydroxyapatite. GenComp Endocrinol. 2009;162(3):245-50.

  20. Phang JM, Berman M, Finerman GA, Neer RM,Rosenberg LE, Hahn TJ. Dietary perturbation ofcalcium metabolism in normal man: compartmentalanalysis. J Clin Invest. 1969;48(1):67-77.

  21. Messa P, Cerutti R, Brezzi B, Alfieri C, Cozzolino M.Calcium and phosphate control by dialysis treatments.Blood Purif. 2009;27(4):360-8.

  22. Palmer BF. Individualizing the dialysate in thehemodialysis patient. Semin Dial. 2001;14(1):41-9.

  23. Felsenfeld AJ, Rodriguez M. Phosphorus, regulation ofplasma calcium, and secondary hyperparathyroidism:a hypothesis to integrate a historical and modernperspective. J Am Soc Nephrol. 1999;10(4):878-90.




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Rev Nefrol Dial Traspl. 2020;40