Valve calcification and coronary artery calcification in peritoneal dialysis patients
DOI:
https://doi.org/10.12923/Abstract
In the course of chronic kidney insufficiency due to renal impairment almost more than 50% of deaths among patients with end – stage renal disease are due to cardiovascular diseases [6]. The risk of death was higher in hemodialysed than general population. Increased mortality rate as a result of damaged cardiac tissues after calcification may lead to abnormal conduction and arrhythmia, left ventricular dysfunction, aortic and mitral stenosis and regurgitation, complete heart block, ischemia, congestive cardiac failure and death [7]. Our aim was to determine the prevalence of valvular calcification and coronary artery calcification in peritoneal dialysis patients and to examine some possible etiologic factors for its occurrence. Calcification complications are frequent among peritoneal dialysis patients. In this study, we have found that coronary vessels calcification is a common finding in 70% group of peritoneal dialysis. However, we found a negative correlation in the concentration of fetuin-A between volumetric units and Agatson score which indicates that it is deficiency of fetuin-A, fundamental of this pathology. VC is mainly characteristic of patients with high indices of coronary vessels calcification. In our study, patients with valvular calcification (VC) had significantly lower concentrations of fetuin-A than patients without VC. We found an important association between fibrinogen, CRP as a biological marker of inflammation and calcification mechanism. This factors and fetuin-A, being so involved in this process, can be predictive factors for evaluation of risk of calcification above osteal and also atherosclerosis. In addition, the elevated level of CRP is associated with mitral valve calcification. Our results indicate that valvular calcification may be useful in stratifying the severity of atherosclerotic vascular disease in peritoneal dialysis patients. In summary, our study shows important association between, inflammation: CRP, fibrinogen and serum fetuin-A in peritoneal dialysis patients.
References
1. Dellegrottaglie S., Sanz J., Rajagopalan S.: Molecular Determinants of Vascular Calcification: A Bench to Bedside View. Current Mole. Med., 6, 515, 2006.
2. Floege J.: When man turns to stone: Extraosseous calcification in uremic patients. Kidney Int., 65, 2447, 2004.
3. Funder J.: Mineralocorticoids and cardiac fibrosis: the decade in review. Clin. Exp. Pharmacol. Physiol., 28, 1002, 2001.
4. Ketteler M.: Fetuin-A and extraosseous calcification in uremia. Curr. Opin. Nephrol. Hypertens., 14 (4), 337, 2005.
5. Ketteler M. et al.: Association of low fetuin-A (AHSG) concentrations in serum with cardiowascular mortality in patients on dialysis: a cross-sectional study. Lancet, 361, 827, 2003.
6. Kosaku N., Takashi A., Koichi S. et al.: Assessment of Coronary Artery Calcification in Hemodialysis Patients Using Multi-Detector Spiral CT Scan. Hypertens. Res., 27, 8, 527, 2004.
7. Mei Y. Speer, Cecilia M. Giachelli: Regulation of cardiovascular calcification. Cardiovasc. Pathol. 2004; 13, 63-70.
8. Muntner P., Hamm L., Kusek J. W. et al.: The prevalance of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease Ann. Intern. Med., 140, 9, 2004.
9. Nakazato Y. et al.: Calcification and osteopontin localization in the peritoneum of patients on long-term continuous ambulatory peritoneal dialysis therapy. Nephrol. Dial Transplant., 17, 1293, 2002.
10. Price P. A. et al.: Discovery of a high molecular weight complex of calcium, phosphate, fetuin, and matrix Gla protein in the serum of etidronate-treated rats. J. Biol. Chem., 277, 3926, 2002.
11. Riberio S., Ramos A., Brandao A. et al.: Cardiac valve calcification in haemodialysis patients: Role of calcium – phosphate metabolism. Nephrol. Dial. Transplant., 13, 2037, 1998.
12. Rufino M. et al.: Heart valve calcification and calcium x phosphorus product in hemodialysis patients: Analysis of optimum values for its prevention. Kidney International, 63(85), 115, 2003.
13. Selocki Y., Turgut F., Kanaby M. et al.: Cardiac valve calcifications and predictive parameters in hemodialysis patients. Cent. Euro. J. Med., 2(3), 304, 2007.
14. Tarrass F. et al.: Heart valve calcification in patients with end-stage renal disease: Analysis for risk factors. Nephrol., 11, 494, 2006.
15. Torun D. et al.: Association of cardiac valve calcification and inflammation in patients on hemodialysis. Ren. Fail., 27, 221, 2005.
16. Urena P., Malergue M. C., Goldfarb B. et al.: Evolutive aortic stenosis in hemodialysis patients: Analysis of risk factors. Néphrol., 20, 217, 1999.
17. Wojtysiak-Duma B., Duma D., Burska A. et al.: Fetuin-A in patients undergoing peritoneal dialysis with coronary artery calcification. Annales UMSC, Sect. DDD, vol. XII, 68, 361, 2008.
18. Yee-Moon Wang A. et al.: Association of serum fetuin – A with malnutrition, inflammation, atherosclerosis and valvular calcification syndrome and outcome in peritoneal dialysis patients. Nephrol. Dial. Transplant., 20, 1676, 2005.
19. Yee-Moon Wang A. et al.: Cardiac Valve Calcification as an Important Predictor for All Cause Mortality and Cardiovascular Mortality in Long – Term Peritoneal Dialysis Patients: A prospective Study. J. Am. Soc. Nephrol., 13, 159, 2003.
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