12
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Cardiovascular mortality in peritoneal dialysis: the impact of mineral disorders Translated title: Mortalidade cardiovascular em diálise peritoneal: o impacto dos distúrbios minerais

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction:

          Mineral and bone disorders (MBD) are associated with higher mortality in dialysis patients. The main guidelines related to the subject, Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO), were elaborated based on published information from hemodialysis participants. The aim of our study was to evaluate the impact of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) (according to guideline ranges from KDOQI and KDIGO) on the cardiovascular mortality of peritoneal dialysis (PD) patients.

          Methods:

          We used the BRAZPDII database, an observational multi-centric prospective study, which assessed participants on PD between December 2004 and January 2011. Amongst 9,905 participants included in this database, we analyzed 4424 participants who were on PD for at least 6 months. The appropriate confounding variables were entered into the model. Serum levels of Ca, P, and PTH were the variables of interest for the purposes of the current study.

          Results:

          We found a significant association between high P serum levels, categorized by KDOQI and KDIGO (P above 5.5 mg/dL), and cardiovascular survival ( p < 0.01). Likewise, a compelling association was found between lower levels of PTH, categorized by guidelines (KDOQI and KDIGO - PTH less than 150 pg/mL, p < 0.01), and cardiovascular survival.

          Conclusion:

          In conclusion, levels of P above and PTH below the values proposed by KDOQI and KDIGO were associated with cardiovascular mortality in PD patients.

          Resumo

          Introdução:

          Os distúrbios minerais e ósseos (DMO) estão associados a maior mortalidade em pacientes de diálise. As principais diretrizes relacionadas ao assunto, Kidney Disease Outcomes Quality Initiative (KDOQI) e Kidney Disease: Improving Global Outcomes (KDIGO) foram elaboradas com base em informações publicadas de pacientes em hemodiálise. O objetivo do nosso estudo foi avaliar o impacto do cálcio (Ca), fósforo (P) e paratormônio (PTH) (de acordo com as faixas propostas pelas diretrizes do KDOQI e KDIGO) na mortalidade cardiovascular de pacientes em diálise peritoneal (DP).

          Métodos:

          Utilizamos o banco de dados BRAZPDII, um estudo prospectivo observacional multicêntrico, que avaliou participantes de DP entre dezembro de 2004 e janeiro de 2011. Entre os 9.905 participantes incluídos neste banco de dados, analisamos 4.424 que estavam em DP há pelo menos 6 meses. As variáveis de confusão apropriadas foram inseridas no modelo. Os níveis séricos de Ca, P e PTH foram as variáveis de interesse para os fins do presente estudo.

          Resultados:

          Encontramos uma associação significativa entre níveis séricos de P elevados, categorizados por KDOQI e KDIGO (P acima de 5,5 mg/dL), e sobrevivência cardiovascular ( p < 0,01). Da mesma forma, foi encontrada uma associação convincente entre níveis mais baixos de PTH, categorizados por diretrizes (KDOQI e KDIGO - PTH inferior a 150 pg/mL, p < 0,01), e sobrevivência cardiovascular.

          Conclusão:

          Em conclusão, níveis de P acima e PTH abaixo dos valores propostos por KDOQI e KDIGO foram associados à mortalidade cardiovascular em pacientes de DP.

          Related collections

          Most cited references46

          • Record: found
          • Abstract: found
          • Article: not found

          Mineral metabolism, mortality, and morbidity in maintenance hemodialysis.

          Mortality rates in ESRD are unacceptably high. Disorders of mineral metabolism (hyperphosphatemia, hypercalcemia, and secondary hyperparathyroidism) are potentially modifiable. For determining associations among disorders of mineral metabolism, mortality, and morbidity in hemodialysis patients, data on 40,538 hemodialysis patients with at least one determination of serum phosphorus and calcium during the last 3 mo of 1997 were analyzed. Unadjusted, case mix-adjusted, and multivariable-adjusted relative risks of death were calculated for categories of serum phosphorus, calcium, calcium x phosphorus product, and intact parathyroid hormone (PTH) using proportional hazards regression. Also determined was whether disorders of mineral metabolism were associated with all-cause, cardiovascular, infection-related, fracture-related, and vascular access-related hospitalization. After adjustment for case mix and laboratory variables, serum phosphorus concentrations >5.0 mg/dl were associated with an increased relative risk of death (1.07, 1.25, 1.43, 1.67, and 2.02 for serum phosphorus 5.0 to 6.0, 6.0 to 7.0, 7.0 to 8.0, 8.0 to 9.0, and >/=9.0 mg/dl). Higher adjusted serum calcium concentrations were also associated with an increased risk of death, even when examined within narrow ranges of serum phosphorus. Moderate to severe hyperparathyroidism (PTH concentrations >/=600 pg/ml) was associated with an increase in the relative risk of death, whereas more modest increases in PTH were not. When examined collectively, the population attributable risk percentage for disorders of mineral metabolism was 17.5%, owing largely to the high prevalence of hyperphosphatemia. Hyperphosphatemia and hyperparathyroidism were significantly associated with all-cause, cardiovascular, and fracture-related hospitalization. Disorders of mineral metabolism are independently associated with mortality and morbidity associated with cardiovascular disease and fracture in hemodialysis patients.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Arterial calcification in chronic kidney disease: key roles for calcium and phosphate.

            Vascular calcification contributes to the high risk of cardiovascular mortality in chronic kidney disease (CKD) patients. Dysregulation of calcium (Ca) and phosphate (P) metabolism is common in CKD patients and drives vascular calcification. In this article, we review the physiological regulatory mechanisms for Ca and P homeostasis and the basis for their dysregulation in CKD. In addition, we highlight recent findings indicating that elevated Ca and P have direct effects on vascular smooth muscle cells (VSMCs) that promote vascular calcification, including stimulation of osteogenic/chondrogenic differentiation, vesicle release, apoptosis, loss of inhibitors, and extracellular matrix degradation. These studies suggest a major role for elevated P in promoting osteogenic/chondrogenic differentiation of VSMC, whereas elevated Ca has a predominant role in promoting VSMC apoptosis and vesicle release. Furthermore, the effects of elevated Ca and P are synergistic, providing a major stimulus for vascular calcification in CKD. Unraveling the complex regulatory pathways that mediate the effects of both Ca and P on VSMCs will ultimately provide novel targets and therapies to limit the destructive effects of vascular calcification in CKD patients.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis.

              Cardiovascular disease is common in older adults with end-stage renal disease who are undergoing regular dialysis, but little is known about the prevalence and extent of cardiovascular disease in children and young adults with end-stage renal disease. We used electron-beam computed tomography (CT) to screen for coronary-artery calcification in 39 young patients with end-stage renal disease who were undergoing dialysis (mean [+/-SD] age, 19+/-7 years; range, 7 to 30) and 60 normal subjects 20 to 30 years of age. In those with evidence of calcification on CT scanning, we determined its extent. The results were correlated with the patients' clinical characteristics, serum calcium and phosphorus concentrations, and other biochemical variables. None of the 23 patients who were younger than 20 years of age had evidence of coronary-artery calcification, but it was present in 14 of the 16 patients who were 20 to 30 years old. Among those with calcification, the mean calcification score was 1157+/-1996, and the median score was 297. By contrast, only 3 of the 60 normal subjects had calcification. As compared with the patients without coronary-artery calcification, those with calcification were older (26+/-3 vs. 15+/-5 years, P<0.001) and had been undergoing dialysis for a longer period (14+/-5 vs. 4+/-4 years, P< 0.001). The mean serum phosphorus concentration, the mean calcium-phosphorus ion product in serum, and the daily intake of calcium were higher among the patients with coronary-artery calcification. Among 10 patients with calcification who underwent follow-up CT scanning, the calcification score nearly doubled (from 125+/-104 to 249+/-216, P=0.02) over a mean period of 20+/-3 months. Coronary-artery calcification is common and progressive in young adults with end-stage renal disease who are undergoing dialysis.
                Bookmark

                Author and article information

                Journal
                J Bras Nefrol
                J Bras Nefrol
                jbn
                Jornal Brasileiro de Nefrologia
                Sociedade Brasileira de Nefrologia
                0101-2800
                2175-8239
                08 February 2021
                Apr-Jun 2021
                : 43
                : 2
                : 182-190
                Affiliations
                [1 ]Universidade de São Paulo, Laboratório de Fisiopatologia Renal, São Paulo, SP, Brasil.
                [2 ]Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brasil.
                Author notes
                Correspondence to: Vanda Jorgetti. E-mail: vandajor@ 123456usp.br

                Authors’ Contribution

                All authors contributed to conception and design of the study and to manuscript revision, reading, and approval of the submitted version. CT organized the database and performed the statistical analysis.

                Conflict of interest

                The authors declare that they have no conflict of interest related to the publication of this manuscript.

                Author information
                http://orcid.org/0000-0001-5334-0496
                http://orcid.org/0000-0001-6358-8727
                http://orcid.org/0000-0002-0255-6710
                http://orcid.org/0000-0002-2983-3968
                http://orcid.org/0000-0002-4824-8879
                Article
                10.1590/2175-8239-JBN-2020-0040
                8257281
                33576763
                10881669-b44a-48c2-85c0-9a5f1d1a1dab

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 February 2020
                : 04 November 2020
                Categories
                Original Article

                phosphates,renal insufficiency, chronic,mortality,peritoneal dialysis,fosfatos,insuficiência renal crônica,mortalidade,diálise peritoneal

                Comments

                Comment on this article

                scite_

                Similar content98

                Cited by3

                Most referenced authors619