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T-score at sites of bone mineral density measurement.
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Aim: Coronary artery calcification (CAC) score on computed tomography (CT) or vascular calcification (VC) scores on plain radiographs are associated with cardiovascular events and fracture. We investigated which VC score among several VC scores on plain radiographs is predictor of CAC, and whether VC scores are related with bone mineral density (BM...
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PurposeThis study aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) in 61 patients from the acromegaly group (AG) with regard to the activity of the disease in comparison to 42 patients—control group (CG). We also analyzed selected bone markers and their association with BMD and TBS.Materials and Methods
Lumbar spine and fe...
Citations
... Depending on the severity of atherosclerosis, calcium deposition in the intima can affect the measurement of the spinal BMD. Our findings are consistent with those of previous studies that reported that peripheral BMD was lower than central BMD [26,27]. Lumbar BMD may be relatively overestimated in patients with ESKD with severe AAC. ...
Background:
T50 is a novel serum-based marker that assesses the propensity for calcification in serum. A shorter T50 indicates a greater propensity to calcify and has been associated with cardiovascular disease and mortality among patients with chronic kidney disease. The factors associated with T50 and the correlation between T50 and bone mineral density (BMD) are unknown in hemodialysis (HD) patients.
Methods:
This cross-sectional study included 184 patients undergoing HD. Individuals were grouped into tertiles of T50 to compare the demographic and disease indicators of the tertiles. Linear regression was used to evaluate the association between T50 and hip and spinal BMD in a multivariate model.
Results:
Mineral and inflammatory parameters, including serum phosphate (r = -0.156, p = 0.04), albumin (r = 0.289, p < 0.001), and high-sensitivity C-reactive protein (r = -0.224, p = 0.003) levels, were associated with T50. We found a weak association between T50 and BMD in the total hip area in the unadjusted model (β = 0.030, p = 0.04) but did not find a statistically significant association with the total hip (β = 0.017, p = 0.12), femoral neck (β = -0.001, p = 0.96), or spinal BMD (β = 0.019, p = 0.33) in multivariable-adjusted models.
Conclusion:
T50 was moderately associated with mineral and inflammatory parameters but did not conclusively establish an association with BMD in HD patients. Broad-scale future studies should determine whether T50 can provide insights into BMD beyond traditional risk factors in this population.
... 14,15 This is consistent with autopsy findings from people with established coronary artery disease in whom a high rate of coexistent medial calcification was observed only in those with CKD. 16 The abdominal aortic calcification score is the most reliable predictor of coronary artery calcification in patients undergoing dialysis, 17 and aortic arch calcification is strongly associated with coronary artery calcification. 18 The discrepancy between Yeo et al.'s findings 9 and our findings in terms of the relationship between CACS and IDH may be due to the method used to quantify the CACS. ...
Introduction
We investigated the association between intradialytic hypotension (IDH) and coronary artery calcification and their effects on mortality in hemodialysis (HD) patients.
Methods
Consecutive patients undergoing maintenance HD were enrolled. The study timeline included the baseline (day 1), exposure assessment (day 1–day 22), and outcome assessment (day 23–3 years) periods. IDH was defined as a nadir systolic blood pressure (SBP) of <100 mmHg or vasopressor use during at least 2 of 10 HD sessions in the exposure assessment period. The clinical data at baseline and the Agatston coronary artery calcium score (CACS) were assessed in the exposure assessment period.
Findings
The median age and dialysis vintage were 67 years [60–75 years] and 73 months [37–138 months], respectively. IDH occurred in 37 patients (21.4%), and the CACS was higher in the IDH group than in the non‐IDH group (p = 0.08). IDH was associated with CACS, diabetes mellitus, mean predialysis SBP, and mean ultrafiltration volume (p < 0.05). The cutoff CACS for mortality was 1829 (sensitivity: 69%, specificity: 77%). In all, 45 all‐cause deaths and 19 cardiovascular deaths occurred over 3 years. Patients with both IDH and a CACS of ≥1829 had a lower 3‐year cumulative survival from cardiovascular death (66.7%) than those with a CACS of ≥1829 (80.3%), IDH (88.5%), or neither (95.5%) (p < 0.01). IDH, a CACS of ≥1829, and IDH + CACS of ≥1829 were predictors of 3‐year all‐cause and cardiovascular mortality (p < 0.05). The hazard ratio for cardiovascular mortality was highest in the group with IDH + CACS ≥ 1829.
Discussion
A high CACS may be a biomarker for IDH. Both IDH and CACS were risk factors for all‐cause and cardiovascular mortality in patients undergoing HD, and there was a synergistic interaction between IDH and high CACS for cardiovascular mortality.
... The assessment of coronary artery calcification by cardiac computed tomography (CT) scan sensitively detects CAD, and has been validated for the prediction of future CV event risk [8][9][10][11]. Yet, due to the limitations of thoracic radiation and the cost of cardiac CT [12], alternative modalities have been examined to estimate the CVD burden. ...
... The predictability of AACS in future CV events seems primarily attributed to its correlation with coronary artery calcification. Previous studies reported that, among the patients on chronic hemodialysis, a high AACS on plain radiograph is independently associated with severe CACS on cardiac CT [12,32,33]. Although there is no direct evidence that AACS assessed by plain radiograph correlates with CACS in patients with non-dialysis CKD, abdominal CT-assessed AAC's correlation with CACS is proven [16]. ...
To investigate the association between abdominal aortic calcification score (AACS) assessed by plain radiograph of the lateral abdomen and the risk of cardiovascular (CV) events in patients with pre-dialysis chronic kidney disease (CKD), a total of 2090 pre-dialysis CKD patients from the Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD) were categorized by AACS into 0, 1–2, 3–4, 5–6, and ≥7. The primary outcome of the study was the composite CV events, defined as a composite of non-fatal CV events and all-cause death. The risk of composite CV events was significantly higher in the subjects with AACS ≥ 7 (adjusted hazard ratio (HR) 1.888, 95% confidence interval (CI) 1.219 to 2.923), compared to that of the subjects with AACS 0. The risks of fatal and non-fatal CV events (adjusted HR 1.052, 95% CI 1.030 to 1.073) and all-cause death (adjusted HR 1.949, 95% CI 1.073 to 3.539) were also significantly higher in the subjects with AACS ≥ 7. In conclusion, AACS assessed by plain radiograph is independently associated with adverse CV outcomes in patients with pre-dialysis CKD. A simple radiographic examination of the lateral abdomen may help CV risk stratification in this population.
... Since C3a level kept at a higher level in our HD patients, we explored the association between the levels of complement factors and the vascular calcification in HD patients. Existing data indicated that abdominal aorta calcification score (AAC) is a strong predictor of cardiovascular disease-related events or death in the general population and in dialysis patients [29,30]. Thus, we choose the abdominal aorta calcification score measurements in this study. ...
The complement system plays an important role in cardiovascular disease in patients on hemodialysis. Vascular calcification is also one of the major causes of cardiovascular disease. We want to investigate the relationship between complement activation and vascular calcification in dialyzed patients. One hundred eight hemodialysis patients and 65 heathy controls were enrolled prospectively. Plasma C3a, C5a, mannose-binding lectin (MBL), and membrane attack complex (MAC or C5b-9) levels were detected using ELISA. Plasma C3c, fB, fH, C1q, and C4 levels were measured by immunity transmission turbidity. Abdominal aortic calcification (AAC) was measured by abdomen lateral plain radiograph, and the AAC score was calculated. We identified increased level of MBL and decreased level of C3c and complement factor B compared with normal control. However, C1q, complement factor H, and C4 levels remained at a similar level compared with individuals with normal renal function. The C3a and C5a levels increased, without change of MAC. Forty two of 108 HD patients had the AAC score. C3a levels were correlated with AAC score (r = 0.461, p = 0.002). The median C3a concentration was 238.72 (196.96, 323.41) ng/mL. When evaluated as AAC categories (≤ 4, > 5) with ordinal logistic regression, univariate analyses revealed that higher C3a levels were associated with severe AAC, while multivariate analyses adjusted for age, sex, and calcium level showed that higher C3a levels (OR, 6.28 (1.25–31.69); p = 0.03) were associated with severe AAC. The areas under the curve (AUC) for C3a to diagnose severe abdominal aortic calcification were 0.75(0.58–0.92, 0.01). The complement system was activated in patients on hemodialysis. Higher C3a levels are independently associated with severe AAC. Plasma C3a might have a diagnostic value for the severe AAC in HD patients.
... VC, a phenotype of vascular aging, is common in dialysis patients with longer dialysis histories and increases the risk of morbidity and mortality in these patients. Previous studies have shown that the abdominal aortic calcification (AAC) score on plain radiography has a very good correlation with the identification of coronary artery calcification and low bone mass, which are risk factors for mortality [8,9]. A previous human study reported that serum myostatin levels were negatively associated with AAC in older males [10]. ...
Background:
Serum myostatin levels are increased according to renal function decline and myostatin may be a main mediator of chronic kidney disease-related sarcopenia. A previous study reported that serum myostatin level was negatively associated with abdominal aortic calcification (AAC) in older males. The aim of this study was to assess the association between serum myostatin level and AAC among dialysis patients of both sexes. In addition, we analyzed the relationship between serum myostatin level, muscle mass, and bone mineral density (BMD).
Methods:
In this cross-sectional study, we evaluated AAC in the lateral lumbar spine using plain radiography and BMD in 71 patients undergoing dialysis. We classified patients into two groups according to the median value of myostatin as follows: those with high myostatin levels (≥ 5.0 ng/mL) and those with low myostatin levels (< 5.0 ng/mL).
Results:
The proportion of patients with an AAC score of five points or more was higher among those with low myostatin levels. Myostatin level was negatively associated with AAC scores on plain radiography and had a positive association with skeletal muscle mass and T-scores for BMD measured at the total hip and femur neck. Lower myostatin levels were independently associated with higher AAC scores following adjustment for age, sex, diabetes mellitus, dialysis vintage, dialysis modality, and osteoprotegerin level.
Conclusion:
Lower serum myostatin levels were associated with higher AAC scores, lower muscle mass, and lower BMD in dialysis patients. Further, prospective studies and those with larger cohorts are necessary to validate these findings.
... The presence of VC on plain radiographs of the feet is associated with peripheral artery disease as well as CAD [9,10]. Among the various VC scoring systems, the AAC score on plain radiographs of the lateral lumbar spine is predictive of CAC on CT and the T-score (an indicator of bone mineral density) of the forearm [15,16]. The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that VC be evaluated using a lateral view of the lumbar spine [17]. ...
Vascular calcification (VC) and malnutrition associated with cardiovascular disease are common in patients with chronic kidney disease (CKD) treated with dialysis. VC, which reflects vascular aging, and malnutrition are also encountered in the non-CKD elderly population. This similarity of clinical findings suggests that the progression of CKD is related to aging and the existence of a causal relationship between VC and malnutrition. To retard renal progression, a low- or very-low-protein diet is usually recommended for CKD patients. Dietary education may induce malnutrition and deficiency of important nutrients, such as vitamins K and D. Menaquinone-7, a type of vitamin K2, is under investigation for inhibiting VC in elderly patients without CKD, as well as for prevention of VC in patients with CKD. Nutritional vitamin D, such as cholecalciferol, may be considered to decrease the required dose of active vitamin D, which increases the risk of VC due to increased calcium and phosphate loads. Omega-3 fatty acids are important nutrients and their ability to inhibit VC needs to be evaluated in clinical trials. This review focuses on the ability of supplementary nutrients to prevent VC in patients with CKD, in whom dietary restriction is essential.
Aim:
To determine the characteristics of coronary artery atherosclerotic plaques in chronic kidney disease (CKD) with coronary computed tomography angiography (CTA).
Materials and methods:
Sixty-six patients with CKD who underwent coronary CTA were analysed retrospectively. The extent, distribution, and types of plaques and stenosis severity were evaluated. The imaging features were compared between dialysis and non-dialysis groups. In the dialysis group, the imaging features were compared between diabetes and non-diabetes patients.
Results:
In total, 152 coronary vessels (2.3±1.3 per patient) and 306 segments (4.6±3.5 per patient) were found to have plaques. The most common diseased coronary vessel was the left anterior descending (LAD) artery (53 vessels, 34.9%) followed by the left circumflex (LCX) artery (39 vessels, 25.7%), and right coronary artery (RCA; 37 vessels, 24.3%) in sequence. The most commonly involved coronary artery segment was the middle segment of LAD artery (14.1%). Calcified plaques (65.9%) were detected more frequently than mixed (25.6%) or non-calcified (8.5%) plaques (p<0.001). Among the degrees of coronary stenosis, minimal stenosis (55.8%) was the most common (p<0.001). The majority of calcified plaques were non-obstructive plaques (n=134, 78.2%), while about half of non-calcified (n=14, 63.6%) and mixed plaques (n=30, 45.5%) were obstructive plaques (p<0.001).
Conclusion:
A heavy plaque burden was detected in CKD patients at coronary CTA. Non-obstructive calcified plaque was the most common imaging feature. CKD patients with type 2 diabetes mellitus had more obstructive mixed plaques.
