Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay

Ashraf Abd El-Khalik Barakat; Manar Abd El-Rouf Raafat Ameen; Amna Ahmed Metwaly; Fatma Mohammed Nasr; Nevine Sherif Ali Khalil; Iris Nessim

doi:doi:10.11648/j.ajls.20140205.11

Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay

Ashraf Abd El-Khalik Barakat, Manar Abd El-Rouf Raafat Ameen, Amna Ahmed Metwaly, Fatma Mohammed Nasr, Nevine Sherif Ali Khalil, Iris Nessim

Published in American Journal of Life Sciences (Volume 2, Issue 5)

Received: 22 August 2014 Accepted: 8 September 2014 Published: 30 September 2014

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Abstract

Traditional cardiovascular risk factors are common among chronic kidney disease (CKD) patients. However the high prevalence of atherosclerosis and arterial calcification in CKD is far beyond the explanation by common cardiovascular risk factors. The aim of this study is to determine the incidence of cardiovascular calcification and its relation to demographic data, hemodialysis data and laboratory biomarkers and to evaluate the cardiovascular risk of atherosclerosis in hemodialysis patients. Fourty CKD patients on regular hemodialysis and twenty healthy volunteers were subjected to echocardiography, carotid ultrasound and laboratory studies including serum parathrmone (PTH), 25(OH) vitamin D, feutin and osteoprotegerin levels (OPG). The echocardiographic data showed a statistically significant increase in interventricular septum thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) in patients group compared to the controls. Thirty patients (75%) had valvular calcification. There was significant increase in carotid intima-media thickness (CIMT) in patients group. Serum levels of Ph, PTH and Osteoprotegerin were significantly increased, however, serum levels of Ca, Vitamin D and Feutin were significantly decreased in patients group. Serum level of Ph, and Osteoprotogerin were significantly increased while Vitamin D and feutin were significantly decreased in patients with valvular calcification compared to patients without valvular calcifications. The level of Vitamin D and Fetuin were negatively correlated with creatinine, PTH and osteoprotogerin. While, the level of osteoprotogerin and PTH were positively correlated with creatinine and with each other, they were negatively correlated with HDL-c and eGFR. CIMT was positively correlated with LVMI, PWT, urea, creatinine, CRP, Ca and was negatively correlated with EF%, eGFR, HDL-c, vitamin D and Feutin. We concluded that hemodialysis patients with valvular calcifications were older in age, with a longer hemodialysis duration and showed higher Ph level, Ca x P product and OPG level and lower 25(OH)-vitamin D and fetuin A level. Also, they showed lower EF % and were on lower doses of alphacalcidol and higher doses of calcium compared to patients without valvular calcifications. So, our study points to the importance of administration of active vitamin D derivatives to decrease the risk of valvular calcification and atherosclerosis. Serum fetuin A and osteoprotegerin can be used as a simple, easily performed biomarkers mirroring valvular calcification in hemodialysis patients. Further studies should be done to assess trials for the addition of fetuin A in the treatment of CKD patients to prevent the occurrence of calcification.

Published in	American Journal of Life Sciences (Volume 2, Issue 5)
DOI	10.11648/j.ajls.20140205.11
Page(s)	251-259
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Chronic Kidney Disease, 25(OH)-Vitamin D, Parathormone, Fetuin A, Osteoprotegerin, Vascular and Valvular Calcification, Carotid Intima-Media Thickness

References

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Ashraf Abd El-Khalik Barakat, Manar Abd El-Rouf Raafat Ameen, Amna Ahmed Metwaly, Fatma Mohammed Nasr, Nevine Sherif Ali Khalil, et al. (2014). Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay. American Journal of Life Sciences, 2(5), 251-259. https://doi.org/10.11648/j.ajls.20140205.11

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Ashraf Abd El-Khalik Barakat; Manar Abd El-Rouf Raafat Ameen; Amna Ahmed Metwaly; Fatma Mohammed Nasr; Nevine Sherif Ali Khalil, et al. Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay. Am. J. Life Sci. 2014, 2(5), 251-259. doi: 10.11648/j.ajls.20140205.11

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AMA Style

Ashraf Abd El-Khalik Barakat, Manar Abd El-Rouf Raafat Ameen, Amna Ahmed Metwaly, Fatma Mohammed Nasr, Nevine Sherif Ali Khalil, et al. Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay. Am J Life Sci. 2014;2(5):251-259. doi: 10.11648/j.ajls.20140205.11

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@article{10.11648/j.ajls.20140205.11,
  author = {Ashraf Abd El-Khalik Barakat and Manar Abd El-Rouf Raafat Ameen and Amna Ahmed Metwaly and Fatma Mohammed Nasr and Nevine Sherif Ali Khalil and Iris Nessim},
  title = {Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay},
  journal = {American Journal of Life Sciences},
  volume = {2},
  number = {5},
  pages = {251-259},
  doi = {10.11648/j.ajls.20140205.11},
  url = {https://doi.org/10.11648/j.ajls.20140205.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajls.20140205.11},
  abstract = {Traditional cardiovascular risk factors are common among chronic kidney disease (CKD) patients. However the high prevalence of atherosclerosis and arterial calcification in CKD is far beyond the explanation by common cardiovascular risk factors. The aim of this study is to determine the incidence of cardiovascular calcification and its relation to demographic data, hemodialysis data and laboratory biomarkers and to evaluate the cardiovascular risk of atherosclerosis in hemodialysis patients. Fourty CKD patients on regular hemodialysis and twenty healthy volunteers were subjected to echocardiography, carotid ultrasound and laboratory studies including serum parathrmone (PTH), 25(OH) vitamin D, feutin and osteoprotegerin levels (OPG). The echocardiographic data showed a statistically significant increase in interventricular septum thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) in patients group compared to the controls. Thirty patients (75%) had valvular calcification. There was significant increase in carotid intima-media thickness (CIMT) in patients group. Serum levels of Ph, PTH and Osteoprotegerin were significantly increased, however, serum levels of Ca, Vitamin D and Feutin were significantly decreased in patients group. Serum level of Ph, and Osteoprotogerin were significantly increased while Vitamin D and feutin were significantly decreased in patients with valvular calcification compared to patients without valvular calcifications. The level of Vitamin D and Fetuin were negatively correlated with creatinine, PTH and osteoprotogerin. While, the level of osteoprotogerin and PTH were positively correlated with creatinine and with each other, they were negatively correlated with HDL-c and eGFR. CIMT was positively correlated with LVMI, PWT, urea, creatinine, CRP, Ca and was negatively correlated with EF%, eGFR, HDL-c, vitamin D and Feutin.  We concluded that hemodialysis patients with valvular calcifications were older in age, with a longer hemodialysis duration and showed higher Ph level, Ca x P product and OPG level and lower 25(OH)-vitamin D and fetuin A level. Also, they showed lower EF % and were on lower doses of alphacalcidol and higher doses of calcium compared to patients without valvular calcifications. So, our study points to the importance of administration of active vitamin D derivatives to decrease the risk of valvular calcification and atherosclerosis. Serum fetuin A and osteoprotegerin can be used as a simple, easily performed biomarkers mirroring valvular calcification in hemodialysis patients. Further studies should be done to assess trials for the addition of fetuin A in the treatment of CKD patients to prevent the occurrence of calcification.},
 year = {2014}
}

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TY  - JOUR
T1  - Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay
AU  - Ashraf Abd El-Khalik Barakat
AU  - Manar Abd El-Rouf Raafat Ameen
AU  - Amna Ahmed Metwaly
AU  - Fatma Mohammed Nasr
AU  - Nevine Sherif Ali Khalil
AU  - Iris Nessim
Y1  - 2014/09/30
PY  - 2014
N1  - https://doi.org/10.11648/j.ajls.20140205.11
DO  - 10.11648/j.ajls.20140205.11
T2  - American Journal of Life Sciences
JF  - American Journal of Life Sciences
JO  - American Journal of Life Sciences
SP  - 251
EP  - 259
PB  - Science Publishing Group
SN  - 2328-5737
UR  - https://doi.org/10.11648/j.ajls.20140205.11
AB  - Traditional cardiovascular risk factors are common among chronic kidney disease (CKD) patients. However the high prevalence of atherosclerosis and arterial calcification in CKD is far beyond the explanation by common cardiovascular risk factors. The aim of this study is to determine the incidence of cardiovascular calcification and its relation to demographic data, hemodialysis data and laboratory biomarkers and to evaluate the cardiovascular risk of atherosclerosis in hemodialysis patients. Fourty CKD patients on regular hemodialysis and twenty healthy volunteers were subjected to echocardiography, carotid ultrasound and laboratory studies including serum parathrmone (PTH), 25(OH) vitamin D, feutin and osteoprotegerin levels (OPG). The echocardiographic data showed a statistically significant increase in interventricular septum thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) in patients group compared to the controls. Thirty patients (75%) had valvular calcification. There was significant increase in carotid intima-media thickness (CIMT) in patients group. Serum levels of Ph, PTH and Osteoprotegerin were significantly increased, however, serum levels of Ca, Vitamin D and Feutin were significantly decreased in patients group. Serum level of Ph, and Osteoprotogerin were significantly increased while Vitamin D and feutin were significantly decreased in patients with valvular calcification compared to patients without valvular calcifications. The level of Vitamin D and Fetuin were negatively correlated with creatinine, PTH and osteoprotogerin. While, the level of osteoprotogerin and PTH were positively correlated with creatinine and with each other, they were negatively correlated with HDL-c and eGFR. CIMT was positively correlated with LVMI, PWT, urea, creatinine, CRP, Ca and was negatively correlated with EF%, eGFR, HDL-c, vitamin D and Feutin.  We concluded that hemodialysis patients with valvular calcifications were older in age, with a longer hemodialysis duration and showed higher Ph level, Ca x P product and OPG level and lower 25(OH)-vitamin D and fetuin A level. Also, they showed lower EF % and were on lower doses of alphacalcidol and higher doses of calcium compared to patients without valvular calcifications. So, our study points to the importance of administration of active vitamin D derivatives to decrease the risk of valvular calcification and atherosclerosis. Serum fetuin A and osteoprotegerin can be used as a simple, easily performed biomarkers mirroring valvular calcification in hemodialysis patients. Further studies should be done to assess trials for the addition of fetuin A in the treatment of CKD patients to prevent the occurrence of calcification.
VL  - 2
IS  - 5
ER  -

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Author Information

Ashraf Abd El-Khalik Barakat

Intensive Care Department, Theodor Bilharz Research Institute, Cairo, Egypt
Manar Abd El-Rouf Raafat Ameen

Nephrology Department, Theodor Bilharz Research Institute, Cairo, Egypt
Amna Ahmed Metwaly

Intensive Care Department, Theodor Bilharz Research Institute, Cairo, Egypt
Fatma Mohammed Nasr

Intensive Care Department, Theodor Bilharz Research Institute, Cairo, Egypt
Nevine Sherif Ali Khalil

Nephrology Department, Theodor Bilharz Research Institute, Cairo, Egypt
Iris Nessim

Clinical Chemistry Department, Theodor Bilharz Research Institute, Cairo, Egypt

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Ashraf Abd El-Khalik Barakat, Manar Abd El-Rouf Raafat Ameen, Amna Ahmed Metwaly, Fatma Mohammed Nasr, Nevine Sherif Ali Khalil, et al. (2014). Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay. American Journal of Life Sciences, 2(5), 251-259. https://doi.org/10.11648/j.ajls.20140205.11

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Ashraf Abd El-Khalik Barakat; Manar Abd El-Rouf Raafat Ameen; Amna Ahmed Metwaly; Fatma Mohammed Nasr; Nevine Sherif Ali Khalil, et al. Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay. Am. J. Life Sci. 2014, 2(5), 251-259. doi: 10.11648/j.ajls.20140205.11

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Ashraf Abd El-Khalik Barakat, Manar Abd El-Rouf Raafat Ameen, Amna Ahmed Metwaly, Fatma Mohammed Nasr, Nevine Sherif Ali Khalil, et al. Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay. Am J Life Sci. 2014;2(5):251-259. doi: 10.11648/j.ajls.20140205.11

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@article{10.11648/j.ajls.20140205.11,
  author = {Ashraf Abd El-Khalik Barakat and Manar Abd El-Rouf Raafat Ameen and Amna Ahmed Metwaly and Fatma Mohammed Nasr and Nevine Sherif Ali Khalil and Iris Nessim},
  title = {Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay},
  journal = {American Journal of Life Sciences},
  volume = {2},
  number = {5},
  pages = {251-259},
  doi = {10.11648/j.ajls.20140205.11},
  url = {https://doi.org/10.11648/j.ajls.20140205.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajls.20140205.11},
  abstract = {Traditional cardiovascular risk factors are common among chronic kidney disease (CKD) patients. However the high prevalence of atherosclerosis and arterial calcification in CKD is far beyond the explanation by common cardiovascular risk factors. The aim of this study is to determine the incidence of cardiovascular calcification and its relation to demographic data, hemodialysis data and laboratory biomarkers and to evaluate the cardiovascular risk of atherosclerosis in hemodialysis patients. Fourty CKD patients on regular hemodialysis and twenty healthy volunteers were subjected to echocardiography, carotid ultrasound and laboratory studies including serum parathrmone (PTH), 25(OH) vitamin D, feutin and osteoprotegerin levels (OPG). The echocardiographic data showed a statistically significant increase in interventricular septum thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) in patients group compared to the controls. Thirty patients (75%) had valvular calcification. There was significant increase in carotid intima-media thickness (CIMT) in patients group. Serum levels of Ph, PTH and Osteoprotegerin were significantly increased, however, serum levels of Ca, Vitamin D and Feutin were significantly decreased in patients group. Serum level of Ph, and Osteoprotogerin were significantly increased while Vitamin D and feutin were significantly decreased in patients with valvular calcification compared to patients without valvular calcifications. The level of Vitamin D and Fetuin were negatively correlated with creatinine, PTH and osteoprotogerin. While, the level of osteoprotogerin and PTH were positively correlated with creatinine and with each other, they were negatively correlated with HDL-c and eGFR. CIMT was positively correlated with LVMI, PWT, urea, creatinine, CRP, Ca and was negatively correlated with EF%, eGFR, HDL-c, vitamin D and Feutin.  We concluded that hemodialysis patients with valvular calcifications were older in age, with a longer hemodialysis duration and showed higher Ph level, Ca x P product and OPG level and lower 25(OH)-vitamin D and fetuin A level. Also, they showed lower EF % and were on lower doses of alphacalcidol and higher doses of calcium compared to patients without valvular calcifications. So, our study points to the importance of administration of active vitamin D derivatives to decrease the risk of valvular calcification and atherosclerosis. Serum fetuin A and osteoprotegerin can be used as a simple, easily performed biomarkers mirroring valvular calcification in hemodialysis patients. Further studies should be done to assess trials for the addition of fetuin A in the treatment of CKD patients to prevent the occurrence of calcification.},
 year = {2014}
}

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TY  - JOUR
T1  - Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay
AU  - Ashraf Abd El-Khalik Barakat
AU  - Manar Abd El-Rouf Raafat Ameen
AU  - Amna Ahmed Metwaly
AU  - Fatma Mohammed Nasr
AU  - Nevine Sherif Ali Khalil
AU  - Iris Nessim
Y1  - 2014/09/30
PY  - 2014
N1  - https://doi.org/10.11648/j.ajls.20140205.11
DO  - 10.11648/j.ajls.20140205.11
T2  - American Journal of Life Sciences
JF  - American Journal of Life Sciences
JO  - American Journal of Life Sciences
SP  - 251
EP  - 259
PB  - Science Publishing Group
SN  - 2328-5737
UR  - https://doi.org/10.11648/j.ajls.20140205.11
AB  - Traditional cardiovascular risk factors are common among chronic kidney disease (CKD) patients. However the high prevalence of atherosclerosis and arterial calcification in CKD is far beyond the explanation by common cardiovascular risk factors. The aim of this study is to determine the incidence of cardiovascular calcification and its relation to demographic data, hemodialysis data and laboratory biomarkers and to evaluate the cardiovascular risk of atherosclerosis in hemodialysis patients. Fourty CKD patients on regular hemodialysis and twenty healthy volunteers were subjected to echocardiography, carotid ultrasound and laboratory studies including serum parathrmone (PTH), 25(OH) vitamin D, feutin and osteoprotegerin levels (OPG). The echocardiographic data showed a statistically significant increase in interventricular septum thickness (IVST), posterior wall thickness (PWT) and left ventricular mass index (LVMI) in patients group compared to the controls. Thirty patients (75%) had valvular calcification. There was significant increase in carotid intima-media thickness (CIMT) in patients group. Serum levels of Ph, PTH and Osteoprotegerin were significantly increased, however, serum levels of Ca, Vitamin D and Feutin were significantly decreased in patients group. Serum level of Ph, and Osteoprotogerin were significantly increased while Vitamin D and feutin were significantly decreased in patients with valvular calcification compared to patients without valvular calcifications. The level of Vitamin D and Fetuin were negatively correlated with creatinine, PTH and osteoprotogerin. While, the level of osteoprotogerin and PTH were positively correlated with creatinine and with each other, they were negatively correlated with HDL-c and eGFR. CIMT was positively correlated with LVMI, PWT, urea, creatinine, CRP, Ca and was negatively correlated with EF%, eGFR, HDL-c, vitamin D and Feutin.  We concluded that hemodialysis patients with valvular calcifications were older in age, with a longer hemodialysis duration and showed higher Ph level, Ca x P product and OPG level and lower 25(OH)-vitamin D and fetuin A level. Also, they showed lower EF % and were on lower doses of alphacalcidol and higher doses of calcium compared to patients without valvular calcifications. So, our study points to the importance of administration of active vitamin D derivatives to decrease the risk of valvular calcification and atherosclerosis. Serum fetuin A and osteoprotegerin can be used as a simple, easily performed biomarkers mirroring valvular calcification in hemodialysis patients. Further studies should be done to assess trials for the addition of fetuin A in the treatment of CKD patients to prevent the occurrence of calcification.
VL  - 2
IS  - 5
ER  -

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