scholarly journals The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3567
Author(s):  
Maria Fusaro ◽  
Giovanni Tripepi ◽  
Mario Plebani ◽  
Cristina Politi ◽  
Andrea Aghi ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vertebral Fractures ◽  
Body Height ◽  
Fragility Fractures ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
High Morbidity ◽  
Cross Sectional ◽  
Relevant Risk Factor ◽  
Stage Renal Disease

Vascular calcification and fragility fractures are associated with high morbidity and mortality, especially in end-stage renal disease. We evaluated the relationship of iliac arteries calcifications (IACs) and abdominal aortic calcifications (AACs) with the risk for vertebral fractures (VFs) in hemodialysis patients. The VIKI study was a multicenter cross-sectional study involving 387 hemodialysis patients. The biochemical data included bone health markers, such as vitamin K levels, vitamin K-dependent proteins, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, and phosphate. VF, IACs and AACs was determined through standardized spine radiograms. VF was defined as >20% reduction of vertebral body height, and VC were quantified by measuring the length of calcium deposits along the arteries. The prevalence of IACs and AACs were 56.1% and 80.6%, respectively. After adjusting for confounding variables, the presence of IACs was associated with 73% higher odds of VF (p = 0.028), whereas we found no association (p = 0.294) for AACs. IACs were associated with VF irrespective of calcification severity. Patients with IACs had lower levels of vitamin K2 and menaquinone 7 (0.99 vs. 1.15 ng/mL; p = 0.003), and this deficiency became greater with adjustment for triglycerides (0.57 vs. 0.87 ng/mL; p < 0.001). IACs, regardless of their extent, are a clinically relevant risk factor for VFs. The association is enhanced by adjusting for vitamin K, a main player in bone and vascular health. To our knowledge these results are the first in the literature. Prospective studies are needed to confirm these findings both in chronic kidney disease and in the general population.

MO798ORAL CALCITRIOL USE, VERTEBRAL FRACTURES AND VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Maria Fusaro ◽  
Andrea Aghi ◽  
Cristina Politi ◽  
Thomas Nickolas ◽  
Giuseppe Cianciolo ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Vitamin K ◽  
Vertebral Fractures ◽  
Body Height ◽  
Secondary Analysis ◽  
Fragility Fractures ◽  
Matrix Gla Protein ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Calcific Deposits

Abstract Background and Aims In patients with Chronic Kidney Disease (CKD) mineral, bone, and calcific cardiovascular abnormalities are associated to adverse clinical outcomes, including fractures, cardiovascular events and mortality. Vitamin D hormonal system along with alteration levels that occur in calcium, phosphate, PTH, FGF23/Klotho are the main responsible of the bone and vascular metabolism changes, particularly in hemodialysis (HD) patients that experienced the very negative clinical consequences (decreased bone mass, increased fragility fractures and vascular calcification). In the setting of a comparative effectiveness study, we investigated the effect of oral calcitriol on fractures in HD patients taking into account a series of potential confounders. Method We conducted a secondary analysis of the VIKI database, a cross-sectional study involving 387 HD patients from 18 Italian dialysis centers. Routine biochemistry and bone biochemical markers such as vitamin K levels, VKDPs, vitamin 25(OH)D, ALP, PTH, Ca, P, osteocalcin (BGP), Matrix Gla Protein (MGP) were assessed. The presence of Vertebral Fractures (VF) and Vascular Calcification (VC) was determined through spine radiograph. Reduction of &gt;20% of vertebral body height was considered a VF. The severity of the vertebral fractures was estimated as mild, moderate and severe (reduction: 20-25%, 25-40% or &gt;40%, respectively). VC were quantified by measuring the length of calcific deposits along the arteries (mild 0,1-5 cm, moderate 5,1-10 cm and severe &gt;10 cm). Results 177 out 387 patients (45.7%) were treated with oral calcitriol. Oral calcitriol-treated and untreated patients did not differ as for Ca, P, PTH, Albumin, BGP, MGP, and ALP. The prevalence of VF was significantly lower in patients receiving oral calcitriol than in those untreated (48.6% vs 61%, P=0.015), whereas the presence of aortic and iliac calcifications was similar between the two groups (aortic: 81.9% vs 79.5% respectively, P=0.552; iliac: 52.0% and 59.5%, P=0.167). No significant between-groups differences were observed in terms of calcification severity. In a multivariable logistic regression analysis, after adjustment for all potential confounders, oral calcitriol was associated with a marked reduction (-40.2%) of the odds of fractures (OR: 0.598, 95% CI: 0.363-0.985, P=0.043) (see Table). Conclusion A significant association was found between oral calcitriol and lower VF rate in HD patients. Such an effect remained significant also after data adjustment for a large series of potential confounders. Further prospective and interventional studies are needed to confirm these findings.

Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross‐Sectional Study

2021 ◽  
Author(s):  
Maria Fusaro ◽  
Giuseppe Cianciolo ◽  
Giovanni Tripepi ◽  
Mario Plebani ◽  
Andrea Aghi ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vertebral Fractures ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals P1485SEVELAMER USE IS ASSOCIATED WITH DECREASED VITAMIN K LEVELS IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Fusaro ◽  
Andrea Aghi ◽  
Pascale Khairallah ◽  
Maurizio Gallieni ◽  
Mario Gennaro Cozzolino ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vertebral Fractures ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Matrix Gla Protein ◽  
Phosphate Binding ◽  
Cross Sectional ◽  
K Deficiency ◽  
Causal Nature ◽  
The Relationship

Abstract Background and Aims Sevelamer (S) is a phosphate binding drug used to treat hyperphosphatemia in patients with CKD. Our aim was to evaluate the hypothesis that the use of (S) could interfere with Vitamin K absorption in hemodialysis (HD) patients of VIKI study. Method We tested this hypothesis in VIKI, a cross-sectional study of 387 hemodialysis patients, we established the prevalence of vitamin K deficiency and to assessed the relationship between vitamin K status, vertebral fractures, vascular calcification. We determined serum concentrations of vitamin 25(OH)D; alkaline phosphatase (ALP); vitamers K1, MK4, MK5, MK6, MK7; osteocalcin (BGP) and Matrix Gla Protein (MGP). We highlighted that MK4 deficiency was the strongest predictor of aortic calcification (OR, 2.82; 95% CI, 1.14–7.01) while vitamin K1 deficiency was the strongest predictor of vertebral fractures fractures (OR: 2.94; 95% CI, 1.38–6.26). Results 163 of 387 patients (42.1%) were treated with Sevelamer. There were no differences in levels of 25(OH)D, K1, MK5, MK6 and MK7 among patients treated with and without Sevelamer. Remarkably, the prevalence of MK4 deficiency was higher in Sevelamer treated patients (13.5% vs 5.4%, p=0.005). Sevelamer treated patients also had higher median levels of ALK (89 UI/L vs 77.5 UI/L, p=0.001) and total BGP (210 mcg/L vs 152 mcg/L, p=0.002) and lower median levels of total MGP (16.4 nmol/L vs 20.3 nmol/L, p=0.037) (Table 1 and Figure 1). In multivariable logistic regression, the odds ratio of MK4 deficiency (dependent variable) in patients treated with compared to without Sevelamer was ∼3-fold higher (OR: 2.64, 95% CI: 1.25-5.58, p=0.011) after adjustment for confounders of Vitamin K levels, including older age, previous myocardial infarction, type of HD, ALP, PTH, MGP, BGP, cholesterol and albumin. Conclusion These data support the hypothesis that Sevelamer could interfere with MK4 absorption in HD patients. Longitudinal interventional studies are needed to prove the causal nature of these associations.

Effect of hyperparathyroidism on vascular stiffness in hemodialysis patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Magdy Mohamed Saeed El-Sharkawy ◽  
Ahmed Hassan Mohamed El Thakaby ◽  
Ahmed Abdelmoniem Emara ◽  
Ahmed Mohamed Abdelkhalek
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Mean Value ◽  
University Hospitals ◽  
Cross Sectional ◽  
Risk Of Death ◽  
Group B ◽  
Stage Renal Disease

Abstract Background Cardiovascular disease (CVD) is present in &gt; 50% of patients undergoing dialysis and the relative risk of death due to CVD events in HD patients is reported to be 20 times higher than in the general population. In fact, in patients on renal replacement therapy (RRT) the prevalence of coronary heart disease and ventricular hypertrophy has been described to be 40% and 70% respectively, other CVD events include hypertention, arrhythmias, valvular calcification and arterial stiffness. Objective To detect the prevalence of arterial stiffness among end stage renal disease patients on prevalent hemodialysis with hyperparathyroidism. Patients and Methods This observational cross sectional study was conducted on 60 prevalent hemodialysis patients attending at hemodialysis unit of Ain Shams University hospitals, with convenient sampling method. The included patients are clinically stable on thrice weekly hemodialysis sessions for 4 hours per session. Results The Dual Pulse Wave Doppler (DPWD) method we proposed in this study may be considered as a useful and convenient option for clinical local Pulse Wave Velocity (PWV) measurement, this clinical practical and reproducible method had the capability to detect an increased local PWV of LCCA (which reflect arterial stiffness) in the patients with PTH &gt; 300 more than the patients with PTH &lt; 300 as it showed that in Group B (PTH&gt;300), the measured carotid artery local PWV values ranged from 6.22 m/s to 8.84 m/s and the mean value was 7.81 ± 0.72 m/s, which was higher than 6.72 ± 1.06 m/s (ranging from 4.48 m/s to 8.44 m/s) of Group A (PTH&lt;300). Conclusion Our study showed that there is a high prevalence of arterial stiffness in prevalent hemodialysis patients.

scholarly journals The Fate of Patients Who Started Hemodialysis during Childhood or Adolescence: Results of an Interregional Moroccan Survey

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
F. Z. Souilmi ◽  
T. Sqalli Houssaini ◽  
G. EL Bardai ◽  
N. Kabbali ◽  
M. Arrayhani ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Pediatric Age ◽  
Sectional Study ◽  
Cross Sectional ◽  
Low Weight ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis is the most used renal replacement therapy for children in Morocco. The objective of this study was to determine the prevalence of patients who started hemodialysis in childhood and study their characteristics and specificities of their care. For this we conducted a multicentric descriptive cross-sectional study of all chronic hemodialysis patients who started dialysis in pediatric age, in hemodialysis centers in four of the sixteen regions of Morocco. We collected 2066 patients undergoing dialysis in 39 hemodialysis centers; from these, only 72 patients (3.48%) started hemodialysis in childhood. The average age of patients was 20.64 ± 6.5 years with a sex ratio of 1.9. Duration of dialysis was 78.2 ± 56 months. The cause of end stage renal disease was urological abnormalities in 18% of cases and glomerulopathy in 12.5% of cases; however, it remains unknown in half of the patients. Over 18 years, 74% of patients are without profession, it is active in 13% of cases, and pursuing studies are only in 13% of cases. Patients under 5 years and those with a low weight are rarely taken care of in chronic hemodialysis with little individualization of prescription. Greater attention should be paid to renal transplantation that is desired by the majority of these patients (92%).

scholarly journals Glucocorticoid replacement therapy and vertebral fractures in hypopituitary adult males with GH deficiency

2010 ◽  
Vol 163 (1) ◽  
pp. 15-20 ◽  
Author(s):  
G Mazziotti ◽  
T Porcelli ◽  
A Bianchi ◽  
V Cimino ◽  
I Patelli ◽  
...  
Keyword(s):  
Vertebral Fractures ◽  
Gh Deficiency ◽  
Fragility Fractures ◽  
Cross Sectional Study ◽  
Adult Males ◽  
Urinary Cortisol ◽  
Cross Sectional ◽  
Replacement Treatment ◽  
Increased Risk ◽  
Glucocorticoid Deficiency

ObjectiveGH deficiency (GHD) and glucocorticoid excess are associated with increased risk of fragility fractures. We aimed to evaluate whether the prevalence of vertebral fractures may be influenced by glucocorticoid over-replacement in hypopituitary males with GHD.DesignCross-sectional study.MethodsFifty-one adult hypopituitary patients (all males; mean age 55 years, range: 23–81) with severe adult-onset GHD (replaced in 21 patients and untreated in 30 patients) and glucocorticoid deficiency on replacement treatment were studied for vertebral fractures using a radiological and morphometric approach.ResultsVertebral fractures were observed in 31 patients (60.8%) in correlation with untreated GHD, urinary cortisol values, and cortisone doses. Patients were stratified according to treatment of GHD, and current and cumulative cortisone doses. In untreated GHD, vertebral fractures occurred more frequently in patients who had received higher (greater than median) cumulative and current doses of cortisone compared with patients who had received lower (less than median) drug doses (95.2 vs 50.0%, P=0.009 and 90.5 vs 55.6%, P=0.04 respectively). In untreated GHD, fractured patients had significantly higher urinary cortisol values compared with patients without vertebral fractures (84 μg/24 h, range: 24–135 vs 49 μg/24 h, range: 30–96; P=0.04). In treated GHD patients, by contrast, the prevalence of vertebral fractures was not influenced by cumulative and current cortisone doses and urinary cortisol values.ConclusionsGlucocorticoid over-replacement may increase the prevalence of vertebral fractures in patients with untreated GHD. However, treatment of GHD seems to protect the skeleton from the deleterious effects of glucocorticoid overtreatment in hypopituitary patients.

scholarly journals Knowledge regarding Arterio-Venous Fistula among Hemodialysis Patients in a Hospital of Rupandehi

2019 ◽  
Vol 7 (2) ◽  
pp. 30-33
Author(s):  
Pragya Shrestha ◽  
Sanjeeta Bhujel ◽  
Santosh Shah
Keyword(s):  
Total Duration ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
High Morbidity ◽  
Maturation Time ◽  
Cross Sectional ◽  
Rubber Ball ◽  
Venous Fistula ◽  
Access Complications

INTRODUCTION: An arteriovenous fistula (AVF) is a connection between an artery and a vein as an access for rapid blood flow for hemodialysis. The vascular access complications are the major causes for high morbidity and mortality among patients. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted to find out the awareness regarding AVF among 70 hemodialysis patients of Universal College of Medical Sciences, Rupandehi. The purposive sampling method was used. The data was collected by semi-structured interview schedule. The total duration of the study was from August 12, 2018 to October 5, 2018. The data was analyzed by using descriptive and inferential statistics with SPSS software version 20.0. RESULTS: The study revealed that 58.57% of the respondents had high awareness regarding AVF, 54.28% answered 4-6 weeks as a maturation time for AVF, 12.90% answered at least three times of daily checking thrill, 95.71% answered to avoid to carry heavy items and to check blood pressure on AVF site and 24.28% answered at least 3-5 times as times of doing daily rubber ball exercise. CONCLUSION: Based on the study findings, it is concluded that the respondents have good knowledge on maturation time of AVF, avoiding sleep on AVF arm, wearing tight cloth and carrying heavy items. Respondents had low knowledge on checking thrill on AVF site as well as rubber ball exercise. Hence, it is needed to continue awareness program regarding AVF among hemodialysis patients.

scholarly journals Lipid Abnormalities Using Random Sampling In Patients With End Stage Renal Disease On Thrice Weekly Hemodialysis

2021 ◽  
Vol 4 (4) ◽  
pp. 328-331
Author(s):  
Shahid Anwar ◽  
Alvina Zainab ◽  
Sobia Mazhar
Keyword(s):  
Total Cholesterol ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Cholesterol Concentration ◽  
Total Cholesterol Concentration ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage ◽  
Lipid Abnormalities

Background: Cardiovascular disease (CVD) is the leading cause of death in the dialysis population. Among other risk factors abnormalities in lipid metabolism occur in patients with all stages of chronic kidney disease (CKD). The most common dyslipidemia in CKD and dialysis is hypertriglyceridemia, whereas the total cholesterol concentration can be normal or low, perhaps due in part to malnutrition. Although  hypertriglyceridemia that occurs in CKD may not significantly increase coronary risk, other changes may contribute to the accelerated atherosclerosis. We tried to find out how many patients in our setup on thrice weekly hemodialysis are suffering from dyslipidemia and whether taking treatment or not. Methodology: Cross sectional study conducted at dialysis center of Sir Ganga Ram Hospital, Lahore including all seventy patients with ESRD undergoing regular HD three times a week, 4 hours per session. Random blood samples (Non-fasting) were collected before dialysis for lipid profile including serum triglyceride, LDL, HDL and total cholesterol. Results: Out of 70 patients only 3 (4.4%) patients were on statins for dyslipidemia. Triglycerides were high in 41.4%, total cholesterol was low in 61.4%, and HDL was low in 34.3%. Conclusion: Hypertriglyceridemia is major lipid abnormality among hemodialysis patients.

scholarly journals The prevalence of malnutrition in hemodialysis patients

2020 ◽  
Vol 9 (2) ◽  
pp. e15-e15
Author(s):  
Ali Ghorbani ◽  
Fatemeh Hayati ◽  
Majid Karandish ◽  
Soudabeh Sabzali
Keyword(s):  
Nutritional Status ◽  
Serum Albumin ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Severe Malnutrition ◽  
Albumin Concentration ◽  
Cross Sectional ◽  
Moderate Malnutrition ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Malnutrition is a complex, multi-factorial and common problem in patients with end-stage renal disease (ESRD) undergoing hemodialysis that increases morbidity and mortality rate in them. Objectives: To assess the prevalence of malnutrition and associated factors in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on 239 hemodialysis patients (162 males and 77 females) referred to three dialysis centers in Ahvaz, Iran in 2018. The nutritional statuswas measured using subjective global assessment (SGA)tool. The anthropometric indices, body mass index (BMI) and biochemical parameters including albumin, triglyceride, C-reactive protein (CRP), and adequacy of dialysis (Kt/V) were also measured in all patients. Results: Based on SGA, 45 (18.8%) patients including 32 males and 13 females had mild to moderate malnutrition while 26 (10.9%) patients consisting of 11 men and 15 women had severe malnutrition. We found a significant association between patients’ gender and malnutrition status (P=0.013). In addition, a significant association was seen between age (P=0.024), BMI (P=0.0001), CRP (P=0.047) and serum albumin concentration (P=0.007) with nutritional status. However, we did not find any significant association between triglyceride, Kt/V and duration of hemodialysis per week with malnutrition (P>0.05). Moreover, BMI, patient’s gender and serum albumin were the significant predictors of severe malnutrition in hemodialysis patients (P<0.05). Conclusion: According to high prevalence of malnutrition in ESRD patients undergoing hemodialysis, periodic assessment of nutritional status is necessary for them. Moreover, female patients, CRP, serum albumin and BMI showed a significant correlation with SGA score, which are important to determine the nutritional status of hemodialysis patients (HD) patients.

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