Cristiana David1,2, Jordi Bover3, Cornelia Voiculet4,5, Ileana Peride1,2, Lucian Cristian Petcu6, Andrei Niculae7,8, Adrian Covic9,10, Ionel Alexandru Checherita1,2. 1. Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital Bucharest, 37th Dionisie Lupu StreetSector 2, 020021, Bucharest, Romania. 2. Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania. 3. Department of Nephrology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain. 4. Department of Internal Medicine, "St. John" Emergency Clinical Hospital Bucharest, Bucharest, Romania. 5. Clinical Department No. 1, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania. 6. Department of Biostatistics and Biophysics, Faculty of Dental Medicine, "Ovidius" University Constanta, Constanta, Romania. 7. Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital Bucharest, 37th Dionisie Lupu StreetSector 2, 020021, Bucharest, Romania. niculaeandrei@yahoo.com. 8. Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania. niculaeandrei@yahoo.com. 9. Department of Nephrology, "Dr. C. I. Parhon" Clinical Hospital Iasi, Iasi, Romania. 10. Department of Internal Medicine I, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Iasi, Romania.
Abstract
INTRODUCTION: Chronic kidney disease-mineral bone disorder enhances coronary artery impairment (often occult and difficult to diagnose) in hemodialysis (HD) patients. The aim of the study was to correlate biochemical and imagistic parameters of MBD with the degree of documented coronary artery disease (CAD) in non-diabetic HD patients, in order to obtain a MBD-coronary risk score as a screening algorithm. METHODS: A 3-year prospective study was conducted on 168 non-diabetic HD patients, evaluating MBD biochemical parameters along with pulse wave velocity (PWV) determination and valve/coronary calcification assessment; coronary angiography was performed in symptomatic patients. Correlations between noninvasive parameters and the degree of coronary obstruction were assessed using IBM SPSS Statistics 20 software, Chi-square test and the determination of odds ratio. RESULTS: Significant differences in serum calcium (p < 0.001), phosphates (p = 0.03), bicarbonate (p < 0.001), albumin and iPTH (p = 0.002), percentage of deviations from PWV normal values (p = 0.004), average doses of phosphate binders and vitamin D and the number of vascular/valve calcifications were noted between the study group (angina, n = 17) and control group (asymptomatic, n = 151). After applying MBD-coronary risk score in control group, coronary angiography was performed in high-score patients. CONCLUSION: A noninvasive screening algorithm for early diagnosis of CAD in asymptomatic HD patients with altered MBD parameters is necessary. Applying MBD-coronary risk score might be an important step in the prevention of major coronary episodes by extending the indication for further investigations, early diagnosis and treatment management.
INTRODUCTION:Chronic kidney disease-mineral bone disorder enhances coronary artery impairment (often occult and difficult to diagnose) in hemodialysis (HD) patients. The aim of the study was to correlate biochemical and imagistic parameters of MBD with the degree of documented coronary artery disease (CAD) in non-diabeticHDpatients, in order to obtain a MBD-coronary risk score as a screening algorithm. METHODS: A 3-year prospective study was conducted on 168 non-diabeticHDpatients, evaluating MBD biochemical parameters along with pulse wave velocity (PWV) determination and valve/coronary calcification assessment; coronary angiography was performed in symptomatic patients. Correlations between noninvasive parameters and the degree of coronary obstruction were assessed using IBM SPSS Statistics 20 software, Chi-square test and the determination of odds ratio. RESULTS: Significant differences in serum calcium (p < 0.001), phosphates (p = 0.03), bicarbonate (p < 0.001), albumin and iPTH (p = 0.002), percentage of deviations from PWV normal values (p = 0.004), average doses of phosphate binders and vitamin D and the number of vascular/valve calcifications were noted between the study group (angina, n = 17) and control group (asymptomatic, n = 151). After applying MBD-coronary risk score in control group, coronary angiography was performed in high-score patients. CONCLUSION: A noninvasive screening algorithm for early diagnosis of CAD in asymptomatic HDpatients with altered MBD parameters is necessary. Applying MBD-coronary risk score might be an important step in the prevention of major coronary episodes by extending the indication for further investigations, early diagnosis and treatment management.
Entities:
Keywords:
Chronic hemodialysis; Coronary angiography; Coronary risk score; Mineral bone disorder
Authors: Alvaro Avezum; Marcia Makdisse; Frederick Spencer; Joel M Gore; Keith A A Fox; Gilles Montalescot; Kim A Eagle; Kami White; Rajendra H Mehta; Elias Knobel; Jean-Philippe Collet Journal: Am Heart J Date: 2005-01 Impact factor: 4.749
Authors: Ronald L Pisoni; Brenda W Gillespie; David M Dickinson; Kenneth Chen; Michael H Kutner; Robert A Wolfe Journal: Am J Kidney Dis Date: 2004-11 Impact factor: 8.860