Aim To evaluate the relationship between cardiovascular remodelling and glomerular filtration rate (eGFR) in pre-dialysis chronic kidney disease (CKD) patients without cardiovascular diseases (CVD) and in renal transplant recipients (RTR). Methods The cross-sectional study included 83 patients with eGFR<60 mL/min/1.73m 2 (45 with CKD 3 stage and 38 with CKD 4 stage). Thirty six RTR had eGFR 67.8 (57.3-73.7) mL/ min/1.73m 2 and control group consisted of 44 patients with eGFR>60 mL/min/1.73m 2. All patients were evaluated by echocardiography and X-ray. Results Left ventricular hypertrophy (LVH) was present in 74.7% CKD patients, most frequently in CKD 4 stage and in RTR. Calcifications of abdominal aorta (CAA) were present in 87% CKD 4, 60% RTR and in 44% CKD 3 patients. Calcifications of the mitral valve were found in 34.2% CKD 4, 25.0% RTR and in 6.7% CKD 3 stage patients. Aortic valve calcifications were most frequently present in CKD 4 stage (26.3%). The LV mass index negatively correlated with eGFR (p<0.001), and positively with parathyroid hormone (p<0.001), phosphorus (p=0.043), age (p<0.001) and diabetes (p=0.043). In multivariate regression analysis the risk factor for calcifications of the mitral and aortic valve, as well as for CAA was the decline in eGFR (p<0.001). Conclusion Renal transplant recipients have a higher incidence of CV remodelling than patients with CKD 3 and less than patients with CKD 4 stage, indicating incomplete regression of CV calcifications and LVH after kidney transplantation. A decrease of renal function represents a significant risk factor for valvular and vascular calcifications occurrence in CKD patients.
Hill N, Fatoba S, Oke J, Hirst J, ’callaghan O, Lasserson C, et al. Global prevalence of chronic kidney disease -a systematic review and meta-analysis. PLoS One. 2016. p. 158765.
2.
El Hafeez A, Bolignano S, D, ’arrigo D, Dounousi G, Tripepi E, et al. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open. 2018. p. 15069.
3.
Pluta A, Stroeecki P, Krintus M, Odrowaz-Sypniewska G, Manitius J. Left ventricular remodeling and arterial remodeling in patients with chronic kidney disease stage 1-3. Ren Fail. 2015. p. 1105–10.
4.
Nitta K, Iimuro S, Imai E, Matsuo S, Makino H, Akizawa T, et al. Risk factors for increased left ventricular hypertrophy in patients with chronic kidney disease: findings from the CKD-JAC study. Clin Exp Nephrol. 2019. p. 85–98.
5.
Massicotte-Azarniouch, David, Carrero J, Lam N, Molnar A, Zimmerman D, et al. Incident atrial fibrillation and the risk of congestive heart failure, myocardial infarction, end-stage kidney disease, and mortality among patients with a decreased estimated GFR. Am J Kidney Dis. 2018. p. 191–9.
6.
Park M, Hsu C, -Y, Li Y, Mishra R, Keane M, et al. Chronic Renal Insufficiency Cohort (CRIS) Study Group. Associations between kidney function and subclinical cardiac abnormalities in CKD. J Am Soc Nephrol. 2012. p. 1725–34.
7.
Paoletti E, Nicola D, Gabbai L, Chiodini F, Ravera P, Pieracci M, et al. Associations of left ventricular hypertrophy and geometry with adverse outcomes in patients with CKD and hypertension. Clin J Am Soc Nephrol. 2016. p. 271–9.
8.
Gorriz J, Molina P, Cerveron M, Vila R, Bover J, Nieto J, et al. Vascular calcification in patients with nondialysis CKD over 3 years. Clin J Am Soc Nephrol. 2015. p. 654–66.
9.
Porter C, Stavroulopoulos A, Roe S, Pointon K, Cassidy M. Detection of coronary and peripheral artery calcification in patients with chronic kidney disease stages 3 and 4, with and without diabetes. Nephrol Dial Transplant. 2007. p. 3208–13.
10.
Wang Y, Osborne M, Tung B, Li M, Li Y. Imaging cardiovascular calcification. J Am Heart Assoc. 2018. p. 8564.
11.
Byon C, Chen Y. Molecular mechanisms of vascular calcification in chronic kidney disease: the link between bone and the vasculature. Curr Osteopor Rep. 2015. p. 206–15.
12.
Gluba-Brzozka A, Michalska-Kasiczak M, Franczyk-Skora B, Nocun M, Banach M, Rysz J. Markers of increased cardiovascular risk in patients with chronic kidney disease. Lipids Health Dis. 2014. p. 135.
13.
Kim I, Kim M, Lee D, Lee S, Shin M, Rhee H, et al. Cardiac valve calcification is associated with presence and severity of coronary artery disease in patients with pre-dialysis chronic kidney disease. Clin Exp Nephrol. 2015. p. 1090–7.
14.
Peeters M, Van Den Brand J, Van Zuilen A, Koster Y, Bots M, Vervloet M, et al. Wetzels JFM and For the MASTERPLAN Study Group. Abdominal aortic calcification in patients with CKD. J Nephrol. 2017. p. 109–18.
15.
Levey A, Coresh J, Greene T, Marsh J, Stevens L, Kusek J, et al. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem. 2007. p. 766–72.
16.
KDIGO 2012 Clinical Practice Guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013. p. 1–150.
17.
Kauppila L, Polak J, Cupples L, Hannan M, Kiel D, Wilson P. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis. 1997. p. 245–50.
18.
Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P, et al. Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group. European Society of Cardiology. J Am Soc Echocardiogr. 2005. p. 1440–63.
19.
Bayauli M, Lepira F, Kayembe P, ’buyamba-Kabangu M, J. Left ventricular hypertrophy and geometry in type 2 diabetes patients with chronic kidney disease. An echocardiographic study. Cardiovasc J Afr. 2012. p. 73–7.
20.
Matsushita K, Kwak L, Sang Y, Ballew S, Skali H, Shah A, et al. Kidney disease measures and left ventricular structure and function: the atherosclerosis risk in communities study. J Am Heart Assoc. 2017. p. 6259.
21.
Ali T, Idrees M, Shoukat, Akhtar S. Left ventricular hypertrophy among predialysis chronic kidney disease patients: Sindh institute of urology and transplantation experience. Saudi J Kidney Dis Transpl. 2017. p. 1375–80.
22.
Shenasa M, Shenasa H. Hypertension, left ventricular hypertrophy, and sudden cardiac death. Int J Cardiol. 2017. p. 60–3.
23.
Chen S, Huang J, Su H, Chiu Y, Chang J, Hwang S, et al. Prognostic cardiovascular markers in chronic kidney disease. Kidney Blood Press Res. 2018. p. 1388–407.
24.
Urena-Torres P, Vervloet M, Mazzaferro S, Oury F, Brandenburg V, Bover J, et al. ERA-EDTA CKD-MBD Working Group. Novel insights into parathyroid hormone: report of the parathyroid day in chronic kidney disease. Clin Kidney J. 2018.
25.
Vervloet M, Van Ballegooijen A. Prevention and treatment of hyperphosphatemia in chronic kidney disease. Kidney International. 2018. p. 1060–72.
26.
Park K, Chang J, Kim T, Kim H, Lee E, Kim H, et al. Lower concentrations of serum phsphorus within the normal range could be associated with less calcification of the coronary artery in Koreans with normal renal function. Am J Clin Nutr. 2011. p. 1465–70.
27.
Custidio M, Koike M, Neves, Reis L, Graciolli F, Neves C, et al. Parathyroid hormone and phosphorus overload in uremia: impact on cardiovascular system. Nephrol Dial Transplant. 2012. p. 1437–45.
28.
Rebić D, Rašić S. Cardiovascular remodelling in chronic kidney disease. EMJ Neph. 2014. p. 113–9.
29.
Benz K, Hilgers K, Daniel C, Amann K. Vascular calcification in chronic kidney disease: the role of inflammation. Int J Nephrol. 2018. p. 4310379.
30.
Paloian N, Giachelli C. A current understanding of vascular calcification in CKD. Am J Physiol Renal Physiol. 2014. p. 891–900.
31.
Fox C, Larson M, Vasanrs, Guo C, Parise H, Levy D, et al. Cross-sectional association of kidney function with valvular and annular calcification: the Framingham heart study. J Am Soc Nephrol. 2006. p. 521–7.
32.
Rong S, Qiu X, Shang J, Huang M, Tang Y, Yuan Z, et al. Risk factors for heart valve calcification in chronic kidney disease. Medicine (Baltimore). 2018. p. 9804.
33.
Leskinen Y, Paana T, Saha H, Groundstroem K, Lehtimaki T, Kilpinen S, et al. Valvular calcification and its relationship to atherosclerosis in chronic kidney disease. J Heart Valve Dis. 2009. p. 429–38.
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