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Hemodiyaliz Hastalarında Vasküler Kalsifikasyon, Arteriyel Sertlik ve Nütrisyonel Durumun Değerlendirilmesi, 5 Yıllık Takip Çalışması

Year 2023, Volume: 76 Issue: 4, 316 - 322, 05.04.2024

Yelda Öztürk

Abstract

Amaç: Bu çalışmada vasküler kalsifikasyon, arter sertlik ve nütrisyonel durum arasındaki ilişkinin ortaya çıkarılması ve 5 yıllık mortalite üzerine etkilerinin araştırılması amaçlanmıştır.

Gereç ve Yöntem: Çalışmaya 79 hemodiyaliz hastası dahil edildi. Fetuin-A ve FGF-23 kan seviyeleri ölçüldü. Önceki 12 ayın ortalama kan basıncı (KB) değerleri kullanıldı. Abdominal aortik kalsifikasyon (AAK) skoru lateral abdominal grafilerden ölçüldü. Arteriyel sertliğin değerlendirmesinde karotis-femoral nabız dalga hızı (kf-NDH) kullanıldı. Nütrsiyonel durumun değerlendirilmesi için geriatrik nütrisyonel risk indeksi (GNRI) kullanıldı.

GNRI formülü; [14,89*serum albümini (g/dL)] + (41,7* vücut ağırlığı/ideal vücut ağırlığı).

Bulgular: Yetmiş dokuz hastanın 25’i (%31,6) 5 yıl içinde öldü. Sağkalan ve ölen gruplar karşılaştırıldığında yaş (p=0,001), diabetes mellitus (p=0,041), GNRI (p=0,019), AAK skoru (p=0,009), kf-NDH (p=0,003), albümin (p=0,030), C-reaktif protein (p=0,003), diyaliz öncesi ortalama sistolik KB (p=0,018) ve diyaliz öncesi ortalama diyastolik KB (p=0,045) açısından iki grup arasında anlamlı fark bulunurken, Fetuin-A ve FGF-23 açısından fark bulunmadı. AAK skoru >3 [eğri altında kalan alan (AUC): 0,682], kf-NDH >8,1 (AUC: 0,727) ve GNRI ≤99,2 (AUC: 0,663) 5 yıllık mortaliteyi öngeren değerler olarak bulundu. Çok değişkenli Cox regresyon analizinde GNRI tek bağımsız değişkendi (tehlike oranı: 0,924, p=0,047).

Sonuç: AAK skoru, GNRI, kf-NDH ve uzun dönem mortalite arasında yakın ilişki mevcuttur. Kf-NDH ve ortalama KB ölçümleri ile yakın ilişkisi gelecekteki çalışmalar için değerlendirilmelidir. Bağımsız bir mortalite faktörü olarak kritik rolü nedeniyle GNRI skorlarının takibi hedeflenmelidir.

Anahtar Kelimeler: Vasküler Kalsifikasyon, Arteriyel Sertlik, Beslenme, FGF-23, Fetuin-A

Keywords

Vasküler Kalsifikasyon Arteriyel Sertlik Beslenme FGF-23 Fetuin-A

Ethical Statement

Ankara University Faculty of Medicine Clinical Research Ethics Committee approved this study on February 23, 2015 (approval no: 03-111-15).

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Zununi Vahed S, Mostafavi S, Hosseiniyan Khatibi SM, et al. Vascular Calcification: An Important Understanding in Nephrology. Vasc Health Risk Manag. 2020;16:167-180.
  • 2. Cannata-Andía JB, Martín-Carro B, Martín-Vírgala J, et al. Chronic Kidney Disease-Mineral and Bone Disorders: Pathogenesis and Management. Calcif Tissue Int. 2021;108:410-422.
  • 3. Gungor O, Kocyigit I, Yilmaz MI, et al. Role of vascular calcification inhibitors in preventing vascular dysfunction and mortality in hemodialysis patients. Semin Dial. 2018;31:72-81.
  • 4. Kauppila LI, Polak JF, Cupples LA, et al. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25- year follow-up study. Atherosclerosis. 1997;132:245-250.
  • 5. Chen Y, Zhao X, Wu H. Arterial Stiffness: A Focus on Vascular Calcification and Its Link to Bone Mineralization. Arterioscler Thromb Vasc Biol. 2020;40:1078-1093.
  • 6. Fiaccadori E, Sabatino A, Barazzoni R, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021;40:1644-1668.
  • 7. Yamada S, Tsuruya K, Kitazono T, et al. Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutritioninflammation complex syndrome (MICS) in patients receiving dialysis. Clin Exp Nephrol. 2022;26:613-629.
  • 8. Nakagawa N, Maruyama K, Hasebe N. Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review. Nutrients. 2021;13:3688.
  • 9. Covic A, Siriopol D. Pulse wave velocity ratio: the new “gold standard” for measuring arterial stiffness. Hypertension. 2015;65:289-290.
  • 10. Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87:106-113.
  • 11. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011). 2017;7:1-59.
  • 12. Niu Q, Hong Y, Lee CH, et al. Abdominal aortic calcification can predict allcause mortality and CV events in dialysis patients: A systematic review and meta-analysis. PLoS One. 2018;13:e0204526.
  • 13. Van Bortel LM, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotidfemoral pulse wave velocity. J Hypertens. 2012;30:445-448.
  • 14. Cabrera-Fischer E, Zocalo Y, Wray S, et al. Arterial Stiffness in Haemodialyzed Patients: Findings and Controversies. Curr Hypertens Rev. 2018;14:100-106.
  • 15. Yakar B, Demir M, Onalan E, et al. Arterial Stiffness and its Related Factors in Patients on Hemodialysis. J Coll Physicians Surg Pak. 2021;31:138-143.
  • 16. Fan Y, Gao W, Li J, et al. Effect of the baseline pulse wave velocity on short term and long term blood pressure control in primary hypertension. Int J Cardiol. 2020;317:193-199.
  • 17. Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777-783.
  • 18. Takahashi H, Ito Y, Ishii H, et al. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol. 2014;64:32-36.
  • 19. Panichi V, Cupisti A, Rosati A, et al. Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort. J Nephrol. 2014;27:193-201.
  • 20. Zhou Z, Ji Y, Ju H, et al. Circulating Fetuin-A and Risk of All-Cause Mortality in Patients With Chronic Kidney Disease: A Systematic Review and Meta- Analysis. Front Physiol. 2019;10:966.
  • 21. Vázquez-Sánchez S, Poveda J, Navarro-García JA, et al. An Overview of FGF- 23 as a Novel Candidate Biomarker of Cardiovascular Risk. Front Physiol. 2021;12:632260.

The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study

Year 2023, Volume: 76 Issue: 4, 316 - 322, 05.04.2024

Yelda Öztürk

Abstract

Objectives: This study aimed to find out the relationship between vascular calcification, arterial stiffness, and nutritional status, and investigate their effects on 5-year mortality.

Materials and Methods: This study included 79 hemodialysis patients. Fetuin-A and FGF-23 levels were measured. The average blood pressure (BP) of the previous 12 months was used. The abdominal aortic calcification (AAC) score was measured from lateral abdominal radiographs. Carotidfemoral pulse wave velocity (cf-PWV) was used for arterial stiffness assessment. The geriatric nutritional risk index (GNRI) was used for nutritional status, and calculated as the following formula; [14.89*serum albumin (g/dL)] + (41.7* body weight/ideal body weight).

Results: Twenty-five (31.6%) of 79 patients died within 5 years. When the alive and deceased groups were compared age (p=0.001), diabetes mellitus (p=0.041), GNRI (p=0.019), AAC score (p=0.009), cf-PWV (p=0.003), albumin (p=0.030), C-reactive protein (p=0.003), mean systolic BP before dialysis (p=0.018), and mean diastolic BP before dialysis (p=0.045) were significantly different between two groups, whereas Fetuin-A and FGF-23 were not. AAC score above 3 points [area under the curve (AUC): 0.682], cf-PWV above 8.1 (AUC: 0.727), and GNRI score 99.2 and lower (AUC: 0.663) had estimated 5-year mortality well. GNRI was the only independent variable (hazard ratio: 0.924, p=0.047) in multivariable cox regression analysis.

Conclusion: There was a close relationship between AAC score, GNRI, cf-PWV, and long-term mortality. The cf-PWV and its close relationship with average BP measurements must be assessed for future studies. Following GNRI must be targeted for its crucial role as an independent factor of mortality.

Key Words: Vascular Calcification, Arterial Stiffness, Nutrition, FGF-23, Fetuin-A

Keywords

Vascular Calcification Arterial Stiffness Nutrition FGF-23 Fetuin-A

Ethical Statement

Ankara University Faculty of Medicine Clinical Research Ethics Committee approved this study on February 23, 2015 (approval no: 03-111-15).

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Zununi Vahed S, Mostafavi S, Hosseiniyan Khatibi SM, et al. Vascular Calcification: An Important Understanding in Nephrology. Vasc Health Risk Manag. 2020;16:167-180.
  • 2. Cannata-Andía JB, Martín-Carro B, Martín-Vírgala J, et al. Chronic Kidney Disease-Mineral and Bone Disorders: Pathogenesis and Management. Calcif Tissue Int. 2021;108:410-422.
  • 3. Gungor O, Kocyigit I, Yilmaz MI, et al. Role of vascular calcification inhibitors in preventing vascular dysfunction and mortality in hemodialysis patients. Semin Dial. 2018;31:72-81.
  • 4. Kauppila LI, Polak JF, Cupples LA, et al. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25- year follow-up study. Atherosclerosis. 1997;132:245-250.
  • 5. Chen Y, Zhao X, Wu H. Arterial Stiffness: A Focus on Vascular Calcification and Its Link to Bone Mineralization. Arterioscler Thromb Vasc Biol. 2020;40:1078-1093.
  • 6. Fiaccadori E, Sabatino A, Barazzoni R, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021;40:1644-1668.
  • 7. Yamada S, Tsuruya K, Kitazono T, et al. Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutritioninflammation complex syndrome (MICS) in patients receiving dialysis. Clin Exp Nephrol. 2022;26:613-629.
  • 8. Nakagawa N, Maruyama K, Hasebe N. Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review. Nutrients. 2021;13:3688.
  • 9. Covic A, Siriopol D. Pulse wave velocity ratio: the new “gold standard” for measuring arterial stiffness. Hypertension. 2015;65:289-290.
  • 10. Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87:106-113.
  • 11. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011). 2017;7:1-59.
  • 12. Niu Q, Hong Y, Lee CH, et al. Abdominal aortic calcification can predict allcause mortality and CV events in dialysis patients: A systematic review and meta-analysis. PLoS One. 2018;13:e0204526.
  • 13. Van Bortel LM, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotidfemoral pulse wave velocity. J Hypertens. 2012;30:445-448.
  • 14. Cabrera-Fischer E, Zocalo Y, Wray S, et al. Arterial Stiffness in Haemodialyzed Patients: Findings and Controversies. Curr Hypertens Rev. 2018;14:100-106.
  • 15. Yakar B, Demir M, Onalan E, et al. Arterial Stiffness and its Related Factors in Patients on Hemodialysis. J Coll Physicians Surg Pak. 2021;31:138-143.
  • 16. Fan Y, Gao W, Li J, et al. Effect of the baseline pulse wave velocity on short term and long term blood pressure control in primary hypertension. Int J Cardiol. 2020;317:193-199.
  • 17. Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777-783.
  • 18. Takahashi H, Ito Y, Ishii H, et al. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol. 2014;64:32-36.
  • 19. Panichi V, Cupisti A, Rosati A, et al. Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients: data from the Riscavid cohort. J Nephrol. 2014;27:193-201.
  • 20. Zhou Z, Ji Y, Ju H, et al. Circulating Fetuin-A and Risk of All-Cause Mortality in Patients With Chronic Kidney Disease: A Systematic Review and Meta- Analysis. Front Physiol. 2019;10:966.
  • 21. Vázquez-Sánchez S, Poveda J, Navarro-García JA, et al. An Overview of FGF- 23 as a Novel Candidate Biomarker of Cardiovascular Risk. Front Physiol. 2021;12:632260.
There are 21 citations in total.

Details

Primary Language English
Subjects Cardiovascular Medicine and Haematology (Other)
Journal Section Articles
Authors

Yelda Öztürk 0000-0003-3847-0967

Project Number -
Publication Date April 5, 2024
Published in Issue Year 2023 Volume: 76 Issue: 4

Cite

APA Öztürk, Y. (2024). The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 76(4), 316-322. https://doi.org/10.4274/atfm.galenos.2023.48295
AMA Öztürk Y. The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study. Ankara Üniversitesi Tıp Fakültesi Mecmuası. April 2024;76(4):316-322. doi:10.4274/atfm.galenos.2023.48295
Chicago Öztürk, Yelda. “The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76, no. 4 (April 2024): 316-22. https://doi.org/10.4274/atfm.galenos.2023.48295.
EndNote Öztürk Y (April 1, 2024) The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76 4 316–322.
IEEE Y. Öztürk, “The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 76, no. 4, pp. 316–322, 2024, doi: 10.4274/atfm.galenos.2023.48295.
ISNAD Öztürk, Yelda. “The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76/4 (April 2024), 316-322. https://doi.org/10.4274/atfm.galenos.2023.48295.
JAMA Öztürk Y. The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;76:316–322.
MLA Öztürk, Yelda. “The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 76, no. 4, 2024, pp. 316-22, doi:10.4274/atfm.galenos.2023.48295.
Vancouver Öztürk Y. The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;76(4):316-22.
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