Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis

We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population

La Terapia della carenza di Vitamina D nella popolazione generale e nei pazienti con Malattia Renale Cronica

Treatment of vitamin D deficiency in the general population and in patients with chronic kidney disease Vitamin D is an essential micronutrient for humans. Vitamin D functions are not limited to the regulation of bone; it plays many pleiotropic effects due to ubiquitous distribution of VDR (Vitamin D Receptor). The vitamin D deficiency (defined as plasma levels of 25 - OH - vitamin D < 30 ng / ml) is now a public health problem worldwide. It is therefore essential to define protocols for supplementation of vitamin D in the general population and in patients with Chronic Kidney Disease and indications on the use of different Vitamins D available

Intestino e rene. La riscoperta di un antico legame

Abstract non disponibil

Crosstalk between intestine and kidney. Revival of an ancient link

Chronic kidney disease (CKD) is associated with systemic inflammation. The latter accelerates comorbidities that are associated with CKD (cardiovascular disease, anemia, infections, cachexia and several other conditions), shortens life span and greatly impairs the quality of life. Recently the attention has been focused intestine and intestinal microbiota as sources of systemic inflammation. On one hand, the microbiota promotes the production of uraemic solute with a biological impact on the progression of kidney failure and vascular diseases. On the other hand, the uraemic status alters the composition of the intestinal microbiota and the structure of the epithelial barrier, causing the translocation of both microbiota and uraemic toxins into the blood stream. Several approaches have recently been tested, including dietary measures, prebiotics, synbiotics and intestinal sorbents in order to reduce the generation and serum concentration of uraemic toxins

Occurrence of ischemic nephropathy in patients with atherosclerotic lesions. Retrospective Study

NTRODUCTION AND AIMS Ischemic renal disease (IRD) is caused by hemodynamically significant mono or bilateral renal artery stenosis. IRD is responsible for reduction of glomerular filtration rate (GFR) and/or loss of renal parenchyma. Clinical features can be renovascular hypertension and ischemic nephropathy. The exact prevalence of IRD is not well known since it is often asymptomatic. Therefore few patients are screened for IRD unless they become symptomatic. Ischemic nephropathy prevalence are based on autopsies and angiographic studies in patients with renovascular hypertension or atherosclerotic disease. This study aimed at assessing the prevalence of IRD, defining its clinic characteristics, evaluating useful imaging procedures in a cohort of patients with chronic kidney disease not in dialysis (CKD) and atherosclerotic lesions. METHODS 1607 CKD patients were retrospectively evaluated during the period 2008-2013 referred to the “Federico II” Department of Nephrology, Naples. Inclusion criteria were: CKD ( I - V KDOQI stages), presence of atherosclerotic lesions anywhere in arterial tree. Kidney transplant recipients and patients with chronic kidney disease requiring dialysis were excluded. Clinical characteristics ( age, sex, blood pressure, body weight, BMI, height), medical history ( previous cardiovascular events, history of familiar cardiovascular events,diabetes mellitus, hypertension ),data of imaging procedures ( angio-TC, angio- RM, color doppler ultrasound (US), renal scintigraphy, angiography, coronarography ) were collected. RESULTS 1 284 patients fulfilled inclusion criteria. Clinical characteristics are reported in Fig 1. Causes of CKD in the study cohort were: hypertension (16,9%), diabetes mellitus (13%), glomerulonephritis (10.9%), interstitial nephritis (3.2%), kidney stones (2.5%), polycystic kidney disease (1.8%),unknown (40%) . IRD prevalence was 11,3 %. The main imaging procedure used to detect renal artery stenosis was color-doppler US (71,9%) in IRD. Other imaging procedures were: angio TC (32%), renal scintigraphy (31%), renal angiography (15%), angio RM (12%). Compared to others, patients with IRD had higher prevalence of history of cardiovascular events in family (46.9% Vs 33.7%) (NS), dyslipidemia (84.4% vs 69%) (NS) and previous cardiovascular events (53.1% vs 32.1%) (NS) . CONCLUSIONS The present study shows that the IRD is frequently misdiagnosed. More careful evaluation should be performed among patients with not well defined cause of CKD and concomitant presence of atherosclerotic lesions on arterial tree. Color-doppler US is the most useful imaging procedure to identify IRD

Etelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in “Real Life”

Abstract: Etelcalcetide is a new calcimimetic indicated for the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients. Etelcalcetide ecacy in SHPT has been ascertained only in randomized controlled trials. This multicenter study was carried out in “real world” setting that is dierent from randomized controlled trials (RCTs) to (1) evaluate the eectiveness of etelcalcetide in SHPT, (2) to assess calcium, phosphorus, alkaline phosphatase changes, (3) to register gastrointestinal side eects. Data were collected from twenty-three dialysis units with n = 1190 patients on the charge. From this cohort, n = 168 (14%) patients were on treatment with etelcalcetide, and they were evaluated for statistics. A median weekly dose of etelcalcetide was 15 mg (7.5–45 mg). Patients were either naïve (33%) or switched from cinacalcet to obtain better control of SHPT with reduced side eects or pills burden. Serum parathyroid hormone (PTH) declined over time from a median value of 636 pg/mL to 357 pg/mL. The median time for responders (intact PTH (iPTH) range: two to nine times the upper normal limit) was 53 days; the percentage of responders increased (from baseline 27% to 63%) being similar in switched-patients and naïve-patients. Few patients had symptomatic hypocalcemia requiring etelcalcetide withdrawal (four cases (3%) at 30-day control, two cases (2%) at 60-day, one case (1%) at 90-day control). Side eects with etelcalcetide were lower (3–4%) than that registered during cinacalcet treatment (53%). Etelcalcetide is a new therapeutic option for SHPT with low side eects and pills burden. Etelcalcetide may improve adherence to therapy, avoiding unremitting SHP. It remains to be assessed whether etelcalcetide may reduce parathyroidectomy, vascular calcification, or mortality. Being etelcalcetide very potent in suppressing PTH levels, even in severe SHPT, future studies should evaluate the potential risk of more adynamic bone disease during long-term therapy

Correction: Etelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in “Real Life”. J. Clin. Med. 2019, 8, 1066

The authors wish to make the following corrections to the previous publication [...