Dephosphorylated-uncarboxylated Matrix Gla protein concentration is predictive of vitamin K status and is correlated with vascular calcification in a cohort of hemodialysis patients.

Background: Matrix Gla protein (MGP) is known to act as a potent local inhibitor of vascular calcifications. However, in order to be active, MGP must be phosphorylated and carboxylated, with this last process being dependent on vitamin K. The present study focused on the inactive form of MGP (dephosphorylated and uncarboxylated: dp-ucMGP) in a population of hemodialyzed (HD) patients. Results found in subjects being treated or not with vitamin K antagonist (VKA) were compared and the relationship between dp-ucMGP levels and the vascular calcification score were assessed. Methods: One hundred sixty prevalent HD patients were enrolled into this observational cohort study, including 23 who were receiving VKA treatment. The calcification score was determined (using the Kauppila method) and dp-ucMGP levels were measured using the automated iSYS method. Results: dp-ucMGP levels were much higher in patients being treated with VKA and little overlap was found with those not being treated (5604 [3758; 7836] vs. 1939 [1419; 2841] pmol/L, p <0.0001). In multivariate analysis, treatment with VKA was the most important variable explaining variation in dp-ucMGP levels even when adjusting for all other significant variables. In the 137 untreated patients, dp-ucMGP levels were significantly (p < 0.05) associated both in the uni- and multivariate analysis with age, body mass index, plasma levels of albumin, C-reactive protein, and FGF-23, and the vascular calcification score. Conclusion: We confirmed that the concentration of dp-ucMGP was higher in HD patients being treated with VKA. We observed a significant correlation between dp-ucMGP concentration and the calcification score. Our data support the theoretical role of MGP in the development of vascular calcifications. We confirmed the potential role of the inactive form of MGP in assessing the vitamin K status of the HD patients

How to manage CKD before dialysis

peer reviewedChronic renal failure is usually a silent disease until its late stage, especially in elderly people. Screening for such disease is particularly useful in hypertensive diabetic patients above 50 years. The causes are indeed often vascular or metabolic (directly or not directly linked to diabetes mellitus). Other less frequent causes are yet possible. The search for the right diagnosis of renal insufficiency is always requested to apply the appropriate treatment, combined with medical measures for secondary and tertiary prevention. This review will give general advices to avoid the development of renal disease (stages 3 and 4) or its progression, and also insist on the potential nephrotoxic effects of some drugs.L’insuffisance rénale chronique (IRC) se développe le plus souvent sournoisement, surtout chez le sujet âgé. La détection de l’insuffisance rénale est particulièrement utile chez le patient hypertendu diabétique âgé de plus de 50 ans. L’origine est, en effet, actuellement le plus souvent vasculaire ou métabolique (directement ou indirectement liée au diabète). Des causes plus rares sont cependant toujours possibles. La recherche d’une étiologie à l’IRC s’impose de façon à appliquer un traitement plus ciblé, tout en stimulant les mesures de prévention secondaire et tertiaire. Cet article se concentrera sur les mesures préventives générales de l’IRC (stades 3 et 4) et sur quelques effets iatrogènes néphrotoxiques

L'insuffisance rénale et sa prise en charge

L’insuffisance rénale chronique constitue un problème chronique de santé, principalement lié de nos jours à 3 facteurs souvent conjointement présents (l’âge avancé, le diabète et l’hypertension artérielle). Une approche multidisciplinaire est nécessaire pour endiguer cette épidémie avec des partenaires de soins maîtrisant bien le sujet. A l’occasion de la journée mondiale du rein en mars 2008, cinq exposés sur le thème de cette prise en charge ont fait le point actualisé de ce problème important de santé publique.Chronic kidney disease is a worldwide growing problem, especially nowadays due to 3 factors very often encountered together (old age, diabetes mellitus and arterial hypertension) A multidisciplinary approach is needed to reduce this epidemic with important health implication. This needs of course well trained health partners. On the occasion of the world kidney day on March 2008, five lectures were given on the topic. The lecturers have insisted on the up to date management of chronic kidney insufficiency, a serious problem of public health

Evolution nutritionnelle des patients hémodialysés du CHBAH

La dénutrition touche les patients en hémodialyse surtout lorsqu'ils ont plus de 50 ans et plus de 5 ans de dialyse. En 2006, nous avions observé que les patients dialysés (n = 27) ne consommaient pas le taux de protéines et de calories recommandé. Depuis, nous avons élargi nos régimes. Cette présente étude évalue l'impact de cette nouvelle attitude nutritionnelle chez les anciens (n=11) et les nouveaux patient (n=10)