La sorveglianza e la prevenzione degli infortuni in ambienti di civile abitazione: alcune riflessioni per l'attuazione dell'art. 4 della Legge 493/1999

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Serum levels of calcification inhibition proteins and coronary artery calcium score: Comparison between transplantation and dialysis

Vascular calcifications in CKD are now linked to serum alterations of both divalent ions and calcification inhibitory proteins. Due to possible biochemical differences between dialysis (D) and transplantation (Tx), we examined the entity and severity of these biochemical modifications and of coronary artery calcium score separately in these two populations. We assayed, besides standard markers of inflammation, divalent ions and serum levels of fetuin, matrix Gla protein (MGP) and osteoprotegerin (OPG), in 51 Tx patients (age 45 +/- 12 years; 30 males, 21 females; previous D duration 4.8 +/- 4.2 years; Tx since 6.6 +/- 5.5 years; Cr 1.8 +/- 0.6 mg/dl) and in 49 D patients (age 49 +/- 14 years; 30 males, 19 females; D duration 5.6 +/- 4.8 years). Additionally, coronary calcium score (AS) was evaluated by cardiac multi-slice CT. Compared with D patients, Tx patients had better values of divalent ions and inflammation markers, and lower prevalence (65 vs. 86%; p < 0.02) and severity (AS = 570 +/- 1,637 vs. 1,311 +/- 3,128; p < 0.008) of coronary calcification. In addition, a tendency toward normalization for all of the three calcification inhibitory proteins was evident. In both Tx and D, AS correlated with age and OPG (Tx: r(s) = 0.439, p < 0.001, and r(s) = 0.510, p < 0.0001; D: r(s) = 0.471, p < 0.001, and r(s) = 0.403, p < 0.005, respectively); in D patients, a correlation was present also with D duration (r(s) = 0.435; p < 0.002), other markers of inflammation and, notably, fetuin (r(s) = -0.442; p < 0.002). Regression analysis selected previous time on D in Tx patients (r(m) = 0.400; p < 0.004), and C-reactive protein and OPG in D patients (r(m) = 0.518; p < 0.004) as the most predictive parameters of AS. Discriminant analysis confirmed the major role of age and D duration in the appearance of AS and evidenced male gender as a distinct risk condition. At variance, Tx duration was never associated with AS. In conclusion, as compared to D, renal Tx patients show serum levels of calcification inhibition proteins and of divalent ions closer to normal. As this is associated with a lower prevalence and severity of AS, it is suggested that Tx antagonize the accelerating role of D in the progression of vascular calcification. Assessment of both coronary calcifications and serum levels of calcification inhibitory proteins may be of value to identify those subjects at higher risk of development and progression of vascular lesions, among whom males have the highest rate. Copyright (c) 2007 S. Karger AG, Basel

Progression of Coronary Artery Calcification in Renal Transplantation and the Role of Secondary Hyperparathyroidism and Inflammation

Background and objectives: Transplantation should favorably affect coronary calcification (CAC) progression in dialysis; however, changes in CAC score in the individual patient are not reliably evaluated

Distinct impact of vitamin D insufficiency on calcitriol levels in chronic renal failure and renal transplant patients: a role for FGF23

Introduction: Vitamin D insufficiency contributes to calcitriol (1,25D) reduction in chronic kidney disease (CKD). Since CKD patients on conservative therapy (CRF) mostly develop, whereas transplant (TX) patients possibly recover from, secondary hyperparathyroidism (SH), we hypothesized a different efficiency of vitamin D hydroxylation in these 2 clinical conditions. Methods: We compared the impact of reduced 25-hydroxyvitamin D (25D) on circulating 1,25D in 111 CRF (mean age 63 \ub1 15 years; estimated glomerular filtration rate [eGFR] 36.4 \ub1 22.0 ml/min) and in 136 TX patients (mean age 50 \ub1 11 years; eGFR 47 \ub1 19.0 ml/min). Results: Vitamin D insufficient patients (69.1% in TX vs. 82% in CRF; p<0.005), compared with those without insufficiency, had lower values of 1,25D in CRF (24.5 \ub1 17.4 vs 35.8 \ub1 17.8 pg/mL; p<0.01) but not in TX (42.7 \ub1 23.8 vs. 50.1 \ub1 25.4 pg/mL; p=n.s.). Serum 25D and 1,25D were correlated in both CRF (r=0.387, p<0.0001) and TX (r=0.240, p0<.005) groups, but 1,25D values were higher in the TX group in any of the 4 ranges for 25D considered. Serum calcitriol correlated with eGFR (CRF: r=0.641, p<0.0001; TX: r=0.426, p<0.0001), but again with higher values in the TX group, in any of the CKD stages considered, except stage 2. In both conditions, the most predictive parameter of 1,25D levels was eGFR, together with phosphate and 25D in the CRF group (r2=0.545; p<0.0001), and with Ca and 25D in the TX group (r2=0.345; p<0.0001). In 2 subgroups, comparable for eGFR and 25D, levels of FGF23 were lower in the TX group, in agreement with higher values of 1,25D. Conclusions: A 25D deficit more significantly affects calcitriol concentrations in CRF as compared with TX. Efficiency of vitamin D hydroxylation should be considered when planning vitamin D replacement strategies