Peripheral Vascular Calcification in Patients on Regular Hemodialysis in relation to Parathyroid Hormone Abnormalities

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Dr. Azzam Hussein Hmoud, Dr. Ibrahim Asi Ali, Dr. Maha Muwafaq Nayyef*, “Peripheral Vascular Calcification in Patients on Regular Hemodialysis in relation to Parathyroid Hormone Abnormalities”, ijmhs, vol. 10, no. 02, pp. 800–809, Feb. 2020.
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Abstract

Background: Peripheral vascular calcification (PVC) commonly develop in patients on hemodialysis (HD) and associated with increase risk of morbidity and mortality. Aim of study: To study risk factors of developing peripheral vascular calcification in patients on hemodialysis especially in relation to parathyroid hormone abnormalities. Patients and Methods: Cross sectional (observational) study on 54 patients on regular hemodialysis and divided into 2 groups according to abdominal X-Ray. Results: 54 patient: 32 female, 22 male; mean age = 51.59 +/- 17.61, mean duration of HD = 44.83 +/- 38. 4 months Peripheral vascular calcification by lateral lumbar X-Ray is 12 patients i.e 22.22% We studied effects of many risk factors and appeared significant effects of age, duration of HD and use of calcium containing oral phosphate binders. Also there is some effects of increased serum calcium and phosphate, hypertension and DM but statistically not significant. PTH abnormalities also affect on PVC especially in low level of PTH (a dynamic bone disease) but statistically not significant. In this study, no apparent effect of inflammation on calcification. Conclusion: Peripheral vascular calcification, commonly present in patients on hemodialysis and associated with increase risk of morbidity and mortality, with many risk factors causing increase peripheral vascular calcification which can be prevented and treated

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1.Braun J. oldendorf M.Moshage W.et al.Electorn beam computed tomography inthe evolution of cardiac calcification inchronic dialysis patients. Am J. Kidney Dis. 1996 : 27 : 394 2.Goodman WG,Goldin J. kuizon BD, etal. Coronary-artery calcification in young,adults with end-stage renal disease whoare undergoing dialysis. N.Engl.J.Med 2000; 342 : 1478. 3.cheratow GM, Burke SK, Raggi P, Treatto Goal working group. Sevelamerattenuates the progression of coronaryand aortic calcification in hemodilysispatients. Kidney int. 2002; 62: 245 4.London GM, Guerin AP, Marchais SJ,et.al. Arterial medical calcification in end-stage renal disease; impact on all- causeand cardiovascularmortality. Nephrol Dial Transplant 2003;18:1731 5.Sigrist MK, Tall MW, Bungay P McIntyre CW. Progressionvascular calcification over2 years is associated with arterial stiffening andincreased mortality in patients with stage4 and 5 chronic kidney disease . Clin J.Am Soc Nephrol.2007;2(6): 1241. 6.Block GA, Klassen PS, Lazarus JM, etal,Mineral metabolism , mortality andmorbidity in maintenance Hemodilysis , JA m Soc Nephrol 2004,15: 2208-18 7.John Feehally,Jurgen F,Marcello T,Richard JJ-ch84.Comprehensive clinical nephrology ;2016: P 979-995. 8.Young EW, Albert JM satayathum S,etal, predictors and sequences of alteredmineral metabolism : the dialysis outcomes and practice pattern study. Kidneyint.2005 ;1179 9.Foley RV, Parefy PS, Harnett JD, etal.Hypocalcemia, morbidity and mobility inend stage renal disease. AMJ Nephrol1996;16 (5) :386-93. 10.O'Neil WC.Lomashvilli KA, MallucheHH, etal. Treatment with pyrophosphate inhibits uremic vascular calcification, kidney int.2011,79; 512 11.KDIGO clinical practice guidelines fordiagnosis evaluation, prevention andtreatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)–kidney int.2009, 76( suppl 113) . 51 12.K/DOQI clinical practice guidelines forcardiovascular disease in dialysispatients. a.AMJ kidney Dis. 2005,45( suppl3), 51 13.Goldsmith DJ. Covic A. Sambrook PA,Ackrill P. Vascular calcification in long termhemodilysis patients in a single unit,retrospective analysis Nephron1997,77,37. 14.Chertow GM, Burke SK, Raggi P. Teat to Goal working group . sevelamerattenuates the progression of coronaryand aortic calcification in hemodilysispatients. Kidney Int.2002,62,245. 15.Mathew S, land RJ, Strebeck F,etal,reversal of the a dynamic bone disorderand decreased vascular calcification inchronic kidney disease by sevelamercarbonate therapy. J Am. Soc. Nephrol 2007, 18:122. 16.Chertow GM,Raggi P, chasan- taber S,etal Determinates of progressive vascularcalcification in hemodilysis patients.Nephrol Dial Transpal 2004,19:1489. 17.National kidney foundation, K/DOQIclinical practice guidelines for bonemetabolism and disease in chronic kidneydisease .AMJ .Kidney Dis.2003,42:51 18.KDIGO clinical practice guidelines forthe diagnosis, evaluation, prevention andtreatment Chronic kidney Disease –Mineral and Bone Disorder (CKD-MBD). Kidney Int.2009, 76( suppl 113) ;51

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References

1.Braun J. oldendorf M.Moshage W.et al.Electorn beam computed tomography inthe evolution of cardiac calcification inchronic dialysis patients.
Am J. Kidney Dis. 1996 : 27 : 394
2.Goodman WG,Goldin J. kuizon BD, etal. Coronary-artery calcification in young,adults with end-stage renal disease whoare undergoing dialysis. N.Engl.J.Med 2000; 342 : 1478.
3.cheratow GM, Burke SK, Raggi P, Treatto Goal working group. Sevelamerattenuates the progression of coronaryand aortic calcification in hemodilysispatients. Kidney int. 2002; 62: 245
4.London GM, Guerin AP, Marchais SJ,et.al. Arterial medical calcification in end-stage renal disease; impact on all- causeand cardiovascularmortality. Nephrol Dial Transplant 2003;18:1731
5.Sigrist MK, Tall MW, Bungay P McIntyre CW. Progressionvascular calcification over2 years is associated with arterial stiffening andincreased mortality in patients with stage4 and 5 chronic kidney disease . Clin J.Am Soc Nephrol.2007;2(6): 1241.
6.Block GA, Klassen PS, Lazarus JM, etal,Mineral metabolism , mortality andmorbidity in maintenance Hemodilysis , JA m Soc Nephrol 2004,15: 2208-18
7.John Feehally,Jurgen F,Marcello T,Richard JJ-ch84.Comprehensive clinical nephrology ;2016: P 979-995.
8.Young EW, Albert JM satayathum S,etal, predictors and sequences of alteredmineral metabolism : the dialysis outcomes and practice pattern study. Kidneyint.2005 ;1179
9.Foley RV, Parefy PS, Harnett JD, etal.Hypocalcemia, morbidity and mobility inend stage renal disease. AMJ Nephrol1996;16 (5) :386-93.
10.O'Neil WC.Lomashvilli KA, MallucheHH, etal. Treatment with pyrophosphate inhibits uremic vascular calcification, kidney int.2011,79; 512
11.KDIGO clinical practice guidelines fordiagnosis evaluation, prevention andtreatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)–kidney int.2009, 76( suppl 113) . 51
12.K/DOQI clinical practice guidelines forcardiovascular disease in dialysispatients. a.AMJ kidney Dis. 2005,45( suppl3), 51
13.Goldsmith DJ. Covic A. Sambrook PA,Ackrill P. Vascular calcification in long termhemodilysis patients in a single unit,retrospective analysis Nephron1997,77,37.
14.Chertow GM, Burke SK, Raggi P. Teat to Goal working group . sevelamerattenuates the progression of coronaryand aortic calcification in hemodilysispatients. Kidney Int.2002,62,245.
15.Mathew S, land RJ, Strebeck F,etal,reversal of the a dynamic bone disorderand decreased vascular calcification inchronic kidney disease by sevelamercarbonate therapy. J Am. Soc. Nephrol 2007, 18:122.
16.Chertow GM,Raggi P, chasan- taber S,etal Determinates of progressive vascularcalcification in hemodilysis patients.Nephrol Dial Transpal 2004,19:1489.
17.National kidney foundation, K/DOQIclinical practice guidelines for bonemetabolism and disease in chronic kidneydisease .AMJ .Kidney Dis.2003,42:51
18.KDIGO clinical practice guidelines forthe diagnosis, evaluation, prevention andtreatment Chronic kidney Disease –Mineral and Bone Disorder (CKD-MBD). Kidney Int.2009, 76( suppl 113) ;51

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