Relation of oral 1alpha-hydroxy vitamin D3 to the progression of aortic arch calcification in hemodialysis patients.

The role of decreased active vitamin D levels on vascular calcification has not been elucidated in hemodialysis (HD) patients. The aim of the present study was to evaluate the relationship between progression of aortic arch calcification (AoAC) and prescribed dose of 1alpha-hydroxy vitamin D. The enrolled study subjects were 65 (40 men and 25 women) HD patients. Calcification of the aortic arch was semiquantitatively estimated with a score (AoACS) on plain chest radiology. Change in AoACS (DeltaAoACS) was obtained by subtracting the baseline AoACS value from the follow-up AoACS value. The second assessment was performed from 2 years after the first determination. The nonprogressors (63.2 +/- 14.5 years) were significantly younger than the progressors (68.2 +/- 10.8 years) (P = 0.0419). In addition, prescribed dose of 1alpha-hydroxy vitamin D3 was significantly higher in the nonprogressors (125.5 +/- 109.1 microg) than progressors (84.8 +/- 81.1 microg) (P = 0.0371). Multiple regression analysis revealed prescribed dose of 1alpha-hydroxy vitamin D(3) (beta value = -0.324, P = 0.0051) as well as DBP (beta value = -0.418, P = 0.007), serum levels of P (beta value = 0.333, P = 0.006) and C-reactive protein (beta value = 0.237, P = 0.0048) to be significant independent determinants of DeltaAoACS. In conclusion, the evaluation of AoACS on chest radiography is a very simple tool in HD patients. Active vitamin D therapy seems to protect patients from developing vascular calcification.

Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients.

OBJECTIVE: Although aortic arch calcification (AoAC) is reported as a predictor for cardiovascular mortality in the general population, it is unknown whether this is also true in hemodialysis (HD) patients in whom vascular calcification and cardiovascular diseases are highly prevalent. METHODS: The enrolled study subjects were 401 patients (270 men and 131 women) on chronic HD therapy. Calcification of the aortic arch was semiquantitatively estimated with a score (AoACS) on plain chest radiography. Survival curves were estimated by means of the Kaplan-Meier method and evaluated using the log-rank test. RESULTS: AoAC was present in 203 patients (50.6%). During a follow-up period of 4.0 years, there were 72 all-cause deaths, of which 41 were from cardiovascular diseases. Of patients with and without AoAC, 15.2 and 20.7% died, respectively (11.3 and 6.6% of cardiovascular diseases, respectively). Kaplan-Meier analysis showed that cardiovascular mortality was significantly greater in patients with AoAC compared to those without (P = 0.0396, log-rank test). Multivariate Cox proportional hazards analysis found that the presence of AoAC was significantly associated with increased cardiovascular mortality (hazard ratio, 2.556; 95% confidence interval, 1.006-6.490; P < 0.05) after adjustment for age, presence of diabetes, body mass index, diastolic blood pressure, and serum albumin level. CONCLUSION: The presence of AoAC is significantly associated with cardiovascular mortality in HD patients, suggesting that careful attention should be given to the presence of AoAC in a plain chest radiograph as a prognostic indicator.

Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients.

BACKGROUND/AIM: Atherosclerosis is evaluated by carotid mean intima-media thickness (mean IMT), pulse wave velocity (PWV), and the aortic calcification index (ACI). We have attempted to examine if these atherosclerotic parameters are associated with each other and which parameters are closely related to cardiac function in chronic HD patients. METHODS: The mean IMT, PWV and ACI were examined in 69 maintenance HD patients using carotid ultrasonography, a blood volume plethysmographic apparatus and abdominal CT, respectively. Echocardiographic studies were also performed for measuring left ventricular (LV) geometry. Serum total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, albumin, C-reactive protein (CRP), calcium and phosphate were measured. RESULTS: The mean IMT correlated positively with ACI (r = 0.461, P < 0.0001) and tended to be correlated with PWV, but did not reach statistical significance. The PWV value correlated positively with ACI (r = 0.494, P

Simple evaluation of aortic arch calcification by chest radiography in hemodialysis patients.

Vascular calcification is associated with a poor prognosis in dialysis patients. It can be assessed with computed tomography but simple inoffice techniques may provide useful information. We compared the results obtained with a simple noninvasive technique with those obtained using multidetector computed tomography for aortic arch calcification volume (AoACV) in chronic hemodialysis (HD) patients. The enrolled study subjects were 63 (32 men and 31 women) maintenance HD patients. Calcification of the aortic arch was semiquantitatively estimated with a AoAC score (AoACS) on plain chest radiology. The AoACV was increased, with a mean value of 6.6 ranging from 0% to 36.5%. The coefficient of intraobserver variation was less than 2.5%. Aortic arch calcification score was highly correlated with AoACV (r=0.635, P<0.001). Multiple regression analysis showed age (F value=12.62, P<0.001) and pulse pressure (F value=4.54, P=0.037) to be significant independent determinants of AoACS. In conclusion, a simple measurement of AoACS may be useful for inoffice imaging to choose a therapeutic regimen in HD patients.

Arterial stiffness in patients with non-diabetic chronic kidney disease (CKD).

BACKGROUND: Patients with chronic kidney disease (CKD) have a high prevalence of cardiovascular disease (CVD). Arterial stiffness plays an important role in the pathogenesis of CVD; however, to date, there have been no reports of the assessment of arterial stiffness in patients at different stages of non-diabetic CKD. METHODS: We studied 50 patients with non-diabetic CKD (stages 1-5, 5D) receiving medical treatment at Tokyo Women's Medical University. Pulse wave velocity (PWV) was assessed using an applanation tonometer to determine arterial compliance. All current medications were recorded and biochemical parameters were analyzed. RESULTS: Non-diabetic CKD stage 5D patients had a higher PWV, and higher serum levels of C-reactive protein (CRP), Ca, P and intact parathyroid hormone (iPTH) than non-diabetic CKD stage 1-5 patients (p=0.03, p=0.009, p=0.006, p=0.00005, and p=0.002, respectably). As compared to non-diabetic CKD stage 1-2 patients, patients with non-diabetic CKD stage 3-5 were older, and had higher serum levels of P and iPTH and a higher PWV (p=0.0002, p=0.009, p=0.03, and p=0.004). Nephrosclerosis was associated with a higher PWV, higher serum levels of CRP, and a higher prevalence of CVD than patients with CKD of other origins. CONCLUSION: We showed a stepwise increase of arterial stiffness with increasing disease severity stage in patients with CKD not associated with diabetes mellitus. CKD caused by nephrosclerosis was found to be associated with increased arterial stiffness and to be a risk factor for CVD.

Relation of stiffness parameter beta to carotid arteriosclerosis and silent cerebral infarction in patients on chronic hemodialysis.

OBJECTIVE: Aortic stiffness measured by pulse wave velocity (PWV) predicts all-cause and cardiovascular mortality in hemodialysis (HD) patients. However, there is a lack of information on stiffness parameter beta, another index of arterial stiffness, in HD patients. The aim of the present study was to investigate the clinical usefulness of stiffness parameter beta in HD patients. MATERIALS AND METHOD: We compared the relation of stiffness parameter beta to carotid intima-media thickness (IMT) and plaque score estimated by carotid ultrasound and investigated the relationship between stiffness parameter beta and silent cerebral infarction (SCI) in 64 HD patients. RESULTS: Stiffness parameter beta was positively correlated with mean IMT (r = 0.318, P = 0.0113) and plaque score (r = 0.672, P < 0.0001). Stepwise regression analysis revealed that pulse pressure and age were found to be independent determinants of stiffness parameter beta (partial correlation coefficients: beta = 0.501 and P < 0.0001 for pulse pressure, beta = 0.488 and P < 0.0001 for age). In addition, stiffness parameter beta in patients with SCI (12.2 +/- 3.9) was significantly higher than those (8.0 +/- 2.4) in patients without SCI. However, there was no significant difference in mean IMT and plaque score in both groups. CONCLUSION: These results suggest that arteriosclerosis assessed by stiffness parameter beta is associated with atherosclerotic changes of carotid arteries and with the presence of SCI in HD patients.

[Effects of steroid therapy on membranous nephropathy].

BACKGROUND: Although membranous nephropathy is a common cause of nephrotic syndrome in adults, its treatment remains under debate. METHODS: To clarify the effects of steroid therapy, the data of 51 Japanese adult patients with idiopathic membranous nephropathy who received treatment at our department were analyzed retrospectively. We divided the patients with nephrotic syndrome and a serum creatinine level <1.7 mg/dL, into two groups: the steroid therapy group (n=20) and the non-steroid therapy group (n=7), and compared the clinical characteristics between the two groups. RESULTS: Significantly decreased proteinuria levels (p<0.05) after 2 and 5 years were observed in the steroid therapy group as compared to the non-steroid therapy group. There was no significant difference in the serum creatinine levels after 2 and 5 years between the steroid therapy group and the non-steroid therapy group. CONCLUSION: Steroid therapy in idiopathic membranous nephropathy showed good efficacy in patients with nephrotic syndrome.

Aortic arch calcification and arterial stiffness are independent factors for diastolic left ventricular dysfunction in chronic hemodialysis patients.

BACKGROUND: Because cardiovascular disease is the major cause of death in dialysis patients, the correlation between diastolic left ventricular (LV) dysfunction and arterial sclerosis, including thoracic aortic calcification, was studied in chronic hemodialysis (HD) patients. METHODS AND RESULTS: The enrolled study subjects were 142 (73 men, 69 women) maintenance HD patients. Aortic arch calcification volume (AoACV) was measured by MDCT scan, arterial stiffness was estimated by brachial-ankle pulse wave velocity (PWV) and diastolic LV function was estimated as E/E' by tissue Doppler imaging with cardiac ultrasonography. E/E' correlated significantly with systolic blood pressure (r=0.29, p=0.037), age (r=0.19, p=0.02), LV mass index (r=0.18, p=0.036), dialysis vintage (r=0.19, p=0.037), AoACV (r=0.37, p<0.0001) and PWV (r=0.33, p=0.0002). Multiple regression analysis indicated that AoACV (beta=0.26, p=0.005) and PWV (beta=0.22, p=0.03) were independent determinants of E/E'. CONCLUSION: Diastolic LV dysfunction may be induced by increased vascular calcification and reduced arterial stiffness in chronic HD patients.

Patterns in the prevalence of hepatitis C virus infection at the start of hemodialysis in Japan.

BACKGROUND: Although hepatitis C virus (HCV) infection is a persistent public health concern in hemodialysis patients, there seem to have been only a few reports on the prevalence of HCV at the start of hemodialysis. In this study we investigated whether patients starting on hemodialysis therapy are positive for anti-HCV antibody or not. METHODS: The 400 patients who began regular hemodialysis between February 2003 and June 2007 were enrolled in this study. Clinical data such as age, anti-HCV antibody and primary cause of end-stage kidney disease (ESKD) were examined. As healthy controls we used 70,717 healthy blood donors in 2005 whose data were obtained from Tokyo Metropolitan Red Cross Blood Center. Anti-HCV antibody was used as an indicator of HCV infection. Since the prevalence of HCV infection is affected by age in Japan, we classified the patients by age group. RESULTS: The anti-HCV antibody prevalence rate among the patients who were new to hemodialysis was 7.3%, as opposed to 0.15% in the healthy volunteers. The prevalence of HCV in the 31-45-, 46-60-, and 61-year-old groups was significantly higher among the hemodialysis patients than among the healthy volunteers (P = 0.0209, <0.0001, and <0.0001, respectively). The prevalence rate of anti-HCV antibody was higher among men (10.0%) than among women (1.5%, P < 0.0001) in the hemodialysis patients. The anti-HCV-antibody-positive patients were significantly older than the anti-HCV-antibody-negative patients (66.4 +/- 14.3 years versus 58.6+/-16.6 years; P = 0.0152). Diabetic nephropathy was a more frequent cause of ESKD among the anti-HCV-antibody-positive patients (30.4%) than among the anti-HCV-antibody-negative patients (19.9%, P = 0.0122). Among the anti-HCV-antibody-positive patients, 55.2% had received a blood transfusion. The rate was significantly higher than that among the anti-HCV-antibody-negative patients (19.4%, P < 0.0001). CONCLUSION: The results showed a much higher rate of anti-HCV antibody positivity in patients new to hemodialysis than in healthy volunteers. Older age, blood transfusion, male gender, and diabetic nephropathy seemed to be risk factors for anti-HCV antibody positivity in Japan.

Add-on effect of bedtime dosing of the alpha(1)-adrenergic receptor antagonist doxazosin on morning hypertension and left ventricular hypertrophy in patients undergoing long-term amlodipine monotherapy.

High morning blood pressure is related to target organ damage and future cardiovascular events. Chronobiologic therapies focusing on the early morning period may be an important strategy for antihypertensive therapy. The aim of this study was to clarify the add-on effects of bedtime dosing of the alpha(1)-adrenergic receptor antagonist doxazosin on morning blood pressure in patients with essential hypertension who were under long-acting calcium channel blocker amlodipine monotherapy. The add-on effects of doxazosin at the maximum dose of 6 mg at bedtime on home blood pressure and left ventricular geometry for 1 year were investigated in 49 subjects (37 men and 12 women, aged 57.5+/-9.1 years) with morning hypertension who had been treated with amlodipine alone for more than 1 year. Doxazosin induced a significant decrease in morning blood pressure (145.6+/-5.6/91.5+/-5.4 to 132.4+/-3.7/83.6+/-5.6 mmHg, p