Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease

Chu Zhou, Fang Wang, Jin-Wei Wang, Lu-Xia Zhang, Ming-Hui Zhao, Chu Zhou, Fang Wang, Jin-Wei Wang, Lu-Xia Zhang, Ming-Hui Zhao

Abstract

Background: Mineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.

Methods: Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients' entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.

Results: Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml.min-1.1.73 m-2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.

Conclusions: In Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

Figures

Figure 1
Figure 1
The percentage of stages 3–5 chronic kidney disease patients with or without treatment of phosphate binders.

References

    1. Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, et al. Prevalence of chronic kidney disease in China: A cross-sectional survey. Lancet. 2012;379:815–22. doi: 10.1016/S0140-6736(12)60033-6.
    1. Bansal N, Lin F, Vittinghoff E, Peralta C, Lima J, Kramer H, et al. Estimated GFR and subsequent higher left ventricular mass in young and middle-aged adults with normal kidney function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Kidney Dis. 2016;67:227–34. doi: 10.1053/j.ajkd.2015.06.024.
    1. Chia YC, Lim HM, Ching SM. Use of chronic kidney disease to enhance prediction of cardiovascular risk in those at medium risk. PLoS One. 2015;10:e0141344. doi: 10.1371/journal.pone.0141344.
    1. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1–201. doi: 10.1016/S0272-6386(03)00905-3.
    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) Kidney Int Suppl. 2009;(113):S1–130. doi: 10.1038/ki.2009.188.
    1. Yao L, Sun YT, Sun W, Xu TH, Ren C, Fan X, et al. High phosphorus level leads to aortic calcification via ß-catenin in chronic kidney disease. Am J Nephrol. 2015;41:28–36. doi: 10.1159/000370250.
    1. Kendrick J, Chonchol M. The role of phosphorus in the development and progression of vascular calcification. Am J Kidney Dis. 2011;58:826–34. doi: 10.1053/j.ajkd.2011.07.020.
    1. Faul C, Amaral AP, Oskouei B, Hu MC, Sloan A, Isakova T, et al. FGF23 induces left ventricular hypertrophy. J Clin Invest. 2011;121:4393–408. doi: 10.1172/JCI46122.
    1. Gao B, Zhang L, Wang H, Zhao M. Chinese Cohort Study of Chronic Kidney Disease: Design and methods. Chin Med J. 2014;127:2180–5. doi: 10.3760/cma.j.issn.0366-6999.20132906.
    1. Andrassy KM. Comments on ‘KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease’. Kidney Int. 2013;84:622–3. doi: 10.1038/ki.2013.243.
    1. Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol. 2006;17:2937–44. doi: 10.1681/ASN.2006040368.
    1. Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: A 25-year follow-up study. Atherosclerosis. 1997;132:245–50. doi: 10.1016/S0021-9150(97)00106-8.
    1. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol. 1986;57:450–8. doi: 10.1016/0002-9149(86)90771-X.
    1. Vassalotti JA, Uribarri J, Chen SC, Li S, Wang C, Collins AJ, et al. Trends in mineral metabolism: Kidney Early Evaluation Program (KEEP) and the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis. 2008;51(4 Suppl 2):S56–68. doi: 10.1053/j.ajkd.2007.12.018.
    1. Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, et al. Chronic Renal Insufficiency Cohort (CRIC) Study: Baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009;4:1302–11. doi: 10.2215/CJN.00070109.
    1. Gallieni M, De Luca N, Santoro D, Meneghel G, Formica M, Grandaliano G, et al. Management of CKD-MBD in non-dialysis patients under regular nephrology care: A prospective multicenter study. J Nephrol. 2016;29:71–8. doi: 10.1007/s40620-015-0202-4.
    1. Imai E, Matsuo S, Makino H, Watanabe T, Akizawa T, Nitta K, et al. Chronic Kidney Disease Japan Cohort study: Baseline characteristics and factors associated with causative diseases and renal function. Clin Exp Nephrol. 2010;14:558–70. doi: 10.1007/s10157-010-0328-6.
    1. Hamano T, Fujii N, Matsui I, Nakano C, Inoue K, Tomida K, et al. Guideline-practice gap in the management of predialysis chronic kidney disease mineral bone disorder in Japan. Ther Apher Dial. 2011;15(Suppl 1):2–8. doi: 10.1111/j.1744-9987.2011.00918.x.
    1. Bellasi A, Ferramosca E, Muntner P, Ratti C, Wildman RP, Block GA, et al. Correlation of simple imaging tests and coronary artery calcium measured by computed tomography in hemodialysis patients. Kidney Int. 2006;70:1623–8. doi: 10.1038/sj.ki.5001820.
    1. Craver L, Dusso A, Martinez-Alonso M, Sarro F, Valdivielso JM, Fernández E. A low fractional excretion of phosphate/Fgf23 ratio is associated with severe abdominal Aortic calcification in stage 3 and 4 kidney disease patients. BMC Nephrol. 2013;14:221. doi: 10.1186/1471-2369-14-221.
    1. Wang M, Wang M, Lu L, Yang B, Li S, Zhang M. Arterial stiffness and associated factors in non-diabetic pre-dialysis patients with chronic kidney disease. Chin J Nephrol. 2009;25:277–81. doi: 10.3760/cma.j.issn.1001-7097.2009.04.007.
    1. Dhingra R, Gona P, Benjamin EJ, Wang TJ, Aragam J, D’Agostino RB, Sr, et al. Relations of serum phosphorus levels to echocardiographic left ventricular mass and incidence of heart failure in the community. Eur J Heart Fail. 2010;12:812–8. doi: 10.1093/eurjhf/hfq106.
    1. Selamet U, Tighiouart H, Sarnak MJ, Beck G, Levey AS, Block G, et al. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: The Modification of Diet in Renal Disease Study. Kidney Int. 2016;89:176–84. doi: 10.1038/ki.2015.284.
    1. Chue CD, Edwards NC, Moody WE, Steeds RP, Townend JN, Ferro CJ. Serum phosphate is associated with left ventricular mass in patients with chronic kidney disease: A cardiac magnetic resonance study. Heart. 2012;98:219–24. doi: 10.1136/heartjnl-2011-300570.
    1. Wang J, Wang F, Dong S, Zeng Q, Zhang L. Levels of serum phosphorus and cardiovascular surrogate markers. J Atheroscler Thromb. 2016;23:95–104. doi: 10.5551/jat.31153.
    1. Nakamura H, Tokumoto M, Mizobuchi M, Ritter CS, Finch JL, Mukai M, et al. Novel markers of left ventricular hypertrophy in uremia. Am J Nephrol. 2010;31:292–302. doi: 10.1159/000279768.

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