Download PDF
Dialyse aktuell 2021; 25(10): 396-402
DOI: 10.1055/a-1557-4295
Schwerpunkt
Nephrologie

Verkalkungsneigung und kardiovaskuläres Risiko bei Dialysepatienten

Neuartiger Bluttest auf dem Weg in die klinische Anwendung
Andreas Pasch
1   Praxis für Innere Medizin und Nephrologie am Hirschengraben, Bern (Schweiz)
2   Lindenhofspital Bern (Schweiz)
3   Calciscon AG, Biel (Schweiz)
4   Institut für Physiologie und Pathophysiologie, Johannes Kepler Universität, Linz (Österreich)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

ZUSAMMENFASSUNG

Dialysepatienten sind kardiovaskuläre Hochrisikopatienten. Mit Phosphat und Parathormon messen und behandeln wir heute lediglich 2 Faktoren des pathophysiologischen Verkalkungssystems. Als Kliniker sind wir bzgl. der Funktionalität dieses Verkalkungssystems weitgehend im Blindflug unterwegs. Wir behandeln zwar vermutlich das Richtige, können aber weder die Patientenprognose noch die Effektstärke unserer Interventionen gut abschätzen. Diese diagnostische Lücke könnte zukünftig der T50-Test füllen, ein neuartiger funktioneller Bluttest zur Messung der Verkalkungsneigung im Serum. Dieser Test hat das Potenzial, durch eine verbesserte koordinierte Therapielenkung und Einbeziehung etablierter Therapien ins Behandlungskonzept, zu einer Verbesserung des kardiovaskulären Outcomes von Dialysepatienten beizutragen.



Publication History

Article published online:
14 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Go AS, Chertow GM, Fan D. et al Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-1305
    CrossrefPubMedSearch in Google Scholar
  • 2 Kidney Disease: Improving Global Outcomes (KDIGO), CKD-MBD Update Work Group KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (2011) 2017; 7: 1-59
    CrossrefPubMedSearch in Google Scholar
  • 3 Ruospo M, Palmer SC, Natale P. et al Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD). Cochrane Database Syst Rev 2018; 8: CD006023
    CrossrefPubMedSearch in Google Scholar
  • 4 Palmer SC, Gardner S, Tonelli M. et al Phosphate-binding agents in adults with CKD: a network meta-analysis of randomized trials. Am J Kidney Dis 2016; 68: 691-702
    CrossrefPubMedSearch in Google Scholar
  • 5 EVOLVE Trial Investigators Chertow GM, Block GA. et al Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med 2012; 367: 2482-2494
    CrossrefPubMedSearch in Google Scholar
  • 6 Block GA, Raggi P, Bellasi A. et al Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007; 71: 438-441
    CrossrefPubMedSearch in Google Scholar
  • 7 Schlieper G, Krüger T, Djuric Z. et al Vascular access calcification predicts mortality in hemodialysis patients. Kidney Int 2008; 74: 1582-1587
    CrossrefPubMedSearch in Google Scholar
  • 8 Blacher J, Guerin AP, Pannier B. et al Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001; 38: 938-942
    CrossrefPubMedSearch in Google Scholar
  • 9 Bäck M, Aranyi T, Cancela ML. et al Endogenous calcification inhibitors in the prevention of vascular calcification: a consensus statement from the COST Action EuroSoftCalcNet. Front Cardiovasc Med 2019; 5: 196
    CrossrefPubMedSearch in Google Scholar
  • 10 Heiss A, DuChesne A, Denecke B. et al Structural basis of calcification inhibition by alpha 2-HS glycoprotein/fetuin-A. Formation of colloidal calciprotein particles. J Biol Chem 2003; 178: 13333-13341
    CrossrefPubMedSearch in Google Scholar
  • 11 Heiss A, Eckert T, Aretz A. et al Hierarchical role of fetuin-A and acidic serum proteins in the formation and stabilization of calcium phosphate particles. J Biol Chem 2008; 283: 14815-14825
    CrossrefPubMedSearch in Google Scholar
  • 12 Ketteler M, Bongartz P, Westenfeld R. et al Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet 2003; 361: 827-833
    CrossrefPubMedSearch in Google Scholar
  • 13 Hamano T, Matsui I, Mikami S. et al Fetuin-mineral complex reflects extraosseous calcification stress in CKD. J Am Soc Nephrol 2010; 11: 199-2007
    CrossrefPubMedSearch in Google Scholar
  • 14 Smith ER, Ford ML, Tomlinson LA. et al Phosphorylated fetuin-A-containing calciprotein particles are associated with aortic stiffness and a procalcific milieu in patients with pre-dialysis CKD. Nephrol Dial Transplant 2011; 27: 1957-1966
    CrossrefPubMedSearch in Google Scholar
  • 15 Smith ER, Cai MM, McMahon LP. et al Serum fetuin-A concentration and fetuin-A-containing calciprotein particles in patients with chronic inflammatory disease and renal failure. Nephrology (Carlton) 2013; 18: 215-221
    CrossrefPubMedSearch in Google Scholar
  • 16 Herrmann M, Schafer C, Heiss A. et al Clearance of fetuin-A--containing calciprotein particles is mediated by scavenger receptor-A. Circ Res 2012; 111: 575-584
    CrossrefPubMedSearch in Google Scholar
  • 17 Bressendorff I, Hansen D, Pasch A. et al The effect of increasing dialysate magnesium on calciprotein particles, inflammation and bone markers: post hoc analysis from a randomized controlled clinical trial. In, Nephrol Dial Transplant 2021; 36: 713-721
    CrossrefPubMedSearch in Google Scholar
  • 18 Aghagolzadeh P, Bachtler M, Bijarnia R. et al Calcification of vascular smooth muscle cells is induced by secondary calciprotein particles and enhanced by tumor necrosis factor-alpha. Atherosclerosis 2016; 251: 404-414
    CrossrefPubMedSearch in Google Scholar
  • 19 Pasch A, Jahnen-Dechent W, Smith ER. Phosphate, calcification in blood, and mineral stress: the physiologic blood mineral buffering system and its association with cardiovascular risk. Int J Nephrol 2018; 2018: 9182078
    CrossrefPubMedSearch in Google Scholar
  • 20 Pasch A, Farese S, Graber S. et al Nanoparticle-based test measures overall propensity for calcification in serum. J Am Soc Nephrol 2012; 23: 1744-1752
    CrossrefPubMedSearch in Google Scholar
  • 21 Pasch A, Bachtler Block GA. et al Blood calcification propensity, crdiovascular events, and survival in patients receiving hemodialysis in the EVOLVE trial. Clin J Am Soc Nephrol 2017; 12: 315-322
    CrossrefPubMedSearch in Google Scholar
  • 22 Sanchez RR, Zawada A, Wolf M. et al P1433 Validation of a serum calcification propensity test for the prediction of all-cause mortality among dialysis patients. Nephrol Dial Transplant 2020; 35: iii270
    CrossrefSearch in Google Scholar
  • 23 Smith ER, Ford ML, Tomlinson LA. et al Serum calcification propensity predicts all-cause mortality in predialysis CKD. J Am Soc Nephrol 2014; 25: 339-348
    CrossrefPubMedSearch in Google Scholar
  • 24 Bundy JD, Cai X, Mehta RC. et al Serum calcification propensity and clinical events in CKD. Clin J Am Soc Nephrol 2019; 14: 1562-1571
    CrossrefPubMedSearch in Google Scholar
  • 25 Keyzer CA, de Borst MH, van den Berg E. et al Calcification propensity and survival among renal transplant recipients. J Am Soc Nephrol 2016; 27: 239-248
    CrossrefPubMedSearch in Google Scholar
  • 26 Dahle DO, Åsberg A, Hartmann A. et al Serum calcification propensity is a strong and independent determinant of cardiac and all-cause mortality in kidney transplant recipients. Am J Transplant 2016; 16: 204-212
    CrossrefPubMedSearch in Google Scholar
  • 27 Bostom A, Pasch A, Madsen T. et al Serum calcification propensity and fetuin-A: biomarkers of cardiovascular disease in kidney transplant recipients. Am J Nephrol 2018; 48: 21-31
    CrossrefPubMedSearch in Google Scholar
  • 28 Eelderink C, Te Velde-Keyzer CA, Frenay AS. et al Serum calcification propensity and the risk of cardiovascular and all-cause mortality in the general population: the PREVEND study. Arterioscler Thromb Vasc Biol 2020; 40: 1942-1951
    CrossrefPubMedSearch in Google Scholar
  • 29 Ponte B, Pruijm M, Pasch A. et al Dialysis initiation improves calcification propensity. Nephrol Dial Transplant 2020; 35: 495-502
    CrossrefPubMedSearch in Google Scholar
  • 30 Dekker M, Pasch A, van der Sande F. et al High-flux hemodialysis and high-volume hemodiafiltration improve serum calcification propensity. PLoS One 2016; 4: e0151508
    CrossrefPubMedSearch in Google Scholar
  • 31 Thiem U, Soellradl I, Robl B. et al The effect of phosphate binder therapy with sucroferric oxyhydroxide on calcification propensity in chronic haemodialysis patients: a randomized, controlled, crossover trial. Clin Kidney J 2020; 14: 631-638
    CrossrefPubMedSearch in Google Scholar
  • 32 Ketteler M, Wiecek A, Rosenkranz AR. et al Efficacy and safety of a novel nicotinamide modified-release formulation in the treatment of refractory hyperphosphatemia in patients receiving hemodialysis – a randomized clinical trial. Kidney Int Rep 2020; 6: 594604
    CrossrefPubMedSearch in Google Scholar
  • 33 Bressendorff I, Hansen D, Schou M. et al The effect of increasing dialysate magnesium on serum calcification propensity in subjects with end stage kidney disease: a randomized, controlled clinical trial. Clin J Am Soc Nephrol 2018; 13: 1373-1380
    CrossrefPubMedSearch in Google Scholar
  • 34 Ter Meulen KJ, Dekker MJE, Pasch A. et al Citric-acid dialysate improves the calcification propensity of hemodialysis patients: A multicenter prospective randomized cross-over trial. PLoS One 2019; 14: e0225824
    CrossrefPubMedSearch in Google Scholar
  • 35 Lorenz G, Mayer CC, Bachmann Q. et al Acetate-free, citrate-acidified bicarbonate dialysis improves serum calcification propensity-a preliminary study. Nephrol Dial Transplant 2018; 33: 2043-2051
    CrossrefPubMedSearch in Google Scholar
  • 36 Shoji T, Nakatani S, Kabata D. et al Comparative effects of etelcalcetide and maxacalcitol on serum calcification propensity in secondary hyperparathyroidism: a randomized clinical trial. Clin J Am Soc Nephrol 2021; 16: 599-612
    CrossrefPubMedSearch in Google Scholar
  • 37 Bressendorff I, Hansen D, Schou M. et al Oral magnesium supplementation in chronic kidney disease stages 3 and 4: efficacy, safety, and effect on serum calcification propensity –a prospective randomized double-blinded placebo-controlled clinical trial. Kidney Int Reports 2016; 2: 380-389
    CrossrefPubMedSearch in Google Scholar
  • 38 Cai MMX, Smith ER, Holt SG. The role of fetuin-A in mineral trafficking and deposition. Bonekey Rep 2015; 4: 672
    CrossrefPubMedSearch in Google Scholar