title: Association of mineral metabolism with an increase in cellular adhesion molecules: another link to cardiovascular risk in maintenance haemodialysis?
abstract: BACKGROUND
  Abnormal mineral metabolism is associated with increased cardiovascular morbidity and mortality. The exact pathogenesis linking mineral metabolism to cardiovascular risk is unknown. This study was undertaken to investigate the association between serum phosphate and/or Ca x PO(4) product with serum levels of soluble E-selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 and the degree of carotid artery atherosclerosis in patients on haemodialysis.
  
  
  METHODS
  Seventy-three patients (46 male, 27 female; mean age 48+/-13 years, on haemodialysis for 82+/-80 months) were included in the study. All patients were stable, had no evidence of vascular disease and/or active infection. Consecutive 6 months clinical and laboratory data were obtained for each patient from their medical records and mean values were used for analysis. Serum levels of soluble adhesion molecules were assayed by ELISA. All subjects underwent a detailed evaluation of the carotid arteries.
  
  
  RESULTS
  The percentage of patients who met all three targets of NKF-K/DOQI for phosphate, calcium and Ca x PO(4) product was 27.1%, whereas those who did not achieve the target in one, two or three parameters was 28.1, 17.7 and 14.6%, respectively. The sICAM-1 levels were significantly higher in patients who had hyperphosphataemia (serum phosphate >5.5 mg/dl; P = 0.044) and hypercalcaemia (serum calcium >9.5 mg/dl; P = 0.014), both sE-selectin and sICAM-1 levels were significantly higher in patients with Ca x PO(4) product levels above 55 mg(2)/dl(2) (P = 0.002 and P = 0.000, respectively). Soluble E-selectin and sICAM levels demonstrated a near-linear increase in parallel to the degree of deviation from mineral metabolism targets. Soluble E-selectin and sICAM levels were correlated with serum phosphate and Ca x PO(4) product, but there were no correlations between adhesion molecules and carotid measurements.
  
  
  CONCLUSIONS
  These findings suggest that in stable haemodialysis patients abnormal bone mineral metabolism was associated with increased soluble adhesion molecules. These alterations in adhesion molecules may favour the development of cardiovascular changes and contribute to high cardiovascular morbidity and mortality in patients with abnormal mineral metabolism.
authors.affiliation: Department of Nephrology, Hacettepe University, Ankara, Turkey. marici@hacettepe.edu.tr
authors.forename: Mustafa
authors.initials: M
authors.lastname: Arici
authors.forename: Serkan
authors.initials: S
authors.lastname: Kahraman
authors.forename: Gültekin
authors.initials: G
authors.lastname: Gençtoy
authors.forename: Bülent
authors.initials: B
authors.lastname: Altun
authors.forename: Umut
authors.initials: U
authors.lastname: Kalyoncu
authors.forename: Aytekin
authors.initials: A
authors.lastname: Oto
authors.forename: Serafettin
authors.initials: S
authors.lastname: Kirazli
authors.forename: Yunus
authors.initials: Y
authors.lastname: Erdem
authors.forename: Unal
authors.initials: U
authors.lastname: Yasavul
authors.forename: Cetin
authors.initials: C
authors.lastname: Turgan
mesh_terms: D050197:Atherosclerosis / Q000097:blood*; D002118:Calcium / Q000378:metabolism; D002340:Carotid Artery Diseases / Q000097:blood*; D002448:Cell Adhesion; D019040:E-Selectin / Q000097:blood*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000378:metabolism; D006435:Renal Dialysis; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
chemical_list: D019040:E-Selectin; D010710:Phosphates; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D002118:Calcium