title: Increased levels of serum parathyroid hormone and fibroblast growth factor-23 are the main factors associated with the progression of vascular calcification in long-hour hemodialysis patients.
abstract: The aim of the present study was to assess the frequency and factors associated with the progression of vascular calcifications (VCs) using a semiquantitative X-ray score. We included all prevalent hemodialysis patients with initial radiological scores ranging from 0 to 3 according to the severity of the VCs. Patients were classified as non-progressors or progressors after 3 years. Among the 85 patients, 44.7% were classified as progressors. Only exhibiting high levels of serum intact parathyroid hormone (PTH, >190 pg/ml) and fibroblast growth factor (FGF)-23 levels (>3,000 RU/ml) is associated with the risk of VC progression (OR 5.8, 95% CI 1.7-19.8, p = 0.004). Calcitriol analogs (38%), cinacalcet (15%), dialysate calcium (mean 1.48 mmol/l), dialysis session time (4-8 h) and calcium- (10%) and non-calcium-based phosphate binders (38%) were prescribed on an individual basis. Hyperphosphatemia (<10%) and, especially, hypercalcemia (1%) and hyperparathyroidism (>585 pg/ml = 0%) were infrequently observed. In conclusion, the main factor associated with VC progression was the association of higher serum PTH and FGF-23 levels. It remains to be seen whether patients should be treated to lower their PTH value, even within the target range, using calcitriol analogs, calcimimetics, parathyroidectomy, or by modifying the Klotho-FGF-23 axis.
authors.affiliation: NEPHROCARE Tassin-Charcot, Sainte Foy-les-Lyon, France. guillaume-jean-crat@wanadoo.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.forename: Eric
authors.initials: E
authors.lastname: Bresson
authors.forename: Christie
authors.initials: C
authors.lastname: Lorriaux
authors.forename: Brice
authors.initials: B
authors.lastname: Mayor
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Hurot
authors.forename: Patrick
authors.initials: P
authors.lastname: Deleaval
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
mesh_terms: D000368:Aged; D019540:Area Under Curve; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood*; D012372:ROC Curve; D011859:Radiography; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D061205:Vascular Calcification / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging
chemical_list: C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23