title: Gelsolin and Progression of Aortic Arch Calcification in Chronic Hemodialysis Patients.
abstract: BACKGROUND
  Vascular calcification (VC) is a key process associated with cardiovascular mortality in dialysis patients. Gelsolin is an actin-binding protein that can modulate inflammation, correlated inversely with hemodialysis (HD) mortality and involved in bone calcification homeostasis. In this report, we aim to characterize progression in aortic arch calcification (AAC) and investigate its association with gelsolin.
  
  
  METHODS
  184 HD patients were enrolled and their annual posterior-anterior chest X-ray films (CXR) in 2009 and 2013 were examined. The severity of AAC was classified as grade 0 to 3. Blood levels of gelsolin were measured by ELISA kits. Biographic and biochemical data at baseline were analyzed with status of AAC at baseline and changes after 4 years.
  
  
  RESULTS
  At baseline, 60% of the patients had detectable AAC on CXR. After 4 years, 77% had AAC. Patients with grade 1 and 2 AAC had increased risk of progression (Odds ratio [OR] 2~3, P=0.001) compared to those with grade 0 at baseline. Compared to those with no AAC, patients with AAC progression had older age, lower gelsolin, higher waist circumference and prevalence of vascular disease. Regression analysis confirmed baseline gelsolin (odds ratio 0.845, 95% confidence interval [0.734-0.974]) and waist circumference as the independent factors associated with AAC progression. Gelsolin is positively correlated with serum albumin and negatively with tumor necrosis factor-alpha.
  
  
  CONCLUSIONS
  Our study demonstrated that HD patients with grades 1 or 2 baseline AAC are at increased risk of further progression compared to those with grade 0. We also found lower blood levels of gelsolin associated with progressive AAC. Further investigation into the mechanistic roles of gelsolin in vascular calcification may provide new understanding of this key process.
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Terry Ting-Yu
authors.initials: TT
authors.lastname: Chiou
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Shang-Chih
authors.initials: SC
authors.lastname: Liao
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Yu-Yin
authors.initials: YY
authors.lastname: Kao
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Wen-Chin
authors.initials: WC
authors.lastname: Lee
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Yueh-Ting
authors.initials: YT
authors.lastname: Lee
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Hwee-Yeong
authors.initials: HY
authors.lastname: Ng
authors.affiliation: 2. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Po-Shun
authors.initials: PS
authors.lastname: Lee
authors.affiliation: 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang-Gung University College of Medicine, Taiwan.
authors.forename: Chien-Te
authors.initials: CT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D018260:Gelsolin / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D013902:Radiography, Thoracic; D006435:Renal Dialysis / Q000009:adverse effects*; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D015415:Biomarkers; D018260:Gelsolin
keywords: Aortic arch calcification; gelsolin; hemodialysis.