title: The role of mineral and bone disorders in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus of long duration.
abstract: OBJECTIVE
  The objective of our study was to evaluate the role of mineral and bone metabolism disorders associated with chronic kidney disease (MBD-CKD) in the development and progression of cardiac and renal pathology in patients with type 1 diabetes mellitus (T1DM) of long duration.
  
  
  METHODS
  We investigated 96 patients with T1DM of long duration, with CKD at different stages (0-5), including patients on hemodialysis (HD) and with kidney transplantation (KT). Along with overall clinical examination, we assessed markers of MBD (calcium, phosphorus, parathormone, vitamin D, fibroblast growth factor (FGF) 23) and levels of cardiac injury marker (atrial natriuretic peptide, NT-proBNP). Multispiral computer tomography with Agatston index calculation was also included.
  
  
  RESULTS
  Decreased kidney function was associated with increased of levels phosphorus, parathormone, FGF 23, and vitamin D deficiency, with the highest deviation from the reference ranges seen in patients on HD with a very high risk of cardiovascular events. In KT patients with satisfactory graft function, these parameters were at the same levels as in patients with CKD stages 0-4. Progression of cardiovascular pathology was accompanied by elevation of NT-proBNP levels as CKD duration increased, decreased glomerular filtration rate, and were correlated with the main parameters of mineral homeostasis. The severity of coronary arteries calcification was associated with patient age and duration of T1DM and arterial hypertension.
  
  
  CONCLUSIONS
  Development and progression of kidney dysfunction is accompanied by MBD, a significant factor in progression of cardiac pathology, which remains a major cause of mortality in this patient population.
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: rituzik-uezd@mail.ru.
authors.forename: Margarita S
authors.initials: MS
authors.lastname: Biragova
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: sgracheva@mail.ru.
authors.forename: Svetlana A
authors.initials: SA
authors.lastname: Gracheva
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: ivetta_86@inbox.ru.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Glazunova
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: smartynov@inbox.ru.
authors.forename: Sergey A
authors.initials: SA
authors.lastname: Martynov
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: org@endocrincentr.ru.
authors.forename: Irina N
authors.initials: IN
authors.lastname: Ulaynova
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: alexilin2005@yandex.ru.
authors.forename: Alexandr V
authors.initials: AV
authors.lastname: Ilyin
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: yuriyivanovich@gmail.com.
authors.forename: Yury I
authors.initials: YI
authors.lastname: Philippov
authors.affiliation: I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st., Moscow 119991, Russia. Electronic address: gulia2004@bk.ru.
authors.forename: Guliya M
authors.initials: GM
authors.lastname: Musaeva
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation. Electronic address: shamkhalova@mail.ru.
authors.forename: Minara S
authors.initials: MS
authors.lastname: Shamkhalova
authors.affiliation: Endocrinology Research Centre, 11 Dmitriya Ulyanova Street, Moscow 117036, Russian Federation; I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya st., Moscow 119991, Russia. Electronic address: nephro@endocrincentr.ru.
authors.forename: Marina V
authors.initials: MV
authors.lastname: Shestakova
mesh_terms: D000328:Adult; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D013997:Time Factors
keywords: Cardiovascular pathology; Chronic kidney disease; Kidney transplantation; Mineral and bone metabolism; NT-proBNP; Type 1 diabetes mellitus