Katarzyna Krzanowska

Elevated Circulating Osteoprotegerin Levels in the Plasma of Hemodialyzed Patients With Severe Artery Calcification: Elevated OPG Levels in HD Patients With Artery Calcification

We studied the correlations between circulating osteoprotegerin (OPG) level and radial artery calcification (RAC) assessed histologically and carotid artery intima‐media thickness (CCA‐IMT). Moreover, we studied the relationship between OPG levels and all‐cause and cardiovascular (CV) mortality during a 5‐year observation period. The study comprised 59 CKD patients (36 hemodialyzed (HD), 23 predialysis). The biochemical parameters included: creatinine, calcium, phosphate, intact parathormone, C‐reactive protein, interleukin‐6, tumor necrosis factor receptor II (TNFRII), transforming growth factor‐β, hepatocyte growth factor, fibroblast growth factor 23, osteonectin (ON), osteopontin, osteoprotegerin, and osteocalcin. CCA‐IMT and the presence of atherosclerotic plaques was assessed by ultrasound. Fragments of radial artery obtained during creation of HD access were prepared for microscopy and stained for calcifications with alizarin red. RAC was detected in 34 patients (58%). In multiple regression adjusted for dialysis status, TNFRII, ON and Framingham risk score (FRS) were identified as the independent predictors of OPG. Serum OPG above the median value of 7.55 pmol/L significantly predicted the presence of RAC in simple logistic regression (OR 5.33; 95%CI 1.39–20.4; P = 0.012) and in multiple logistic regression adjusted for FRS, dialysis status and CCA‐IMT values (OR 6.56; 95%CI 1.06–40.6; P = 0.036). OPG levels above the median were associated with higher CCA‐IMT values (1.02 ± 0.10 vs. 0.86 ± 0.13; P < 0.001) and predicted the presence of atherosclerotic plaques in carotid artery (OR 14.4; 95%CI 2.84–72.9; P < 0.001), independently of FRS, dialysis status and RAC. In this study, elevated serum OPG levels correlated with higher CCA‐IMT, the presence of atherosclerotic plaques and the severity of the RAC independently of each other. During follow‐up, 25 patients (42%) died, including 21 due to CV causes. In multiple Cox regression, OPG above the median predicted overall survival independently of dialysis status, Framingham risk score, CCA‐IMT above the median value, and the presence of atherosclerotic plaques in CCA, but not independently of RAC. We postulate that circulating OPG may play a dual role as a marker for both medial arterial calcification and atherosclerosis, hence it seems to be a valuable tool for assessing CV risk in patients with CKD. OPG might be an early indicator of all‐cause mortality in CKD patients with advanced medial arterial calcification.

Comparison of the incidence of skin cancers in patients on dialysis and after kidney transplantation

Introduction Kidney transplant (KTx) patients on immunosuppressive therapy are predisposed to the development of infections and cancers. Aim To compare the incidence and type of malignant skin lesions in kidney transplant patients and the dialyzed population based on the initiated dermatologic screening. Material and methods The study included 598 patients: 486 kidney transplant recipients and 112 patients on maintenance dialysis. All the patients underwent dermatological examination. Only histologically confirmed cancers were included in this study. Age, gender and immunosuppressive therapy administration were also considered. Patients were followed up by a dermatologist for a period of 5 years. Results Fifty-eight skin cancers; 39 basal cell carcinomas (BCC), 13 squamous cell carcinomas (SCC), 1 Bowen disease, 2 Kaposi sarcoma, 1 malignant melanoma, 1 Merkel cell carcinoma, and 1 fibrosarcoma protuberans were diagnosed in 30 (6.2%) kidney transplant patients, and 8 lesions (7 BCC and 1 SCC) were found in 4 (3.6%) patients on dialysis. Conclusions The initiated dermatologic screening program indicates that the risk of skin cancer incidence in post kidney transplant patients receiving immunosuppressive therapy was significantly higher than in patients on dialysis.

Isolated carotid artery fibromuscular dysplasia unifocal type diagnosed in the postpartum period

Fibromuscular dysplasia (FMD) is an idiopathic noninflammatory and nonarteriosclerotic segmental disorder of almost every arterial bed, leading to arterial sclerosis, occlusion, aneurysm, or dissection. It occurs most frequently in renal (80%), extracranial carotid and vertebral arteries (25–30%). Isolated intracranial FMD develops in 8.3% of patients. Carotid artery FMD is typically located bilaterally, in the middle and distal parts of the carotid artery [1, 2]. There are two characteristic angiographic types of FMD: multifocal with a typical string-of-beads appearance; and unifocal, characterized by stenosis [1]. Patients with carotid or vertebral artery FMD present with numerous nonspecific symptoms. However, specific neurological signs, such as transient ischemic attack, Horner syndrome, cranial nerve palsies, cerebral infarction, amaurosis fugax, and subarachnoid hemorrhage, may also be observed [3]. A 39-year-old woman with Graves disease, after radioisotope therapy, and suffering from polycystic ovary syndrome, was admitted to the hospital due to paraparesis reported on the third day postpartum. Two years earlier she suddenly developed transient right Horner syndrome, alteration in the bitter taste (a symptom of dysgeusia), and right mandible and ear pain. Duplex ultrasound (DUS) performed 10 days after the neurological episode revealed occlusion of the right internal carotid artery (RICA) with very limited blood flow, similarly to computed tomography angiography (CT angiography). No tear or blood accumulation was revealed. At the beginning of her third pregnancy, she experienced periodic episodes of paresthesia of her right upper and lower extremities. Approximately during the 18th week of pregnancy, the symptoms of paresthesia in her left leg and arm became more pronounced. Finally, due to the loss of sensation on the left side of her body and proprioception, a caesarean section was performed in the 30th week of pregnancy. An unexpected increase in blood pressure (200/110 mm Hg) following the administration of angiotensin-converting-enzyme inhibitors was observed. During hospitalization, all neurological symptoms gradually resolved. Another DUS examination showed a narrow RICA with an irregular lumen. No other changes constricting the lumen were detected. Computed tomography angiography revealed patent (1–2 mm) tortuous course of the right extracranial carotid artery (Figures 1 A, B), patent (1–1.8 mm) intracranial carotid artery with dilation to 2.5 mm in its cavernous part (Figure 1 C), and well-developed compensatory circulation from the circle of Willis via the anterior and posterior communicating arteries (Figure 1 D). The unifocal type of FMD was diagnosed. No changes in the vertebral or renal arteries and no other abnormalities in the circle of Willis were detected. The patient’s clinical condition significantly improved with resolution of neurological symptoms, and blood pressure was well controlled with amlodipine (110/80 mm Hg on average). Because of the compensatory circulation and the lack of neurological symptoms, no balloon angioplasty was performed. Interestingly, in this case, spontaneous carotid artery dissection (SCAD) may be superimposed on FMD, which has been observed in up to 90% of SCAD patients. Unfortunately, even angiography may be inadequate to differentiate the cause of the artery narrowing [4]. Perhaps the pregnancy was a trigger of the second episode of neurological symptoms.

The ACEF (age, creatinine, ejection fraction) scorepredicts ischemic and bleeding outcomes of patients withacute coronary syndromes treated conservatively

Corresponding author: Artur Dziewierz MD, PhD, 2 Department of Cardiology, Jagiellonian University Medical College, 17 Kopernika St, 31-501 Krakow, Poland, phone: +48 12 424 71 81, +48 12 424 71 82, fax: +48 12 424 71 84, e-mail: adziewierz@gmail.com Received: 6.02.2017, accepted: 28.05.2017. The ACEF (age, creatinine, ejection fraction) score predicts ischemic and bleeding outcomes of patients with acute coronary syndromes treated conservatively

Carboxylated and intact osteocalcin predict adiponectin concentration in hemodialyzed patients

Abstract Purpose Disrupted bone metabolism in patients with chronic kidney disease (CKD) is associated with elevated concentrations of biochemical bone markers. Recently, animal studies show the role of osteocalcin in energy metabolism, which is partially confirmed in humans. The aim of our study was to evaluate the relationships between serum concentrations of bone markers and indices of energy metabolism in CKD patients on maintenance hemodialysis; in particular, the relationship between various forms of osteocalcin and adiponectin. Patients and methods The cross-sectional study included 155 hemodialyzed stage 5 CKD patients. Serum concentrations of glucose, insulin, adiponectin, bone alkaline phosphatase (bALP), tartrate resistant acid phosphatase (TRAP), carboxylated (cOC), undercarboxylated (ucOC), and intact osteocalcin (OC) were determined. Results In total cohort, bALP, TRAP, cOC, and ucOC negatively correlated with BMI. All analyzed bone markers positively correlated with adiponectin in total cohort and in men. In multiple linear regression analysis including all patients, log(cOC) and log(intact OC) were the only bone markers that predicted log(adiponectin) (beta = 0.22; p = 0.016 and beta = 0.26; p = 0.010) independently of sex, dialysis vintage, CRP, insulin, iPTH concentrations, BMI, and age. Conclusions Our data confirm the positive association between cOC, intact OC, and adiponectin concentrations in CKD patients on maintenance hemodialysis.