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Vol. 34. Issue 1.
Pages 1-9 (January - February 2022)
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Vol. 34. Issue 1.
Pages 1-9 (January - February 2022)
Original article
Impact of renal function on the prognostic value of mineral metabolism in patients with chronic ischaemic heart disease patients with chronic ischaemic heart disease
Impacto de la función renal en el valor pronóstico del metabolismo mineral en pacientes con cardiopatía isquémica crónica
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Álvaro Aceñaa,b, Ana María Pello-Lázaroa, Juan Martínez-Millaa, Óscar González-Lorenzoa, Nieves Tarínc, Carmen Cristóbald,e, Luis M. Blanco-Coliof,g, José Luis Martín-Venturab,f,g, Ana Huelmosh, Marta López-Castillob, Joaquín Alonsoe,i, Carlos Gutiérrez-Landaluced, Lorenzo López Bescóse, Luis Alonso-Pulpónb,j, Emilio González-Parrab,k, Jesús Egidob,f,k,l, Ignacio Mahíllo-Fernándezm, Óscar Lorenzob,f,l, María Luisa González-Casausn, José Tuñóna,b,f,g,
Corresponding author
jtunon@fjd.es

Corresponding author.
a Departmento de Cardiología, IIS-Fundación Jiménez Díaz, Madrid, Spain
b Universidad Autónoma de Madrid, Madrid, Spain
c Departmento de Cardiología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
d Departmento de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
e Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
f Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain
g CIBERCV, Madrid, Spain
h Departamento de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
i Departamento de Cardiologia, Hospital de Getafe, Getafe, Madrid, Spain
j Departamento de Cardiología, Hospital Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
k Departamento de Nefrología, IIS-Fundación Jiménez Díaz, Madrid, Spain
l CIBERDEM, Madrid, Spain
m Research Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain
n Laboratorio de Nefrología y Metabolismo Mineral, Hospital Gómez-Ulla, Madrid, Spain
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Figures (1)
Tables (3)
Table 1. Baseline characteristics of the patients according to their renal function.
Table 2. Univariate Cox analysis with significance at P < .2 according to eGFR.
Table 3. Multivariate Cox analysis for the search for predictors of adverse events according to eGFR.
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Abstract
Background

Parathormone (PTH) is a component of the Mineral Metabolism (MM) system that has been shown recently to add prognostic value in pts. with stable coronary artery disease (SCAD) and average renal function. However, the influence of renal function on the prognostic role of PTH in pts. with SCAD has not been shown yet.

Purpose

To assess the influence of estimated glomerular filtration rate (eGFR) on the prognostic role of PTH and other MM markers in pts. with SCAD.

Methods

We analyzed the prognostic value of MM markers (PTH, klotho, phosphate, calcidiol [25-hydroxyvitamin D], and fibroblast growth factor-23 [FGF-23]) in 964 pts. with SCAD and eGFR < 60 mL/min/1.73 m2 (LGFR) vs pts. with eGFR ≥ 60 mL/min/1.73 m2 (HGFR) included in five hospitals of Madrid. The main outcome was the combination of death with ischemic events (any acute coronary syndrome, ischemic stroke or transient ischemic attack). eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI).

Results

Age was 60.0 (52.0–72.0) years, 76.2% of patients were men, and eGFR was 80.4 (65.3–93.1) ml/min/1,73 m2. Median follow-up was 5.39 (2.81–6.92) years. There were 790 pts. with HGFR and 174 with LGFR. In HGFR pts., predictors of ischemic events or death were plasma levels of calcidiol [HR = 0.023 (0.94−0.99) P = .023], FGF-23 [HR = 1.00 (1.00–1.003) P = .036], non-HDL cholesterol [HR = 1.01 (1.00−1.01) P = .026] and high sensitivity troponin I [HR = 5.12 (1.67–15.59) P = .004], along with age [HR = 1.03 (1.01−1.05) P = .01], treatment with statins [HR = 0.36 (0.19−0.68) P = .002], nitrates [HR = 1.13 (1.07−2.79) P = .027], dihydropyridines [HR = 1.71 (1.05−2.77) P = .032], verapamil [HR = 5.71 (1.35–24.1) P = .018], and proton-pump inhibitors [HR = 2.23 (1.36−3.68) P = .002]. In the LGFR subgroup, predictors of death or ischemic events were PTH plasma levels, [HR = 1.01 (1.00−1.01) P = .005], eGFR [HR = 0.96 (0.94−0.99) P = .004], age [HR = 1.06 (1.02−1.10) P = .003], caucasian race [HR = 0.04 (0.004−0.380) P = .005], and treatment with insulin [HR = 2.6 (1.20–5.63) P = .015].

Conclusions

In pts. with SCAD, PTH is an independent predictor of poor outcomes only in those with eGFR < 60 mL/min/1.73 m2, while in pts. with eGFR ≥ 60 mL/min/1.73 m2 calcidiol and FGF-23 become the only components of MM that may predict prognosis. Then, renal function influences the predictive power of MM markers in pts. with SCAD.

Keywords:
Mineral metabolism
Ischaemic heart disease
Renal function
Resumen
Introducción

La parathormona (PTH) es un componente del metabolismo mineral (MM) que ha demostrado aportar valor pronóstico en los pacientes con cardiopatía isquémica crónica (CIC) y función renal preservada. Sin embargo, la influencia de la función renal en el papel pronóstico de la PTH en los pacientes con CIC aún no se ha demostrado.

Objetivo

Evaluar la influencia del filtrado glomerular renal estimado (FGRe) sobre el papel pronóstico de la PTH y otros marcadores del MM en los pacientes con CIC.

Métodos

Analizamos el valor pronóstico de distintos componentes del MM (PTH, klotho, fósforo, calcidiol y factor de crecimiento de fibroblastos-23 [FGF-23]) en 964 pacientes con CIC incluidos en cinco hospitales de Madrid en función de si presentaban FGRe < 60 mL/min/1,73 m2 (LFGR) o FGRe ≥ 60 mL/min/1,73 m2 (HFGR). El objetivo primario fue la combinación de muerte con eventos isquémicos (cualquier síndrome coronario agudo, accidente cerebrovascular isquémico o accidente isquémico transitorio). El FGR se calculó mediante el método CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation).

Resultados

La edad era de 60,0 (52,0–72,0) años y el 76,2% de los casos eran varones, con una mediana del FGRe de 80,4 (65,3–93,1) ml/min/1,73 m2. El seguimiento fue de 5,39 (2,81–6,92) años. 790 pacientes presentaron HGFR y 174 LGFR. En pacientes con HFGR, los predictores del endpoint combinado fueron los niveles plasmáticos de calcidiol [HR = 0,023 (0,94–0,99) P = ,023], FGF23 [HR = 1,00 (1,00–1,003) P = ,036], colesterol no HDL [ HR = 1,01 (1,00–1,01) P = ,026] y troponina de alta sensibilidad [HR = 5,12 (1,67–15,59) P = ,004], junto con la edad [HR = 1,03 (1,01–1,05) P = ,01], el tratamiento con estatinas [HR = 0,36 (0,19–0,68) P = ,002], nitratos [HR = 1,13 (1,07–2,79) P = ,027], dihidropiridinas [HR = 1,71 (1,05–2,77) P = ,032], verapamilo [HR = 5,71 (1,35–24,1) P = ,018] e inhibidores de la bomba de protones [HR = 2,23 (1,36–3,68) P = ,002]. En el subgrupo LFGR, los predictores de muerte o eventos isquémicos fueron los niveles plasmáticos de PTH, [HR por cada 10 unidades de PTH = 1,01 (1,02–1,11) P = ,008], el FGRe [HR = 0,96 (0,94–0,99) P = ,001], la edad [HR = 1,06 (1,02–1,10) P = ,003], la raza caucásica [HR = 0,04 (0,004–0,355) P = ,004], y el tratamiento con insulina [HR = 2,34 (1,11–4,95) P = ,026].

Conclusiones

En pts. con CIC, la PTH es un predictor independiente de mala evolución sólo en aquellos con FGRe < 60 mL/min/1,73 m2, mientras que en los pts. con FGRe ≥ 60 mL/min/1,73 m2, el calcidiol y el FGF-23 se convierten en los únicos componentes del MM que pueden predecir el pronóstico. Por lo tanto, la función renal influye en el poder predictivo de los componentes del MM en los pacientes con CIC.

Palabras clave:
Metabolismo mineral
Cardiopatía isquémica
Función renal

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