Browsing by Author "Silva, Ana P."
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- Fracturing issue concerning cardiovascular mortality in chronic kidney disease patientsPublication . Mendes, Filipa; Silva, Ana P.; Alonso, Isis; Fragoso, André; Pereira, Luisa Helena; Jerónimo, Teresa; Pimentel, Ana; Neves, Pedro L.With the ageing of population worldwide, the riskof both osteoporosis and chronic kidney disease increased. These two conditions multiply the riskof bone fractures. The higher riskoffractures in CKD is accompanied bya higher mortality rate in hemodialysis patients. According to the Universityof Michigan’s study,the risk mortalityafter hip fracturewas 6.5 times higher in stage 5 CKD patients compared with patient with normal kidney function. In this study we analyzed the role of bone mineral metabolism and of hip fractures on cardiovascular mortality in a population of chronic kidney disease pre-dialysis patients. Methods: In an observational study, we included 300 patients followed in a pre-dialysis clinic during a 8 years period (2005-2013). Descriptive statistics and the Cox proportional hazard regression model were used to find risk factors of cardiovascular mortality.The mean age of these patients was 69.38 years, the mean eGFR (MDRD) was 20.40 ml/min and 60% (180) were female. Results: Using the Cox proportional hazard regression model, adjusted to age, gender, Diabetes Mellitus, Charlson comorbidity index, e-GFR, calcium, phosphorus, PTH, 25 OHD, osteocalcin, albumin and hip fractures, we found that25(OH)2D3 (HR= 0.950, 95% CI, 0.697 to 0.993 p=0.035), eGFR (HR= 0.638, 95% CI, 0.586 to 0.993, p=0.028) and hip fractures (HR= 1.753, 95% CI, 1.294 to 1.893 p=0.036) were independent risk factors of cardiovascular mortality. Conclusions: In our population of chronic kidney pre-dialysis patients, the levels of 25 (OH)2D3 and renal function, as well asthe presence of hip fractures increased the risk of cardiovascular mortality.
- Gla-rich protein (GRP) as an early and novel marker of vascular calcification and kidney dysfunction in diabetic patients with CKD: a pilot cross-sectional studyPublication . Silva, Ana P.; Viegas, Carla; Mendes, Filipa; Macedo, Ana; Guilherme, Patrícia; Tavares, Nelson; Dias, Carolina; Rato, Fátima; Santos, Nélio; Faísca, Marília; Almeida, Edgar de; Neves, Pedro Leão; Simes, DinaVascular calcification (VC) is one of the strongest predictors of cardiovascular risk in chronic kidney disease (CKD) patients. New diagnostic/prognostic tools are required for early detection of VC allowing interventional strategies. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor, whose clinical utility is here highlighted. The present study explores, for the first time, correlations between levels of GRP in serum with CKD developmental stage, mineral metabolism markers, VC and pulse pressure (PP), in a cohort of 80 diabetic patients with mild to moderate CKD (stages 2-4). Spearman's correlation analysis revealed a positive association of GRP serum levels with estimated glomerular filtration rate (eGFR) and α-Klotho, while a negative correlation with phosphate (P), fibroblast growth factor 23 (FGF-23), vascular calcification score (VCS), PP, calcium (x) phosphate (CaxP) and interleukin 6 (IL-6). Serum GRP levels were found to progressively decrease from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 associated with both the VCS and PP. These results indicate an association between GRP, renal dysfunction and CKD-mineral and bone disorder. The relationship between low levels of GRP and vascular calcifications suggests a future, potential utility for GRP as an early marker of vascular damage in CKD.
- Gla-Rich protein, magnesium and phosphate associate with mitral and aortic valves calcification in Didabetic patients with moderate CKDPublication . Silva, Ana P.; Viegas, Carla; Guilherme, Patrícia; Tavares, Nelson; Dias, Carolina; Rato, Fátima; Santos, Nélio; Faísca, Marília; de Almeida, Edgar; Neves, Pedro L.; Simes, Dina C.Accelerated and premature cardiovascular calcification is a hallmark of chronic kidney disease (CKD) patients. Valvular calcification (VC) is a critical indicator of cardiovascular disease and all-cause mortality in this population, lacking validated biomarkers for early diagnosis. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor recently associated with vascular calcification, pulse pressure, mineral metabolism markers and kidney function. Here, we examined the association between GRP serum levels and mitral and aortic valves calcification in a cohort of 80 diabetic patients with CKD stages 2–4. Mitral and aortic valves calcification were detected in 36.2% and 34.4% of the patients and associated with lower GRP levels, even after adjustments for age and gender. In this pilot study, univariate, multivariate and Poisson regression analysis, show that low levels of GRP and magnesium (Mg), and high levels of phosphate (P) are associated with mitral and aortic valves calcification. Receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) values of GRP for mitral (0.762) and aortic (0.802) valves calcification were higher than those of Mg and P. These results suggest that low levels of GRP and Mg, and high levels of P, are independent and cumulative risk factors for VC in this population; the GRP diagnostic value might be potentially useful in cardiovascular risk assessment.
- The effect of paricalcitolon dialysate protein loss in peritoneal dialysis patientsPublication . Jerónimo, Teresa; del Peso, Gloria; Gayo, Lucia; Guedes, A. Malho; Silva, Ana P.; Neves, Pedro L.; Selgas, Rafael; Bajo, Maria A.Ever since peritoneal dialysis (PD) has been used in the treatment of chronic kidney disease (CKD), high peritoneal protein loss has been observed on each PD exchange. In adult patients, the loss has been estimated at 6 to 13 g daily. Paricalcitol, a selective activator of vitamin D receptors (VDR), is successfully used as a treatment of hyperparathyroidism secondary to CKD. In addition, it has been proposed for reducing proteinuria in patients with CKD. Nonetheless, little is known about its effect on peritoneal protein loss (PPL) in patients on PD, namely after the identification of VDRon the peritoneal membrane. The aim of this study wasto examine the effect of paricalcitol on PPL in PD patients.