Chapters authored
Vascular Calcification and Cardiovascular Risk in Chronic Kidney Disease: A Problem That Is Here to Stay
Cardiovascular disease is the primary cause of morbidity and mortality in chronic kidney disease (CKD) population, particularly in end stage renal disease (ESRD). This could be explained in part due to the presence of traditional cardiovascular risk factors, such as older age, hypertension, dyslipidemia and diabetes, but is also associated with nontraditional cardiovascular risk factors related to CKD, like inflammation, anemia, abnormal calcium and phosphate metabolism and extracellular fluid volume overload, which may contribute to intimal or medial wall arterial calcification. Vascular calcification (VC) is a dynamic process, resulting from the dysregulation of the balance of molecules that promote and those that inhibit this course. It is important for clinicians to both acknowledge and recognize the pathways and risk factors of VC in order to improve cardiovascular health in CKD patients. This chapter will focus on the biology of VC, the association with CKD, risk factor modification, screening and prevention of VC and cardiovascular disease in CKD patients.
Part of the book: Risk Factors for Cardiovascular Disease
Resistin in Early Diabetic Chronic Kidney Disease: Exploring the Link with Nutritional Status and Cardiovascular Outcome
High resistin levels have been associated with malnutrition, inflammation, and cardiovascular risk in patients with chronic kidney disease (CKD). This study aimed to elucidate the relationship between serum resistin levels and the Patient-Generated Subjective Global Assessment (PG-SGA), a validated nutritional assessment tool in this population. It also investigates the role of resistin as a potential predictor of cardiovascular mortality in early-stage diabetic CKD. Prospective observational study that included 217 type 2 diabetic patients with mild to moderate CKD. Patients were divided into three groups according to PG-SGA: well-nourished (category A), moderately malnourished or suspected of being malnourished (category B), or severely malnourished (category C). The severely malnourished group had higher resistin levels, and resistin was positively correlated with IL-6, PG-SGA score, left ventricular mass index, and pulse pressure, while negatively correlating with vitamin D and estimated glomerular filtration rate (eGFR). We found that high resistin levels (HR = 1.350; 95% CI 1.187–1.535), PG-SGA greater than 10 (HR = 4.858; 95% CI 1.664–14.185), and higher HOMA-IR (HR = 1.099; 95% CI 1.007–4.001) were significant independent predictors of cardiovascular mortality. The study suggests that high resistin levels are associated with malnutrition in mild to moderate CKD and independently predict cardiovascular mortality in this population.
Part of the book: Chronic Kidney Disease