Skip to main content

Advertisement

SpringerLink
Log in

Do trace elements play a role in coronary artery calcification in hemodialysis patients?

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Abnormalities of trace elements have previously been linked to inflammatory processes in hemodialysis (HD) patients. We aimed to establish the trace element status of maintenance HD patients, to investigate the relationship between coronary artery calcification scores (CACs) and whole blood levels of trace elements.

Methods

Patients undergoing HD in three times a week for > 6 months and age-and sex-matched controls were included from October 2015 to June 2016. Data were collected from patient files. All subjects' whole blood levels of trace elements were measured by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). CACs for patients were assessed by multi-detector computed tomography.

Results

The 35 patients (male, 60%) with a mean age of 45.7 ± 10.4 years and 35 controls were included. HD patients showed significantly lower levels of selenium and uranium and higher cadmium (Cd), cobalt, lithium, manganese, nickel, lead, platinum, tin, strontium, and thallium levels compared to controls. Coronary artery calcification (CAC) was present in 21 patients (60%), and median CACs were 14.2 (IQR 0–149). Patients with CACs > median were significantly older, had a higher prevalence of hypertension and lower ALP levels than patients with CACs ≤ median. No significant differences in whole blood levels of trace elements were found between patients with CACs > median and patients with CACs ≤ median. A near significance was noted in median whole blood levels of Cd between these groups (P = 0.096). According to multivariate analysis, age was the only independent determinant for CAC development.

Conclusion

Age is independently associated with coronary vascular calcification. High Cd levels might play a role in CAC development in HD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Tonelli M, Wiebe N, Bello A, Field CJ, Gill JS, Hemmelgarn BR et al (2018) Alberta Kidney Disease Network. Concentrations of trace elements and clinical outcomes in hemodialysis patients: a prospective cohort study. Clin J Am Soc Nephrol 13:907–915. https://doi.org/10.2215/CJN.11451017

    Article  Google Scholar 

  2. Tonelli M, Wiebe N, Hemmelgarn B, Klarenbach S, Field C, Manns B, Alberta Kidney Disease Network et al (2009) Trace elements in hemodialysis patients: a systematic review and meta-analysis. BMC Med 7:25. https://doi.org/10.1186/1741-7015-7-25

    Article  CAS  Google Scholar 

  3. Kaya Y, Ari E, Demir H, Gecit I, Beytur A, Kaspar C (2012) Serum cadmium levels are independently associated with endothelial function in hemodialysis patients. Int Urol Nephrol 44:1487–1492. https://doi.org/10.1007/s11255-011-0055-2

    Article  CAS  Google Scholar 

  4. Sigrist M, Bungay P, Taal MW, McIntyre CW (2006) Vascular calcification and cardiovascular function in chronic kidney disease. Nephrol Dial Transplant 21:707–714. https://doi.org/10.1093/ndt/gfi236

    Article  Google Scholar 

  5. Block GA (2000) Prevalence and clinical consequences of elevated CaXP product in hemodialysis patients. Clin Nephrol 54:318–324

    CAS  Google Scholar 

  6. Vattikuti R, Towler D (2004) Osteogenic regulation of vascular calcification: an early perspective. Am J Physiol Endocrinol Metab 286:686–696. https://doi.org/10.1152/ajpendo.00552.2003

    Article  Google Scholar 

  7. Demer L, Tintut Y, Parhami F (2002) Novel mechanisms in accelerated vascular calcification in renal disease patients. Curr Opin Nephrol Hypertens 11:437–443. https://doi.org/10.1097/00041552-200207000-00011

    Article  Google Scholar 

  8. Shroff R, Long DA, Shanahan C (2013) Mechanistic insights into vascular calcification in CKD. J Am Soc Nephrol 24:179–189. https://doi.org/10.1681/ASN.2011121191

    Article  CAS  Google Scholar 

  9. Kraśniak A, Drozdz M, Pasowicz M, Chmiel G, Michałek M, Szumilak D et al (2007) Factors involved in vascular calcification and atherosclerosis in maintenance haemodialysis patients. Nephrol Dial Transplant 22:515–521. https://doi.org/10.1093/ndt/gfl564

    Article  Google Scholar 

  10. Solbu MD, Mjøen G, Mark PB, Holdaas H, Fellström B, Schmieder RE et al (2018) Predictors of atherosclerotic events in patients on haemodialysis: post hoc analyses from the AURORA study. Nephrol Dial Transplant 33:102–112. https://doi.org/10.1093/ndt/gfw360

    Article  CAS  Google Scholar 

  11. Salehi M, Sohrabi Z, Ekramzadeh M, Fallahzadeh MK, Ayatollahi M, Geramizadeh B et al (2013) Selenium supplementation improves the nutritional status of hemodialysis patients: a randomized, double-blind, placebo-controlled trial. Nephrol Dial Transplant 28:716–723. https://doi.org/10.1093/ndt/gfs170

    Article  CAS  Google Scholar 

  12. Lobo JC, Stockler-Pinto MB, Farage NE, Faulin Tdo E, Abdalla DS, Torres JP et al (2013) Reduced plasma zinc levels, lipid peroxidation, and inflammation biomarkers levels in hemodialysis patients: implications to cardiovascular mortality. Ren Fail 35:680–685. https://doi.org/10.3109/0886022X.2013.789960

    Article  CAS  Google Scholar 

  13. Ari E, Kaya Y, Demir H, Asicioglu E, Keskin S (2011) The correlation of serum trace elements and heavy metals with carotid artery atherosclerosis in maintenance hemodialysis patients. Biol Trace Elem Res 144:351–359. https://doi.org/10.1007/s12011-011-9103-0

    Article  CAS  Google Scholar 

  14. Covic A, Kanbay M, VoroneanuL TF, Serban DN, Serban IL et al (2010) Vascular calcification in chronic kidney disease. Clin Sci 119:111–121. https://doi.org/10.1042/CS20090631

    Article  CAS  Google Scholar 

  15. Nishizawa Y, Mizuiri S, Yorioka N, Hamada C, Tomino Y (2015) Determinants of coronary artery calcification in maintenance hemodialysis patients. J Artif Organs 18:251–256. https://doi.org/10.1007/s10047-015-0823-3

    Article  CAS  Google Scholar 

  16. Wang YN, Sun Y, Wang Y, Jia YL (2015) Serum S100A12 and progression of coronary artery calcification over 4 years in hemodialysis patients. Am J Nephrol 42:4–13. https://doi.org/10.1159/000438869

    Article  CAS  Google Scholar 

  17. Shantouf R, Kovesdy CP, Kim Y, Ahmadi N, Luna A, Luna C et al (2009) Association of serum alkaline phosphatase with coronary artery calcification in maintenance hemodialysis patients. Clin J Am Soc Nephrol 4:1106–1114. https://doi.org/10.2215/CJN.06091108

    Article  CAS  Google Scholar 

  18. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D et al (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483. https://doi.org/10.1056/NEJM200005183422003

    Article  CAS  Google Scholar 

  19. Ohtake T, Ishioka K, Honda K, Oka M, Maesato K, Mano T et al (2010) Impact of coronary artery calcification in hemodialysis patients: risk factors and associations with prognosis. Hemodial Int 14:218–225. https://doi.org/10.1111/j.1542-4758.2009.00423.x

    Article  Google Scholar 

  20. Ishimura E, Okuno S, Okazaki H, Norimine K, Yamakawa K, Yamakawa T et al (2014) Significant association between bone-specific alkaline phosphatase and vascular calcification of the hand arteries in male hemodialysis patients. Kidney Blood Press Res 39:299–307. https://doi.org/10.1159/000355807

    Article  CAS  Google Scholar 

  21. Asci G, Ok E, Savas R, Ozkahya M, Ozkahya M, Duman S, Toz H et al (2011) The link between bone and coronary calcifications in CKD-5 patients on haemodialysis. Nephrol Dial Transplant 26:1010–1015. https://doi.org/10.1093/ndt/gfq491

    Article  Google Scholar 

  22. Qunibi WY (2005) Dyslipidemia and progression of cardiovascular calcification (CVC) in patients with end-stage renal disease (ESRD). Kidney Int 95:S43-50. https://doi.org/10.1111/j.1523-1755.2005.09507.x

    Article  Google Scholar 

  23. Ozkok A, Caliskan Y, Sakaci T, Erten G, Karahan G, Ozel A et al (2012) Osteoprotegerin/RANKL axis and progression of coronary artery calcification in hemodialysis patients. Clin J Am Soc Nephrol 7:965–973. https://doi.org/10.2215/CJN.11191111

    Article  CAS  Google Scholar 

  24. Mizuiri S, Nishizawa Y, Yamashita K, Ono K, Naito T, Tanji C et al (2019) Relationship of matrix gla protein and vitamin k with vascular calcification in hemodialysis patients. Ren Fail 41:770–777. https://doi.org/10.1080/0886022X.2019.1650065

    Article  CAS  Google Scholar 

  25. Brandenburg VM, Kramann R, Koos R, Krüger T, Schurgers L, Mühlenbruch G et al (2013) Relationship between sclerostin and cardiovascular calcification in hemodialysis patients: a cross-sectional study. BMC Nephrol 14:219. https://doi.org/10.1186/1471-2369-14-219

    Article  CAS  Google Scholar 

  26. Thompson B, Towler DA (2012) Arterial calcification and bone physiology: role of the bone-vascular axis. Nat Rev Endocrinol 8:529–543. https://doi.org/10.1038/nrendo.2012.36B

    Article  CAS  Google Scholar 

  27. Malluche HH, Porter DS, Monier-Faugere MC, Mawad H, Pienkowski D (2012) Differences in bone quality in low- and high-turnover renal osteodystrophy. J Am Soc Nephrol 23:525–532. https://doi.org/10.1681/ASN.2010121253

    Article  CAS  Google Scholar 

  28. Park JC, Kovesdy CP, Duong U, Streja E, Rambod M, Nissenson AR et al (2010) Association of serum alkaline phosphatase and bone mineral density in maintenance hemodialysis patients. Hemodial Int 14:182–192. https://doi.org/10.1111/j.1542-4758.2009.00430.x

    Article  Google Scholar 

  29. London GM, Marty C, Marchais SJ, Guerin AP, Metivier F, de Vernejoul MC (2004) Arterial calcifications and bone histomorphometry in end-stage renal disease. J Am Soc Nephrol 15:1943–1951. https://doi.org/10.1097/01.asn.0000129337.50739.48

    Article  Google Scholar 

  30. Adragao T, Herberth J, Monier-Faugere MC, Branscum AJ, Ferreira A, Frazao JM et al (2009) Low bone volume–a risk factor for coronary calcifications in hemodialysis patients. Clin J Am Soc Nephrol 4:450–455. https://doi.org/10.2215/CJN.01870408

    Article  Google Scholar 

  31. Bover J, Ureña P, Brandenburg V, Goldsmith D, Ruiz C, DaSilva I et al (2014) Adynamic bone disease: from bone to vessels in chronic kidney disease. Semin Nephrol 34:626–640. https://doi.org/10.1016/j.semnephrol.2014.09.008

    Article  Google Scholar 

  32. Barreto DV, Barreto Fde C, Carvalho AB, Cuppari L, Draibe SA, Dalboni MA et al (2008) Association of changes in bone remodeling and coronary calcification in hemodialysis patients: a prospective study. Am J Kidney Dis 52:1139–1150. https://doi.org/10.1053/j.ajkd.2008.06.024

    Article  CAS  Google Scholar 

  33. Ok E, Asci G, Bayraktaroglu S, Toz H, Ozkahya M, Yilmaz M et al (2016) Reduction of dialysate calcium level reduces progression of coronary artery calcification and improves low bone turnover in patients on hemodialysis. J Am Soc Nephrol 27:2475–2486. https://doi.org/10.1681/ASN.2015030268

    Article  CAS  Google Scholar 

  34. Hernandes FR, Canziani ME, Barreto FC, Santos RO, Moreira VM, Rochitte CE et al (2017) The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients: a 12-month follow-up study. PLoS ONE 12:e0174811. https://doi.org/10.1371/journal.pone.0174811

    Article  CAS  Google Scholar 

  35. Hsu CW, Yen TH, Chen KH, Lin-Tan DT, Lin JL, Weng CH et al (2015) Effect of blood cadmium level on mortality in patients undergoing maintenance hemodialysis. Medicine 94:e1755. https://doi.org/10.1097/MD.0000000000001755

    Article  CAS  Google Scholar 

  36. Yen TH, Lin JL, Lin-Tan DT, Hsu CW, Chen KH, Hsu HH (2011) Blood cadmium level’s association with 18-month mortality in diabetic patients with maintenance haemodialysis. Nephrol Dial Transplant 26:998–1005. https://doi.org/10.1093/ndt/gfq448

    Article  CAS  Google Scholar 

  37. Hsu CW, Lin JL, Lin-Tan DT, Yen TH, Huang WH, Ho TC (2009) Association of environmental cadmium exposure with ınflammation and malnutrition in maintenance hemodialysis patients. Nephrol Dial Transplant 24:1282–1288. https://doi.org/10.1093/ndt/gfn602

    Article  CAS  Google Scholar 

  38. Tinkov AA, Filippini T, Ajsuvakova OP, Skalnaya MG, Aaseth J, Bjørklund G et al (2018) Cadmium and atherosclerosis: a review of toxicological mechanisms and a meta-analysis of epidemiologic studies. Environ Res 162:240–260. https://doi.org/10.1016/j.envres.2018.01.008

    Article  CAS  Google Scholar 

  39. Menke A, Muntner P, Silbergeld EK, Platz EA, Guallar E (2009) Cadmium levels in urine and mortality among U.S. adults. Environ Health Perspect 117:190–196. https://doi.org/10.1289/ehp.11236

    Article  CAS  Google Scholar 

  40. Tellez-Plaza M, Navas-Acien A, Menke A, Crainiceanu CM, Pastor-Barriuso R et al (2002) Cadmium exposure and all-cause and cardiovascular mortality in the U.S. general population. Environ Health Perspect 120:1017–1022. https://doi.org/10.1289/ehp.1104352

    Article  CAS  Google Scholar 

Download references

Funding

The present work was supported by the Scientific Research Projects Coordination Unit of Istanbul University (Project No: 2991). The funders had no role in the design or analysis of this study or the drafting or approval of this manuscript.

Author information

Authors and Affiliations

  1. Department of Nephrology, Kartal Dr Lutfi Kirdar City Hospital, 34865, Istanbul, Turkey

    Meric Oruc

  2. Department of Science, Institute of Forensic Sciences and Legal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Selda Mercan

  3. Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Selim Bakan

  4. Department of Nephrology, Istanbul Education and Research Hospital, Istanbul, Turkey

    Sennur Kose

  5. Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Baris Ikitimur

  6. Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Sinan Trabulus & Mehmet Riza Altiparmak

Authors
  1. Meric Oruc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selda Mercan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Selim Bakan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sennur Kose
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Baris Ikitimur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sinan Trabulus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehmet Riza Altiparmak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: MO, ST. Data extraction and analysis: MO, SM, SB, SK, BI. Manuscript drafting: MO, ST. Manuscript revision and approval: MO, ST, MA.

Corresponding author

Correspondence to Meric Oruc.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

This study was approved by the local medical ethics commitees of two hospitals (Istanbul University-Cerrahpasa Medical Faculty Hospital and Istanbul Education and Research Hospital, approval date:05.05.2015/number:135426). The study was in adherence with the Helsinki Declaration of 1975 (as revised in 1983).

Consent to participate

Written consent was obtained from each subject.

Consent for publication

The participants have consented to the submission of this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 25 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oruc, M., Mercan, S., Bakan, S. et al. Do trace elements play a role in coronary artery calcification in hemodialysis patients?. Int Urol Nephrol 55, 173–182 (2023). https://doi.org/10.1007/s11255-022-03303-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03303-4

Keywords

Search

Navigation