Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
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Rania Mahmoud
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
The prevalence of CVD has not decreased over time. : The prevalence of CVD in patients with CKD was 69% in 2013 and 63% to 75% (depending on disease stage) in 2018, whereas the prevalence of CVD in patients on dialysis was 61% to 74% in 2013 and 65% to 77% in 2018. Mortality owing to CVD in patients with ESKD has increased, with CVD accounting for 51% of deaths with known causes in patients with ESKD in 2011 to 2013 and 53% and 55% of deaths with a known cause in patients on peritoneal and hemodialysis, respectively, in 2018 .
The complexity of maintaining CV health in patients with CKD is high because nontraditional factors also increase the risk of CVD in this population; in addition to traditional risk factors (e.g., smoking, diabetes, hypertension).
Mineral and endocrine abnormalities are key nontraditional risk factors associated with increased CV morbidity and all-cause mortality.
The association between CV health and nontraditional risk factors, including phosphorus, albumin, hemoglobin, and urate. This study found that increased serum phosphorus concentrations were associated with increased risk of CV events
No major change in the proportion of patients with all mineral bone disease markers (serum phosphorus, calcium, and parathyroid hormone) within the recommended range from 2010 (31%) to 2021 (30%).
The prevalence of CVD has not decreased over time. Mortality owing to CVD in patients with ESKD has increased, with CVD accounting for 51% of deaths with known causes in patients with ESKD in 2011 to 2013 and 53% and 55% of deaths with a known cause in patients on peritoneal and hemodialysis, respectively, in 2018.
Causes:
· Complexity of maintaining CV health in patients with CKD is high because nontraditional factors also increase the risk of CVD in this population; in addition to traditional risk factors (e.g., smoking, diabetes, hypertension).
· Lack of novel approaches to improving CV health.
· Most patients on dialysis are not consistently achieving and maintaining.
target phosphorus goals of <5.5 mg/dl, let alone more normal levels of <4.5 mg/dl.
· No major change in the proportion of patients with all mineral bone disease markers (serum phosphorus, calcium, and parathyroid hormone) within the recommended range from 2010 (31%) to 2021 (30%).
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.The prevalence of CVD has not decreased over time Mortality owing to CVD in patients with ESKD has increased
in addition to traditional risk factors (e.g., smoking, diabetes, hypertension), there are also nontraditional risk factors associated with increased CV morbidity in CKD patients including serum phosphorus, albumin, hemoglobin, and urate
so increased serum phosphorus concentrations were associated with increased risk of CV events in ckd patients
Phosphate retention increases in fibroblast growth factor-23 and PTH , both linked to CV morbidity and mortality.
overall, the prevalence of CV disease and mortality in CKD decreased in recent yearsdid not decrease, and its one of the challenges in CKD patients and hyperphosphatemia directly related to cardiovascular diseases on addition with other risk factors such as hyperlipidemia , diabetes ,smoking and hypertension
The prevalence of CVD did not changed over the last years, as it is multifactorial (traditional and non traditional risk factors).
CVD is directly related to hyperphosphatemia, which show difficulty in management in some pts due to noncompliance to inorganic phosphate restriction & high pill burden of phosphorus chelators, drug side effects, hidden phosphorus in diet and medications.
Hyperphophatemia causes endothelial dysfunction, ROS production and mitochondrial dysfunction, endothelial apoptosis, also causes increase FGF23& PTH with LVH, CCF, HTN, vascular calcification, increased mortality.
No significant decrease in the CV disease due to ; It is difficult to control phosphorus, it is present in most foods, hidden PO4 in additives and some medications, non adherence to the medication due to big number of pills , medications side effects .
there is no decrease in CVD as controlling hyperphosphatemia , which is a major non traditional risk factor for CVD , is still challenging and still cause this issue
The prevalence of CVD and mortality has not decreased over time.
Due to traditional( smoking, diabetes, hypretension) and nontraditional (mineral and endocrine abnormalities) risk factors.
Hyperphosphatemia leads to endothelial dysfunction, causing cell injury by inducing endothelial cell apoptosis and disrupting mitochondrial function by increased production( of reactive oxygen species.It also induces the calcification of vascular smooth muscle cells,which increases the risk of CV and all-cause mortality.
Elevated fibroblast growth factor-23 is associated with congestive heart failure and left ventricular hypertrophy.
Hyperparathyroidism is associated with hypertensionand increased risk of CV mortality.
Despite all medical achievements,most patients are not achieving or maintaining target phosphorus level due to an abundance of “hidden” phosphates in food, suboptimal adherence owing to the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
No I don’t think so the CVD remain the most common cause of mortality among the renal patient mostly due to the effect of hyperphosphatemia and difficulty to achieve the target level of po4 due to high content of po4 in diet hidden amount in po4 in drug uncompliance with po4 chelator
The sheer volume of evidence linking higher phosphorus levels to CV and overall mortality and the data showing that phosphate promotes several physiological changes that raise CV risk make phosphorus concentrations a natural target for CKD intervention.
No significant decrease in the CV disease due to:
It is difficult to control phosphorus, it is present in most foods, hidden PO4, and Intolerability to the medication due to side effects. even with the new medication.
There is no dramatic decrease in terms of cardiovascular mortality. This is somehow complex. The reported information in this review comparing 2013 and 2018 are consistent with USRDS data. In the link (https://usrds-adr.niddk.nih.gov/2022/end-stage-renal-disease/6-mortality) there has been an increase in the last few years, but this is complicated by COVID. Till 2019 we observe that mortality is still parallel over the years.
The vascular calcifications and unawareness of the importance of this sneaky killer seem to be the major factor.
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
No, i don’t think it is decreasing it could be the same or even worse and this explores the non-traditional risk factors for CVS which is present in CKD patients like hyperphosphatemiaurate and low Hb , albumin,high urate and low Hb .
phosphate retension triggers increases in FGF23 and PTH concentrations elevated FGF23 associated with congestive heart failure and LVH high PTH associated with hypertension and increased cv risk
The prevalence of CV disease and mortality in Ckd not decrease in recent years because of the complexity to keep CV health and decrease all causes mortality caused by the traditional factors such as smoking, diabetes, hyperlipidemia and hypertension in addition to the non traditional factors such as s. Phosphorous, hemoglobin, albumin and urate.
Studies show that increases s. Phosphorous associated with CV events.
Prevalence of CV disease and mortality in CKD has not decreased in recent years it can be argued it same or even worse. This is a reflection that current management of cv disease needs to change . One of the areas that this could be improved in in hyperphopshatemia in ckd as it has been shown that phosphate is an important contributor of CV disease and mortality in CKD
nothe prevalence of CV disease and mortality in CKD increased because nontraditional cardiovascular risk factors increased ..increase serum phosphate associated with increase risk of CV events .
most patients on dialysis not maintaining target phosphate goals of <5.5 mg/dl
improving the phosphate management is the rationa approach to improve CV health
high phosphate level lead to endothelial dysfunction ,increase production of ROS ,induce vascular calcification which increases the risk of cv and all cause mortality .
phosphate retension triggers increases in FGF23 and PTH concentrations
elevated FGF23 associated with congestive heart failure and LVH
high PTH associated with hypertension and increased cv risk
I think that the death with CVD is increasing with years because of poor phosphate control. Statistic in this article above show that every year the phosphate control is worsening . There is a direct relationship between CVD and hyperphosphatemia.
The adherence and education of patient is low.
There is more hidden phosphate in our products. With industrialisation of food products and absence of control of phosphate the CVD ratio will worsen.
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
I think so based on observational studies but there is some lacking of RCT for evaluation of this hopeful target.
the possible causes are related to the following :
1- more efficient and intensive hemodialysis with introduction of high flux dialyzers, HDF, … etc.
2- more careful follow-up and optimization of CKD-MBD parameters.
3- more experiences in management of CKD-MBD
4- more developments in management of CVD and related morbidities.
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
No, actually the opposite is correct, the mortality rate has increased significantly across all the stages of CKD over years.
CVD mortality is worse in dialysis population with increased prevalence
CVD is responsible for more than half of deaths with known causes in HD & PD patients
The reasons behind these are ; the novel or non traditional risk factors such as phosphate, albumin, hemoglobin and urate. Also the presence of traditional risk factors for CVD in general population e.g., smoking, diabetes, dyslipidemia,& hypertension)
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
Here is a suggested answer:
The prevalence of CVD has not decreased over time. Mortality owing to CVD in patients with ESKD has increased, with CVD accounting for 51% of deaths with known causes in patients with ESKD in 2011 to 2013 and 53% and 55% of deaths with a known cause in patients on peritoneal and hemodialysis, respectively, in 2018.
Causes:
· Complexity of maintaining CV health in patients with CKD is high because nontraditional factors also increase the risk of CVD in this population; in addition to traditional risk factors (e.g., smoking, diabetes, hypertension).
· Lack of novel approaches to improving CV health.
· Most patients on dialysis are not consistently achieving and maintaining.
target phosphorus goals of <5.5 mg/dl, let alone more normal levels of <4.5 mg/dl.
· No major change in the proportion of patients with all mineral bone disease markers (serum phosphorus, calcium, and parathyroid hormone) within the recommended range from 2010 (31%) to 2021 (30%).
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.The prevalence of CVD has not decreased over time Mortality owing to CVD in patients with ESKD has increased
in addition to traditional risk factors (e.g., smoking, diabetes, hypertension), there are also nontraditional risk factors associated with increased CV morbidity in CKD patients including serum phosphorus, albumin, hemoglobin, and urate
so increased serum phosphorus concentrations were associated with increased risk of CV events in ckd patients
Phosphate retention increases in fibroblast growth factor-23 and PTH , both linked to CV morbidity and mortality.
Indeed the prevelance not changed , because calcium and phosphate balance is still a matter of debate.
overall, the prevalence of CV disease and mortality in CKD decreased in recent yearsdid not decrease, and its one of the challenges in CKD patients and hyperphosphatemia directly related to cardiovascular diseases on addition with other risk factors such as hyperlipidemia , diabetes ,smoking and hypertension
The prevalence of CVD did not changed over the last years, as it is multifactorial (traditional and non traditional risk factors).
CVD is directly related to hyperphosphatemia, which show difficulty in management in some pts due to noncompliance to inorganic phosphate restriction & high pill burden of phosphorus chelators, drug side effects, hidden phosphorus in diet and medications.
Hyperphophatemia causes endothelial dysfunction, ROS production and mitochondrial dysfunction, endothelial apoptosis, also causes increase FGF23& PTH with LVH, CCF, HTN, vascular calcification, increased mortality.
No significant decrease in the CV disease due to ;
It is difficult to control phosphorus, it is present in most foods, hidden PO4 in additives and some medications, non adherence to the medication due to big number of pills , medications side effects .
No regarding hyperphosphatemia as a risk factor for CV dis
due to Challenges in Achieving Target Phosphorus Concentration besides its impact on CV events after correction not confirmed yet.
there is no decrease in CVD as controlling hyperphosphatemia , which is a major non traditional risk factor for CVD , is still challenging and still cause this issue
the prevalence of cardiovascular diseases in chronic kidney disease did not change in the recent years
Possible causes
No improvement in CVD in the background of hyperphosphatemia
The prevalence of CVD and mortality has not decreased over time.
Due to traditional( smoking, diabetes, hypretension) and nontraditional (mineral and endocrine abnormalities) risk factors.
Hyperphosphatemia leads to endothelial dysfunction, causing cell injury by inducing endothelial cell apoptosis and disrupting mitochondrial function by increased production( of reactive oxygen species.It also induces the calcification of vascular smooth muscle cells,which increases the risk of CV and all-cause mortality.
Elevated fibroblast growth factor-23 is associated with congestive heart failure and left ventricular hypertrophy.
Hyperparathyroidism is associated with hypertension and increased risk of CV mortality.
Despite all medical achievements,most patients are not achieving or maintaining target phosphorus level due to an abundance of “hidden” phosphates in food, suboptimal adherence owing to the burden of taking phosphate binders multiple times per day, and side effects of phosphate binders.
No I don’t think so the CVD remain the most common cause of mortality among the renal patient mostly due to the effect of hyperphosphatemia and difficulty to achieve the target level of po4 due to high content of po4 in diet hidden amount in po4 in drug uncompliance with po4 chelator
The sheer volume of evidence linking higher phosphorus levels to CV and overall mortality and the data showing that phosphate promotes several physiological changes that raise CV risk make phosphorus concentrations a natural target for CKD intervention.
No significant decrease in the CV disease due to:
It is difficult to control phosphorus, it is present in most foods, hidden PO4, and Intolerability to the medication due to side effects. even with the new medication.
No improvement in CVD in the background of hyperphosphatemia
For all mentioned factors
Targeting inhibitor medication can help to control hyperphosphatemia
There is no dramatic decrease in terms of cardiovascular mortality. This is somehow complex. The reported information in this review comparing 2013 and 2018 are consistent with USRDS data. In the link (https://usrds-adr.niddk.nih.gov/2022/end-stage-renal-disease/6-mortality) there has been an increase in the last few years, but this is complicated by COVID. Till 2019 we observe that mortality is still parallel over the years.
The vascular calcifications and unawareness of the importance of this sneaky killer seem to be the major factor.
No, i don’t think it is decreasing it could be the same or even worse and this explores the non-traditional risk factors for CVS which is present in CKD patients like hyperphosphatemiaurate and low Hb , albumin,high urate and low Hb .
phosphate retension triggers increases in FGF23 and PTH concentrations
elevated FGF23 associated with congestive heart failure and LVH
high PTH associated with hypertension and increased cv risk
I think so
the causes may be :
The prevalence of CV disease and mortality in Ckd not decrease in recent years because of the complexity to keep CV health and decrease all causes mortality caused by the traditional factors such as smoking, diabetes, hyperlipidemia and hypertension in addition to the non traditional factors such as s. Phosphorous, hemoglobin, albumin and urate.
Studies show that increases s. Phosphorous associated with CV events.
Prevalence of CV disease and mortality in CKD has not decreased in recent years it can be argued it same or even worse. This is a reflection that current management of cv disease needs to change . One of the areas that this could be improved in in hyperphopshatemia in ckd as it has been shown that phosphate is an important contributor of CV disease and mortality in CKD
nothe prevalence of CV disease and mortality in CKD increased because nontraditional cardiovascular risk factors increased ..increase serum phosphate associated with increase risk of CV events .
most patients on dialysis not maintaining target phosphate goals of <5.5 mg/dl
improving the phosphate management is the rationa approach to improve CV health
high phosphate level lead to endothelial dysfunction ,increase production of ROS ,induce vascular calcification which increases the risk of cv and all cause mortality .
phosphate retension triggers increases in FGF23 and PTH concentrations
elevated FGF23 associated with congestive heart failure and LVH
high PTH associated with hypertension and increased cv risk
I think that the death with CVD is increasing with years because of poor phosphate control. Statistic in this article above show that every year the phosphate control is worsening . There is a direct relationship between CVD and hyperphosphatemia.
The adherence and education of patient is low.
There is more hidden phosphate in our products. With industrialisation of food products and absence of control of phosphate the CVD ratio will worsen.
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.
1- more efficient and intensive hemodialysis with introduction of high flux dialyzers, HDF, … etc.
2- more careful follow-up and optimization of CKD-MBD parameters.
3- more experiences in management of CKD-MBD
4- more developments in management of CVD and related morbidities.
Do you think the prevalence of CV disease and mortality in CKD decreased in recent years? Explain the possible causes.