NDT Advance Access originally published online on December 2, 2005
Nephrology Dialysis Transplantation 2006 21(4):999-1005; doi:10.1093/ndt/gfi308
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Association of mineral metabolism with an increase in cellular adhesion molecules: another link to cardiovascular risk in maintenance haemodialysis?
erafettin Kirazli31 Department of Nephrology, 2 Department of Radiology and 3 Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Correspondence and offprint requests to: Dr Mustafa Arici, Hacettepe Hastanesi, Nefroloji Bolumu, 06100-Sihhiye, Ankara, Turkey. Email: marici{at}hacettepe.edu.tr
Background. Abnormal mineral metabolism is associated with increased cardiovascular morbidity and mortality. The exact pathogenesis linking mineral metabolism to cardiovascular risk is unknown. This study was undertaken to investigate the association between serum phosphate and/or Ca x PO4 product with serum levels of soluble E-selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 and the degree of carotid artery atherosclerosis in patients on haemodialysis.
Methods. Seventy-three patients (46 male, 27 female; mean age 48±13 years, on haemodialysis for 82±80 months) were included in the study. All patients were stable, had no evidence of vascular disease and/or active infection. Consecutive 6 months clinical and laboratory data were obtained for each patient from their medical records and mean values were used for analysis. Serum levels of soluble adhesion molecules were assayed by ELISA. All subjects underwent a detailed evaluation of the carotid arteries.
Results. The percentage of patients who met all three targets of NKF-K/DOQI for phosphate, calcium and Ca x PO4 product was 27.1%, whereas those who did not achieve the target in one, two or three parameters was 28.1, 17.7 and 14.6%, respectively. The sICAM-1 levels were significantly higher in patients who had hyperphosphataemia (serum phosphate >5.5 mg/dl; P = 0.044) and hypercalcaemia (serum calcium >9.5 mg/dl; P = 0.014), both sE-selectin and sICAM-1 levels were significantly higher in patients with Ca x PO4 product levels above 55 mg2/dl2 (P = 0.002 and P = 0.000, respectively). Soluble E-selectin and sICAM levels demonstrated a near-linear increase in parallel to the degree of deviation from mineral metabolism targets. Soluble E-selectin and sICAM levels were correlated with serum phosphate and Ca x PO4 product, but there were no correlations between adhesion molecules and carotid measurements.
Conclusion. These findings suggest that in stable haemodialysis patients abnormal bone mineral metabolism was associated with increased soluble adhesion molecules. These alterations in adhesion molecules may favour the development of cardiovascular changes and contribute to high cardiovascular morbidity and mortality in patients with abnormal mineral metabolism.
Keywords: adhesion molecules; atherosclerosis; calcium x phosphate product; carotid artery intima-media thickness; haemodialysis; mineral metabolism