miRNAs and indicators of mineral metabolism in the population of dialysis patients

Abstract

Introduction. Cardiovascular events are the leading cause of death in patients on renal replacement dialysis therapy. The vast majority of patients with CKD 5D have left ventricular hypertrophy (LVH), which is a predisposing factor to diastolic dysfunction, heart failure (HF), arrhythmias, and sudden cardiac death. In recent years, a significant role in the development of cardiovascular pathology in CKD has been attributed to disturbances in calcium and phosphorus homeostasis. Mineral bone correction may have a beneficial effect on LVH.Aim. To evaluate the associations between indices of mineral-bone metabolism and cardiac echocardiography parameters in patients on renal replacement therapy (RRT) with hemo- and peritoneal dialysis, receiving and not receiving phosphate binders.Materials and methods. The study included 75 patients, of whom 53 received treatment with program hemodialysis (HD), 22 with peritoneal dialysis (PD). The control group consisted of 28 healthy volunteers. 43 patients were treated with phosphate binders. Of all patients receiving treatment aimed at correcting hyperphosphatemia, 22 received sevelamer carbonate: 86% of patients took sevelamer carbonate at a dose of 4800 mg/day and 14% at a dose of 2400 mg/day. All biochemical parameters were determined on an automatic biochemical analyzer; FGF-23 was also determined by enzyme-linked immunosorbent assay (ELISA) and the level of intact PTH was determined by chemiluminescence immunoassay. Instrumental studies included echocardiography.Results. In patients with left ventricular hypertrophy (LVMM in the group of patients on hemodialysis 206.6 [120.0; 300.0], in the group on peritoneal dialysis 176.2 [134.0; 204.0]) the level of FGF-23 was significantly increased (p = 0.005). In the group of patients receiving sevelamer carbonate, there was a decrease in the incidence of left ventricular hypertrophy, lower levels of FGF-23 (12.4 ± 5.9), in contrast to the group that did not receive this drug (23 ± 7.3; p = 0.003 ) and PTH (110 ± 27 ng/ml, in the group that did not receive the drug – 340 ± 15; p = 0.01).Conclusions. The use of phosphate binders, in particular sevelamer carbonate, is associated with a decrease in left ventricular hypertrophy and lower levels of FGF-23.