Approaches to predicting the risk of acute cerebrovascular accident in patients with stage 5 chronic kidney disease and bone mineral disorders

Abstract

   BACKGROUND. Among the causes of death in patients with chronic kidney disease (CKD) on dialysis, cardiovascular complications play a leading role. One of them is acute incidences of cerebral circulation (AICC). The assessment of the impact of mineral and bone disorders on the risk of developing AICC is interesting and on par with the assessment of the impact of traditional risk factors.   THE AIM: to evaluate the effects of bone mineral disorders on the risk of acute cerebrovascular accident in patients with stage 5 D CKD.   PATIENTS AND METHODS. A single-center cohort prospective (three-year) study of 85 patients with stage 5D CKD on program hemodialysis was conducted. In the first stage, we evaluated traditional risk factors (blood pressure, echocardiography parameters) and parameters that reflect bone mineral disorders (parathyroid hormone, blood phosphate, calcium levels, 1.25 (OH) D, fibroblast growth factor-FGF-23, a-klotho of blood). Signs of calcification of the heart valves (CHV) and the aortic wall (CAW) were also recorded. In the second stage, three years later, patients were re-examined with the registration of the endpoint, which was identified as cases of fatal and non-fatal AICC.   RESULTS. Within three years, 10 cases of AICC were registered. Mineral and bone disorders in patients on hemodialysis, such as hyperphosphatemia, CKD and its severity are risk factors for the development of AICC. It is shown that the severity of CCS and pulse pressure levels determined before the dialysis procedure and intradialytic have a positive effect on the risk of AICC. Factors such as FGF-23 and α-Klotho of blood have not demonstrated their effect on the risk of AICC.