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Cluj-Napoca, Romania

Moldovan D.,Victor Babes University of Medicine and Pharmacy Timisoara | Rusu C.,Victor Babes University of Medicine and Pharmacy Timisoara | Patiu I.,Nefromed Dialysis Center | Racasan S.,Nefromed Dialysis Center | And 5 more authors.
Acta Endocrinologica | Year: 2010

Background. Vascular calcifications (VCs) represent an important complication in dialysis patients. It is still a subject of debate whether VCs are associated with low or high intact parathormone (iPTH), or if it is not any relation. The purpose of this study was to assess the predictive value of iPTH and other mineral markers for VCs development. Methods. The study evaluated peripheral VCs in haemodialysis (HD) and peritoneal dialysis (PD) patients using radiographies. We counted a semiquantitative score ranging from 0 to 8. Each category was divided into two groups according to VCs score. We assessed the relationship between the VCs score and mineral markers. Results. A VC score=2 was positively associated with male gender, serum Ca, P, CaxP, ALP and iPTH levels in HD patients. There was no correlation with age, HD vintage, received treatment. In PD patients, did CaxP have a higher significance with VC score>/2; were iPTH, CaxP and P of higher significance for a score=5. Conclusions. Hyperparathyroidism can be considered a predictor for VCs development in dialysis patients. Other risk factors are increased serum Ca, P, CaxP and ALP levels. In PD patients, high iPTH could predict VCs only for severe calcifications, but the CaxP could even predict for less extended VCs.


Moldovan D.,University of Medicine and Pharmacy, Cluj-Napoca | Kacso I.M.,University of Medicine and Pharmacy, Cluj-Napoca | Rusu C.,University of Medicine and Pharmacy, Cluj-Napoca | Potra A.,University of Medicine and Pharmacy, Cluj-Napoca | And 5 more authors.
Biomarkers | Year: 2015

Aim: To assess the osteoprotegerin (OPG) relationship with cardiovascular complications in hemodialysis (HD) patients. Methods: The study included 87 HD patients. Clinical characteristics, ankle-arm index (AAI), OPG and mineral markers levels were recorded. Arterial intimal calcification (AIC) and arterial medial calcification (AMC) were registered. Results: OPG levels were increased in HD patients. Patients with AIC (p=0.006)/AMC (p=0.01) had higher OPG levels. OPG did not have any relation with cardiovascular diseases. OPG correlated positively with age, increased HD vintage and inversely with albumin and AAI. OPG has not been a risk factor for VC or cardiovascular disease. Conclusion: OPG rising could be a reaction in defense to vascular aggression, because OPG was associated with VC, but not with vascular disease. © 2015 Informa UK Ltd. All rights reserved.


Moldovan D.,University of Medicine and Pharmacy, Cluj-Napoca | Moldovan I.,Military Hospital | Rusu C.,University of Medicine and Pharmacy, Cluj-Napoca | Kacso I.,University of Medicine and Pharmacy, Cluj-Napoca | And 2 more authors.
International Urology and Nephrology | Year: 2014

Introduction: Chronic hemodialysis (HD) patients have bad prognosis and cardiovascular diseases (CVD) represent their main threatening complication. Fibroblast growth factor (FGF-23) has been associated with all kinds of evil consequences, including cardiovascular morbidity, but some studies demonstrated the contrary. Therefore, it is important to know whether FGF-23 is associated with cardiovascular risk or protection. The purpose of this study was to assess the links between FGF-23 and intimal vascular calcification (VC) and with the presence of CVD in chronic HD patients. Patients and methods: This study was carried out on a cohort of randomly selected 88 prevalent HD patients. We recorded demographical, clinical, and biochemical data, including FGF-23. VC was evaluated on carotid ultrasound. CVD were registered. Results: The mean age was 59.68 ± 14.49 years, HD vintage was 59.61 ± 52.39 months, and 20 patients were diabetic (22.72 %). VC was present in 54 patients (61.4 %) and 25 patients (28.4 %) had CVD. FGF-23 correlated positively with HD vintage (r = 0.37; p < 0.001) and iPTH (r = 0.21; p = 0.048). FGF-23 did not correlate with VC score. Patients with CVD were older (p = 0.006), had lower FGF-23 (p = 0.008), higher VC score (p = 0.009), lower Hb (p = 0.008), albumin (p = 0.003), and creatinine (p = 0.03). Low FGF-23 was identified as a risk factor for CVD. Conclusion: We report on a novel association between low FGF23 and CVD in chronic HD patients and a lack of correlation of FGF-23 with VC. FGF-23 could play a role in cardiovascular protection that remains to be confirmed in larger studies. © 2013 Springer Science+Business Media Dordrecht.


Moldovan D.,University of Medicine and Pharmacy, Cluj-Napoca | Moldovan I.,Emergency Military Hospital | Rusu C.,University of Medicine and Pharmacy, Cluj-Napoca | Racasan S.,Nefromed Dialysis Center | And 7 more authors.
International Urology and Nephrology | Year: 2011

Introduction Vascular calcifications (VCs) and renal osteodystrophy (ROD) are frequently seen together and represent the major causes of morbidity and mortality in hemodialysis (HD) patients. Some studies suggest a pathogenic link between them, but there is no consensus as yet regarding this issue. The main objective of our study was to establish whether there is any relation between VCs and ROD in our HD patients. We evaluated the prevalence of VCs and ROD and the relationship between VCs and some clinical and biochemical characteristics of HD patients. Methods We examined radiological signs of VCs and RODon hands and pelvis bone radiographs in 81 chronic HD patients, and we calculated a VC score on this basis. Results We found a significant relation between radiological signs of ROD and those of VC (P = 0.019). The patients with ROD had a higher mean VC score (P = 0.02). By linear regression, the VC score correlated directly with serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH) and CaxP product and inversely with serum albumin. The logistic regression model revealed that ROD, male gender and treatment with calcium salts were predictive of VCs development. There were no associations between VCs and age, HD vintage, diabetes, dialysate Ca concentration, vitamin D treatment, spKt/V, URR and C-reactive protein (CRP) levels. Conclusion There seems to be a pathogenetic link between bone and artery diseases in chronic HD patients. Both VCs and ROD have a high prevalence. ROD, male gender and treatment with calcium salts are risk factors for VCs. © 2011 Springer Science+Business Media, B.V.


Moldovan D.,University of Medicine and Pharmacy, Cluj-Napoca | Racasan S.,Nefromed Dialysis Center | Kacso I.M.,University of Medicine and Pharmacy, Cluj-Napoca | Rusu C.,University of Medicine and Pharmacy, Cluj-Napoca | And 4 more authors.
International Urology and Nephrology | Year: 2015

Introduction: The life for end-stage renal disease patients has remarkably improved in the last years. Although mineral and bone disorders remain as unsolved complication, in severe secondary hyperparathyroidism (sHPT), the ultimate treatment is parathyroidectomy (PTX). It is an old treatment, but there are still insufficient data regarding survival after PTX. The study goals were to compare 2-year mortality and morbidity after PTX in surgically versus medically treated sHPT and to compare the efficacy and safety in subtotal versus total PTX in a cohort of patients receiving hemodialysis (HD). Methods: This prospective, longitudinal study was carried out on a cohort of chronic HD patients with severe sHPT (iPTH over 700 pg/ml). Among the overall HD population, 26 patients underwent PTX. This group was compared to a control group treated with specific drugs. Laboratory parameters, specific symptoms and mortality were registered after 24 months of follow-up for each group. The subgroups of subtotal and total PTX patients were also compared. Results: All average values of mineral markers were significantly reduced after PTX, as a proof that surgical treatment was effective. The reduction in mineral markers and the improvement in symptoms and mortality rates were similar after total and subtotal PTX. Bone pain was significantly lower in patients after PTX than in those drug treated (p = 0.0005), but not muscle weakness and itching. Survival at 2 years was better in patients surgically treated (PTX) despite significantly higher mean baseline values of iPTH, Ca and ALP compared to patients medically treated (p = 0.03). Conclusions: We compared clinical and laboratory outcomes in HD patients with severe sHPT. Mortality, bone pain and mineral markers were improved by PTX. Total and subtotal PTX had similar clinical outcomes. © 2015, Springer Science+Business Media Dordrecht.

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