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People with kidney damage are prone to a chain reaction that increases their risk of heart problems, the leading cause of death among kidney patients, according to researchers at Washington University in St. Louis.
Researchers hope the findings, which will appear in the April issue of the Journal of the American Society of Nephrology, will create new possibilities for treating kidney patients suffering from heart-related problems.
In a study using mice, researchers followed the chain reaction: Kidney damage leads to weakening of the skeleton, which leads to increased phosphorous in the blood. The higher phosphorous levels are linked to vascular calcification ? a stiffening of the smooth muscle cells that line blood vessels.
The vascular calcification leads to enlargement of one of the heart’s four chambers, and that creates increased risk of congestive heart failure, heart attack and other cardiac problems.
Researchers treated mice with an experimental medication that alleviates skeletal weakening brought on by kidney damage. Those mice had normal phosphorous levels and decreased signs of vascular calcification.
"We already have treatments available that can control phosphorous levels in the blood, and those should be very helpful for kidney patients," said Dr. Keith Hruska, senior investigator of the study and a professor of nephrology.
Dr. David Warnock, director of the division of nephrology at the University of Alabama-Birmingham and president of the National Kidney Foundation, called the study "a very exciting development in our understanding of the relationship between chronic kidney disease and heart disease.
"We know from large-scale population studies that the severity of kidney disease predicts cardiovascular events," he said. "The worse your kidney function is, the greater the chance of a cardiovascular event."
Hruska and other researchers have discovered links between the skeleton and kidney. He said hormones made in the kidney regulate activity in the skeleton, while skeletal hormones regulate activity in the kidney.
Hruska last year showed that injections of bone morphogenetic protein-7 (BMP-7) could prevent bone weakening in mice whose kidneys had been damaged or removed.
Researchers in the new study worked with a mouse model of metabolic syndrome, a condition that is increasing in both adults and children and one that also is associated with higher risks of diabetes and heart disease. The condition is common for patients with chronic kidney disease, with symptoms such as obesity, high blood pressure and insulin resistance.
Mice develop the syndrome both because of genetic modification and a high-fat, high-cholesterol diet.
Researchers simulated chronic kidney disease by damaging or removing part of the kidney, leading to shutdown of cells that normally tear down and rebuild bones. The result was vascular calcification.
Under normal circumstances, the body takes minerals like calcium and phosphorous from the bloodstream and deposits them in bones during bone reconstruction. Researchers suspected that with those processes shut down, the levels of minerals in the bloodstream would increase, creating pressure to deposit them somewhere else.
The changed smooth muscle cells can put minerals outside their membranes, researchers said, decreasing the flexibility of blood vessels and making the heart work harder.
"Vascular stiffness happens to patients with end-stage kidney failure when they go on dialysis, and it leads to many dangerous cardiovascular complications," Hruska said.
Hruska said injection of BMP-7 stopped vascular calcification. In another group of mice, researchers injected a substance that binds to compounds with phosphorous but has no effect on the skeleton. That substance also stopped vascular calcification, indicating that phosphorous was the key link, researchers said.
"The connection that Dr. Hruska has come up with BMP-7 is very exciting and very intriguing and opens a new therapeutic approach to treating these issues," Warnock said.