Test Your Knowledge: CRS and the Role of Bone-Mineral Axis & Anemia

Charytan et al AJKD fig 2

Fig 2 from Charytan et al AJKD, © National Kidney Foundation.

There has been longstanding recognition of the relationship between CKD and cardiovascular morbidity and mortality. More recently, the term “cardiorenal syndrome” has been used to describe the interplay between heart and kidney dysfunction. In a recent AJKD article by Charytan et al, the possible interaction between factors involved in renal osteodystrophy and anemia of CKD are discussed, along with their associations with cardiac dysfunction. The following questions based on the article will test your knowledge on this topic:


1. Match the Acute Dialysis Quality Initiative subtype descriptions of cardiorenal syndrome with the physiologic description.

A. Cardiorenal Syndrome Type 1 i. Chronic abnormalities in cardiac function leading to kidney dysfunction
B. Cardiorenal Syndrome Type 2 ii. Systemic conditions causing simultaneous dysfunction of the heart & kidney
C. Cardiorenal Syndrome Type 3 iii. Chronic abnormalities in kidney function leading to cardiac disease
D. Cardiorenal Syndrome Type 4 iv. Acute worsening of kidney function causing cardiac dysfunction
E. Cardiorenal Syndrome Type 5 v. Acute worsening of cardiac function leading to kidney dysfunction


2. In a recent study by Bacchetta et al, supplementation with a single dose of vitamin D resulted in which of the following results relevant to anemia?

A. Reduction in hepcidin levels

B. Increase in ferritin levels

C. Increased tissue sensitivity to EPO

D. Increased transferrin saturation

E. Reduced GI iron absorption

3. Which of the following factors are thought to contribute to vascular calcification?

A. Suppression of the renin-angiotensin-aldosterone system

B. Down-regulation of the Pit-1 receptor

C. Transformation of vascular smooth muscle cells to osteoblastic-type cells

D. Vitamin D supplementation

E. Administration of sevelamer as a phosphorus binder

 4. Which of the following was a clinically significant finding from trials to evaluate treatment of renal osteodystrophy on cardiovascular outcomes?

A. Treatment with paracalcitol in the PRIMO trial is associated with regression of LVH

B. Treatment with cinacalcet in the EVOLVE trial was associated with a reduction in hospitalizations for heart failure

C. Sevelamer, when compared to calcium-containing binders in the DCOR trial, was associated with reduced vascular calcification and reduction in cardiovascular events


Post prepared by Dr. John O’Bell, AJKD Blog Contributor.

To see the answers, please click here.

To view the article abstract or full-text (subscription required), please visit AJKD.org.

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