Clinical study: end-stage renal design
Cardiac calcification in adult hemodialysis patients: A link between end-stage renal disease and cardiovascular disease?

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Abstract

Objectives

We sought to determine clinical and laboratory correlates of calcification of the coronary arteries (CAs), aorta and mitral and aortic valves in adult subjects with end-stage renal disease (ESRD) receiving hemodialysis.

Background

Vascular calcification is known to be a risk factor for ischemic heart disease in non-uremic individuals. Patients with ESRD experience accelerated vascular calcification, due at least in part to dysregulation of mineral metabolism. Clinical correlates of the extent of calcification in ESRD have not been identified. Moreover, the clinical relevance of calcification as measured by electron-beam tomography (EBT) has not been determined in the ESRD population.

Methods

We conducted a cross-sectional analysis of 205 maintenance hemodialysis patients who received baseline EBT for evaluation of vascular and valvular calcification. We compared subjects with and without clinical evidence of atherosclerotic vascular disease and determined correlates of the extent of vascular and valvular calcification using multivariable linear regression and proportional odds logistic regression analyses.

Results

The median coronary artery calcium score was 595 (interquartile range, 76 to 1,600), values consistent with a high risk of obstructive coronary artery disease in the general population. The CA calcium scores were directly related to the prevalence of myocardial infarction (p < 0.0001) and angina (p < 0.0001), and the aortic calcium scores were directly related to the prevalence of claudication (p = 0.001) and aortic aneurysm (p = 0.02). The extent of coronary calcification was more pronounced with older age, male gender, white race, diabetes, longer dialysis vintage and higher serum concentrations of calcium and phosphorus. Total cholesterol (and high-density lipoprotein and low-density lipoprotein subfractions), triglycerides, hemoglobin and albumin were not significantly related to the extent of CA calcification. Only dialysis vintage was significantly associated with the prevalence of valvular calcification.

Conclusions

Coronary artery calcification is common, severe and significantly associated with ischemic cardiovascular disease in adult ESRD patients. The dysregulation of mineral metabolism in ESRD may influence vascular calcification risk.

Abbreviations

ASVD
atherosclerotic vascular disease
CA
coronary artery
CAD
coronary artery disease
EBT
electron-beam tomography
ESRD
end-stage renal disease
HDL
high-density lipoprotein
LDL
low-density lipoprotein
MI
myocardial infarction
PTH
parathyroid hormone

Cited by (0)

Funding provided by Genzyme, Inc.

1

Dr. Burke, Ms. Dillon, and Ms. Boulay are employees of GelTex Pharmaceuticals, Inc, a subsidiary of Genzyme, Inc. Dr. Amin is an employee of Genzyme, Inc. All have equity interest in Genzyme, Inc. Drs. Raggi, Chasan-Taber, and Chertow have no equity interest in Genzyme, Inc. Dr. Raggi and Dr. Chertow serve on the Physician Advisory Board of Genzyme, Inc. Dr. Chasan-Taber works for a firm retained by Genzyme, Inc for statistical analysis of clinical trials.