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Published on: June 2, 2022
Natural history of vascular calcification in dialysis and transplant patients
Sharon M Moe1, Kalisha D O'Neill, Martina Reslerova
1Departmrnt of Medicine, Indiana University School of Medicine, 1001 W. 10th Street, OPW 526, Indianapolis, IN 46202, USA. smoe@iupui.edu
Insights
Renal transplantation may halt coronary artery calcification (CAC), while it progresses in patients on hemodialysis. Higher baseline CAC in dialysis patients correlated with increased mortality and hospitalization.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Vascular calcification is a common complication in chronic kidney disease (CKD).
- The natural history of vascular calcification after renal transplant versus hemodialysis is not well understood.
Purpose of the Study:
- To investigate the progression of coronary artery calcification (CAC) and aorta calcification (AoC) in renal transplant recipients.
- To compare the natural history of vascular calcification in renal transplant patients versus patients on chronic hemodialysis.
Main Methods:
- Prospective study using spiral computed tomography (CT) to assess CAC and AoC.
- Cohort 1: 23 renal transplant patients with baseline and 15-20 month follow-up CT scans.
- Cohort 2: 33 hemodialysis patients with baseline CT, 17 having a second scan.
Main Results:
- Renal transplant recipients showed stable or arrested CAC.
- Hemodialysis patients exhibited a significant increase in median CAC (1.27+/-1.88 score/day, P=0.013).
- Baseline CAC was significantly higher in hemodialysis patients who died or were hospitalized compared to survivors or those not hospitalized.
Conclusions:
- Renal transplantation may slow or arrest CAC progression.
- CAC continues to progress in hemodialysis patients.
- Elevated baseline CAC in dialysis patients is a predictor of adverse outcomes, including mortality and hospitalization.
Background:
The purpose of the present study was to determine the natural history of coronary artery and aorta calcification by spiral computed tomography (CT) in patients who undergo a renal transplant and patients on haemodialysis.
Methods:
Two cohorts were evaluated for the natural history of vascular calcification: (i) 23 patients who underwent a baseline CT scan at the time of renal transplant and a repeat evaluation 15-20 months later; and (ii) 33 chronic kidney disease, stage 5 haemodialysis subjects who underwent a baseline CT scan, all followed for a minimum of 15 months, and 17 of whom underwent a second CT scan.
Results:
In the patients undergoing a renal transplant, there was no net change in CAC with time, suggesting stabilization of calcification. In the haemodialysis patients, the median CAC increased by 1.27+/-1.88 score/days, P = 0.013. There was a trend towards increasing AoC score in both groups. All patients without calcification at baseline remained calcification free at follow-up. In the 15 months following baseline, the six dialysis patients who died had a significantly greater CAC score at baseline compared with the 24 patients who remained alive. Similarly, those patients who were hospitalized had a greater baseline CAC than patients who were not hospitalized.
Conclusion:
In this preliminary study, renal transplantation appears to slow down or arrest CAC, whereas CAC progresses in haemodialysis patients. In haemodialysis patients, CAC was greater in patients who died or were hospitalized compared with those who remained alive or were not hospitalized.
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