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Effect of etidronic acid on arterial calcification in dialysis patients
Tsuneo Ariyoshi1, Kiyoyuki Eishi, Ichiro Sakamoto
1Department of Cardiovascular Surgery, Nagasaki University School of Medicine, Nagasaki, Japan. t-ariyoshi@hospital.sasebo.nagasaki.jp
Insights
Etidronic acid significantly reduced aortic calcification in patients undergoing chronic haemodialysis. This bisphosphonate treatment may improve long-term outcomes by reducing arterial stiffness.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pharmacology
Background:
- Bisphosphonates, like etidronic acid, are used to treat osteoporosis and may reduce arterial calcification.
- Patients with end-stage renal disease (ESRD) undergoing chronic haemodialysis are at high risk for arterial calcification.
Purpose of the Study:
- To evaluate the effect of etidronic acid on arterial calcification in patients on chronic haemodialysis.
- To assess changes in serum markers related to calcification in these patients.
Main Methods:
- A randomized controlled trial was conducted with two groups: etidronic acid (400 mg/day for 24 weeks) and a control group.
- Aortic and coronary artery calcification scores were measured using multi-detector-row computed tomography.
- Serum levels of calcium, phosphate, and other relevant markers were monitored bi-weekly.
Main Results:
- Etidronic acid treatment led to a significant decrease in aortic calcification scores over one year (-64.1%).
- The control group showed a significant increase in aortic calcification scores over the same period (+130.0%).
- No significant changes in coronary artery calcification or serum markers were observed in either group.
Conclusions:
- Etidronic acid effectively reduces aortic calcification in ESRD patients on chronic haemodialysis.
- This reduction in aortic calcification may help mitigate arterial stiffness and improve long-term patient outcomes.
Background:
Bisphosphonate drugs, including etidronic acid, are effective agents for the treatment of osteoporosis and may reduce arterial calcification. The aim of this randomised control trial was to characterise the effect of etidronic acid on arterial calcification in patients undergoing chronic haemodialysis.
Methods:
Patients undergoing chronic haemodialysis were assigned to one of two groups by a simple randomisation method: an etidronic acid group (n = 8; 400 mg/day for 24 weeks) and a control group (n = 6; no etidronic acid therapy). Serum calcium, phosphate, calcium-phosphate product, alkaline phosphatase, lactate dehydrogenase, activated colecalciferol and parathyroid hormone levels were measured at baseline and then at 4-weekly intervals thereafter.
Results:
Calcification scores of the coronary arteries and the thoracic and abdominal aorta were determined by volume-correcting data collected by a multi- detector-row computerised tomographic scanner at baseline, at 6 months and at 1 year. Two patients in the etidronic acid group were excluded from the final analysis because of medical complications. The remainder of the patients (n = 6) showed no significant temporal changes in serum levels of assessed parameters. While no significant temporal changes in coronary calcification score were observed in either group, the mean aortic calcification score significantly decreased over time from 1000 +/- 460mm(3 )at baseline to 970 +/- 580mm(3) at the completion of treatment and 350 +/- 180mm(3) at 1 year (p = 0.009), corresponding to a mean percentage decrease of -64.1% (range -86.5% to -50.1%). By contrast, in the control group, the mean aortic calcification score significantly increased with time from 1460 +/- 1280mm(3) to 1510 +/- 1150mm(3) at the completion of treatment and 2070 +/- 1200mm(3) at 1 year (p = 0.006), corresponding to a mean percentage change in the calcification score of +130.0% (range 2.1-414%).
Conclusion:
Etidronic acid markedly reduced aortic calcification in patients with end-stage renal disease undergoing chronic haemodialysis. The effect of this agent on aortic calcification may attenuate the increase in aortic stiffness and result in improved long-term outcomes in patients undergoing chronic haemodialysis.
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