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Poor correlation between coronary artery calcification and obstructive coronary artery disease in an end-stage renal

Li-Li Tong1, Rajnish Mehrotra, David M Shavelle

  • 1Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, Torrance, California, U.S.A.

Hemodialysis International. International Symposium on Home Hemodialysis
|February 15, 2008
PubMed

Insights

Vascular calcification is common in chronic kidney disease patients. Extremely high coronary calcium scores may not accurately reflect obstructive atherosclerosis in dialysis patients, suggesting media calcification.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Radiology

Background:

  • Vascular calcification is prevalent and severe in chronic kidney disease (CKD) patients.
  • Arterial calcification in CKD can occur in the intima (with plaques) or media (Monckeberg's sclerosis).
  • The correlation between coronary artery calcium (CAC) scores and obstructive atherosclerotic disease in dialysis patients is unclear.

Purpose of the Study:

  • To investigate the relationship between CAC scores and coronary angiography findings in a dialysis patient.
  • To assess the utility of CAC scores as a surrogate marker for obstructive atherosclerosis in this population.

Main Methods:

  • Case report of an asymptomatic patient with diabetes mellitus and end-stage renal disease on maintenance hemodialysis.
  • Electron beam computed tomography (EBCT) for coronary artery calcium scoring.
  • Coronary angiography to evaluate atherosclerotic plaque.

Main Results:

  • The patient had extremely elevated CAC scores on EBCT.
  • Coronary angiography revealed varied degrees of atherosclerotic plaque, not fully correlating with the high calcium score.
  • Findings suggest calcification in both the intima and arterial media.

Conclusions:

  • Extremely high CAC scores may not be a reliable indicator of obstructive atherosclerosis in elderly diabetic dialysis patients.
  • The presence of medial calcification (Monckeberg's sclerosis) likely contributes to high CAC scores.
  • Further research is needed to understand CAC scoring limitations in CKD populations.

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