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High-dose calcitriol therapy and progression of cardiac vascular calcifications
M Morosetti1, L Jankovic, G Palombo
1Nephrology and Dialysis Department, 'G.B. Grassi' Hospital - Ostia Lido, Rome - Italy. morosetti@med.uniroma2.it
Insights
Dialysis patients experience accelerated vascular calcification. This study found that baseline calcification levels, not calcitriol dosage, predict progression in cardiac vascular calcification.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Dialysis patients have a high prevalence of cardiovascular complications, including accelerated vascular calcifications and mineral metabolism disorders.
- Multislice computed tomography (MSCT) is a high-resolution imaging technique for quantifying coronary artery calcification using the Agatston score.
Purpose of the Study:
- To investigate the impact of high-dose versus low-dose calcitriol therapy on the progression of cardiac vascular calcifications in patients undergoing dialysis.
Main Methods:
- A prospective study involving 36 dialysis patients over 24 months (12 months intervention, 12 months follow-up).
- Patients received either high-dose or low-dose calcitriol combined with sevelamer hydrochloride.
- Two MSCT scans were performed at baseline and end of follow-up to calculate the Agatston score.
Main Results:
- At baseline, both groups had similar levels of cardiac vascular calcification.
- All patients showed a statistically significant increase in Agatston score at the end of follow-up.
- Higher baseline Agatston scores were associated with worse calcification progression in both high-dose and low-dose calcitriol groups.
Conclusions:
- Baseline vascular calcification level is a strong predictor of progression in dialysis patients.
- The administered dose of calcitriol (high vs. low) did not show an association with the progression of cardiac vascular calcification.
Background:
Dialysis patients show a very high prevalence of cardiovascular complications, affected as they are with abnormal and accelerated vascular calcifications and, eventually, calcium and phosphorous metabolism disorders. Multislice computed tomography (MSCT) provides a reproducible, high-resolution imaging of calcium contained in cardiac arteries, measured by Agatston score. The aim of the present study was to evaluate the influence of high-dose and low-dose calcitriol therapy on the progression of cardiac vascular calcifications in dialyzed patients.
Methods:
We enrolled 36 dialyzed patients in a prospective study, including an interventional period of 12 months and a follow-up period of 12 months. Eighteen protocol patients received intravenous pulses of high-doses calcitriol at the end of dialytic treatment and sevelamer hydrochloride therapy. Control patients received low-dose calcitriol and sevelamer hydrochloride as well. Two MSCT scans were performed: 1 at the start of the study and 1 at the end of follow-up, and Agatston score was calculated at both examinations.
Results:
At first examination, protocol patients showed almost the same level of cardiac vascular calcification as control patients. At the second MSCT, statistically significantly higher values of Agatston score were recorded for all patients. Indeed, patients who showed higher baseline values developed worse calcifications as recorded at the end of follow-up, both in the protocol and control group.
Conclusions:
Our data show that baseline level is strongly predictive of vascular calcification progression, and, moreover, there is no association between calcitriol administered doses and the progression of cardiac vascular calcification.
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