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Published on: June 2, 2022
Coronary and aortic calcifications in patients new to dialysis
David M Spiegel1, Paolo Raggi, Ravindra Mehta
1Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, Colorado, U.S.A. david.spiegel@uchsc.edu
Insights
Many patients starting hemodialysis show no initial signs of vascular calcification. This suggests that factors related to dialysis treatment itself may contribute to the development of calcific vascular disease in end-stage kidney disease.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Vascular calcification is linked to mortality in end-stage kidney disease (ESKD).
- It remains unclear if calcification is present at dialysis initiation or develops during treatment.
- This study investigated vascular and coronary calcification prevalence in new hemodialysis patients.
Purpose of the Study:
- To determine the prevalence and extent of coronary artery, aortic, and valvular calcification in patients newly starting hemodialysis.
Main Methods:
- Electron beam computed tomography (EBCT) was used.
- 129 subjects new to dialysis were evaluated.
- Coronary artery, aortic, and valvular calcification were the primary outcomes.
Main Results:
- 43% had no significant coronary calcification (score ≤30); 27% had no detectable aortic calcification.
- 34% exhibited coronary calcification above the 90th percentile for age/sex.
- Coronary calcification correlated with coronary artery disease and atherosclerotic vascular disease (ASVD).
- Aortic calcification correlated with ASVD.
- Independent predictors for coronary calcification included age, pulse pressure, diabetes, and smoking history.
- Age and pulse pressure independently predicted aortic calcification extent.
Conclusions:
- A significant proportion of new hemodialysis patients lacked initial coronary or aortic calcification.
- These findings imply that dialysis-specific factors contribute to calcific vascular disease progression in ESKD.
- This contrasts with extensive calcification observed in prevalent dialysis patients.
Background:
Vascular calcification has been associated with all cause and cardiovascular mortality in patients with end-stage kidney disease (ESRD). Whether vascular calcification is present in persons with advanced chronic kidney disease starting dialysis or develops in patients on dialysis is unknown. The purpose of this study was to examine the prevalence of vascular and coronary calcification in patients new to hemodialysis.
Methods:
A total of 129 subjects new to dialysis were evaluated using electron beam computed tomography. The primary outcome was the presence and extent of coronary artery, aortic, and valvular calcification.
Results:
Forty-three percent of subjects had no significant coronary artery calcification (total score
Conclusions:
A large fraction of patients new to hemodialysis had no evidence of coronary artery or aortic calcification. Coupled with the extensive vascular calcification reported by others in prevalent dialysis patients these findings suggest that dialysis-specific factors contribute to calcific vascular disease in ESRD.
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