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Prevalence and progression of cardiovascular calcifications in peritoneal dialysis patients: A prospective study
Maurizio Gallieni1, Flavia Caputo, Armando Filippini
1Nephrology and Dialysis Unit-Ospedale San Carlo Borromeo, Milan, Italy.
Insights
Cardiovascular calcification (CC) is common and progresses in most patients undergoing peritoneal dialysis. This study highlights the prevalence of CC in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Bone Metabolism
Background:
- Dialysis patients often have abnormal mineral levels and bone disease.
- Cardiovascular calcification (CC) contributes to mortality in dialysis patients.
- Peritoneal dialysis patients may have higher risks of hyperlipidemia and atherosclerotic plaque.
Purpose of the Study:
- To investigate the presence and progression of CC in peritoneal dialysis patients.
- To explore associations between serum calcium (Ca) and phosphorus (P) with mortality and cardiovascular morbidity.
Main Methods:
- Prospective observational study (ROCK-PD) over 36 months in Italy.
- Examined CC in cardiac valves and arterial sites.
- Investigated associations of serum Ca and P with clinical variables and outcomes.
Main Results:
- CC was present in 77% at baseline and 90% by study end, with 73% progression.
- 42 deaths (11%) occurred during the study.
- Baseline P levels correlated with left ventricular hypertrophy, but Ca/P showed no consistent links to mortality/morbidity.
Conclusions:
- Cardiovascular calcification is highly prevalent and progressive in peritoneal dialysis patients.
- Further research is needed to understand the clinical implications of CC in this population.
Background:
Patients on dialysis may have abnormal serum levels of Ca, P and parathyroid hormone, with related bone diseases. This population has an increased risk of death, with cardiovascular calcification (CC) a contributing factor. Patients on peritoneal dialysis appear to be at increased risk of hyperlipidemia, a contributing factor to atherosclerotic plaque formation. Although several studies have described the presence and progression of CC in hemodialysis populations, there are fewer data in patients on peritoneal dialysis.
Study Design:
The Renal Osteodystrophy and Calcifications: Key factors in Peritoneal Dialysis (ROCK-PD) study was a 36-month, prospective observational study conducted in Italy. The study examined the presence and progression of CC in two cardiac valves and five arterial sites. The potential associations of serum Ca and P with mortality and cardiovascular morbidity, demographic, clinical and blood chemistry variables was investigated.
Results:
CC was present in 77% of patients at baseline (N=369) and in 90% of patients by study end (N=145), progressing in 73% of patients. There were 42 deaths (11%). Analyses showed a marked correlation between baseline P levels and the presence of left ventricular hypertrophy. However, there were no consistent correlations between serum Ca or P with mortality or morbidity.
Conclusions:
CC was common in peritoneal dialysis patients and progressed in a majority of patients.
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