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Dissociation between progression of coronary artery calcification and endothelial function in hemodialysis patients:

Roberto S Kalil1, Michael Flanigan, William Stanford

  • 1Department of Internal Medicine, Roy J. and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA 52240, USA. Roberto-kalil@uiowa.edu

Clinical Nephrology
|June 27, 2012
PubMed

Insights

Lanthanum carbonate (LC) slowed coronary artery calcification (CAC) progression in hemodialysis (HD) patients. This calcium-free phosphate binder did not affect endothelial function, suggesting a dissociation between vascular calcification and endothelial health in HD.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) disrupts calcium-phosphate metabolism, increasing atherosclerosis risk.
  • Hemodialysis (HD) patients commonly experience coronary artery calcification (CAC) and endothelial dysfunction.
  • Vascular calcification and endothelial dysfunction are key contributors to cardiovascular complications in CKD.

Purpose of the Study:

  • To investigate if a calcium-free phosphate binder, lanthanum carbonate (LC), could improve endothelial function and slow vascular calcification progression in HD patients.
  • To assess the impact of LC on coronary artery calcification (CAC) and brachial artery flow-mediated dilation (FMD).

Main Methods:

  • A randomized parallel-group trial comparing LC with non-LC phosphate binders in HD patients.
  • CAC was measured at baseline, 6, and 12 months.
  • Endothelial function (FMD) was assessed at baseline and 6 months.

Main Results:

  • The LC group showed a trend towards decreased CAC (-10% at 6 months, -2% at 12 months), while the control group showed increased CAC (33% at 6 months, 77% at 12 months).
  • Significantly less CAC progression was observed in the LC group compared to the control group at 6 (p=0.002) and 12 months (p=0.003).
  • No significant difference in FMD or inflammatory markers was found between the groups.

Conclusions:

  • Lanthanum carbonate treatment resulted in a slower rate of CAC progression in HD patients, independent of changes in endothelial function.
  • This study is the first to demonstrate a dissociation between CAC progression and FMD changes in HD patients.
  • Larger studies are needed to confirm the effects of phosphate binders on atherosclerosis in HD patients.
Abstract

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