Cardiac calcifications are more prevalent in children receiving hemodialysis than peritoneal dialysis

Children receiving maintenance dialysis exhibit high cardiovascular (CV) associated mortality. We and others have shown high prevalence of cardiac calcifications (CC) in children with endstage renal disease (ESRD). However, no pediatric study has examined modality difference in CC prevalence. The current study was conducted to assess for a difference in CC prevalence between hemodialysis (HD) and peritoneal dialysis (PD) in children with ESRD.

38 patients (19 female, 19 male; mean age 15.5 ± 4.1 years) receiving dialysis (21 HD, 17 PD) were included in the study. CC were assessed by ultrafast gated CT and quantified by Agatston score. Patients received thrice weekly HD for 3 - 3.5 hours or daily continuous cycler PD (CCPD). FGF 23, IL-6, IL-8, and CRP levels were obtained at time of CT. Time-averaged (6 months prior to CT) serum Ca, P, Alb, iPTH, and cholesterol levels were obtained. Patients on aspirin, with evidence of infection, underlying collagen vascular disease were excluded.

CC were present in 11/38 patients, but more prevalent in HD vs. PD (9/21 vs. 2/17, p = 0.04). Subjects with CC were older (p = 0.0003), had longer dialysis vintage (p = 0.02) and higher serum phosphorus (p = 0.02) and FGF 23 levels (p = 0.03). HD patients also had significantly higher phosphorus (p = 0.02), FGF 23 (p = 0.009), and IL-8 levels (p = 0.02) when compared to PD patients. Residual renal function was not different between modalities or patients with CC. On a multinomial regression model, modality, and age remained independent associations for CC prevalence.

We have shown that pediatric patients receiving CCPD have lower CC prevalence conferring lower CV risk. The better control of mineral imbalance in patients receiving PD may play an important role in lower CC prevalence.