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Updated: Feb 8, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Is progression of coronary artery calcification influenced by modality of renal replacement therapy? A systematic
Thijs T Jansz1, Marianne C Verhaar1, Gérard M London2
1Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands.
Insights
Coronary artery calcification progresses in end-stage renal disease patients across therapies. Kidney transplant recipients may show the least progression, but more standardized research is needed.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Coronary artery calcification (CAC) progression is a key indicator of cardiovascular risk in patients with end-stage renal disease (ESRD).
- Understanding CAC progression across different renal replacement therapies (RRTs) is crucial for managing cardiovascular morbidity in ESRD patients.
Purpose of the Study:
- To review existing evidence on the progression of coronary artery calcification in patients undergoing various renal replacement therapies.
- To identify potential differences in CAC progression rates among hemodialysis, peritoneal dialysis, and kidney transplantation.
Main Methods:
- A systematic literature search was conducted in MEDLINE, Embase, and TRIP databases (1999-2016), supplemented by manual bibliography and citation searches.
- Included prospective studies utilized at least two multislice computed tomography scans (≥6 months apart) in patients aged 18-75 receiving any RRT.
- Data extraction and risk of bias assessment were performed independently by two researchers, requiring separate CAC scores for different modalities.
Main Results:
- Twenty-nine studies were included, focusing on hemodialysis (19 studies) and kidney transplantation (8 studies); evidence for peritoneal dialysis (3 studies) and nocturnal hemodialysis (1 study) was limited.
- Meta-analysis was precluded by heterogeneous reporting of CAC scores and progression definitions.
- While CAC progressed universally, median scores were higher at baseline in hemodialysis cohorts. Visual inspection suggested slower progression in kidney transplant recipients.
Conclusions:
- Current evidence is insufficient to definitively compare the impact of different renal replacement therapies on coronary artery calcification progression.
- Standardization of CAC progression reporting methods is recommended to enable robust comparative analyses in future research.
Background:
Progression of coronary artery calcification is an important marker for cardiovascular morbidity in end-stage renal disease patients. Therefore, we reviewed the evidence on coronary artery calcification progression in different renal replacement therapies.
Methods:
MEDLINE (PubMed), Embase and TRIP databases were searched from 1999 - 2016. Additionally, bibliographies were searched by hand and citation tracking of key publications was performed. Prospective studies were included that examined coronary artery calcification with two or more multislice computed tomography scans ≥6 months apart in patients 18-75 years old receiving any renal replacement therapy, including kidney transplantation. Reporting of separate scores for different modalities was required. Two researchers extracted data independently with pilot-tested forms and assessed the risk of bias using a validated tool.
Results:
We identified 29 eligible studies that assessed coronary artery calcification progression in end-stage renal disease patients, of which 19 studies evaluated haemodialysis and 8 kidney transplantation. Evidence on progression in peritoneal dialysis (three studies) and nocturnal haemodialysis (one study) was limited. Meta-analysis was not possible due to diverse reporting methods of coronary artery calcification scores and definitions of progression. Median coronary artery calcification scores were considerably higher in haemodialysis cohorts at baseline, presumably due to a generally higher age and dialysis vintage. Median coronary artery calcification progressed universally. Visual inspection suggested the least progression in kidney transplant recipients.
Conclusions:
There is insufficient evidence to compare the influence of renal replacement therapies on coronary artery calcification progression. We advocate the adoption of a standardized reporting method of coronary artery calcification progression.
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