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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis
Thijs T Jansz1, Franka E van Reekum2, Akin Özyilmaz3,4
1Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands, t.t.jansz@umcutrecht.nl.
Insights
Peritoneal dialysis (PD) does not reduce vascular calcification compared to hemodialysis (HD). Studies show PD may even be associated with greater coronary artery calcification progression, challenging previous assumptions.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Vascular calcification is prevalent in dialysis patients and linked to cardiovascular mortality.
- Phosphate levels are typically higher in hemodialysis (HD) than peritoneal dialysis (PD), potentially influencing calcification.
- The comparative development of vascular calcification between PD and HD remains unclear.
Purpose of the Study:
- To compare coronary artery calcification (CAC) and its progression between patients on HD and PD.
- To investigate differences in calcification biomarkers between the two dialysis modalities.
- To determine if PD offers a protective effect against vascular calcification compared to HD.
Main Methods:
- Cross-sectional and longitudinal analysis of CAC in 134 patients (94 HD, 40 PD).
- Annual CAC progression measured over 3 years in a subset of 57 patients.
- Comparison of CAC volume scores, progression rates (ΔCAC SQRV), and biomarkers (dp-ucMGP, fetuin-A, osteoprotegerin) using regression and mixed-effects models, adjusting for confounders.
Main Results:
- Cross-sectionally, CAC scores were numerically higher in PD patients (492 mm³ vs. 92 mm³ in HD), though not statistically significant (p=0.08).
- Longitudinally, PD was associated with significantly greater CAC progression (ΔCAC SQRV, p=0.03).
- PD patients exhibited higher osteoprotegerin levels (p=0.02), but no significant differences in dp-ucMGP or fetuin-A.
Conclusions:
- Peritoneal dialysis is not associated with less coronary artery calcification or slower progression compared to hemodialysis.
- Findings suggest that PD may be associated with increased CAC progression, contrary to expectations.
- Vascular calcification risk in dialysis patients should be carefully considered regardless of the dialysis modality.
Background:
Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in peritoneal dialysis than in hemodialysis is currently unknown. Therefore, we compared coronary artery calcification (CAC), its progression, and calcification biomarkers between patients on hemodialysis and peritoneal dialysis.
Methods:
We measured CAC in 134 patients who had been treated exclusively with hemodialysis (n = 94) or peritoneal dialysis (n = 40) and were transplantation candidates. In 57 of them (34 on hemodialysis and 23 on peritoneal dialysis), we also measured CAC progression annually up to 3 years and the inactive species of desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, osteoprotegerin. We compared CAC cross-sectionally with Tobit regression. CAC progression was compared in 2 ways: with linear mixed models as the difference in square root transformed volume score per year (ΔCAC SQRV) and with Tobit mixed models. We adjusted for potential confounders.
Results:
In the cross-sectional cohort, CAC volume scores were 92 mm3 in hemodialysis and 492 mm3 in peritoneal dialysis (adjusted difference 436 mm3; 95% CI -47 to 919; p = 0.08). In the longitudinal cohort, peritoneal dialysis was associated with significantly more CAC progression defined as ΔCAC SQRV (adjusted difference 1.20; 95% CI 0.09 to 2.31; p = 0.03), but not with Tobit mixed models (adjusted difference in CAC score increase per year 106 mm3; 95% CI -140 to 352; p = 0.40). Peritoneal dialysis was associated with higher osteoprotegerin (adjusted p = 0.02) but not with dp-ucMGP or fetuin-A.
Conclusions:
Peritoneal dialysis is not associated with less CAC or CAC progression than hemodialysis, and perhaps with even more progression. This indicates that vascular calcification does not develop less in peritoneal dialysis than in hemodialysis.
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