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Vascular calcification in skin and subcutaneous tissue in patients with chronic and end-stage kidney disease

Irene Ruderman1,2, Tim D Hewitson3,4, Edward R Smith3,4

  • 1Department of Nephrology, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia. irene_ruderman@hotmail.com.

BMC Nephrology
|July 18, 2020
PubMed

Insights

Vascular calcification (VC) affects skin and subcutaneous tissues in 38% of advanced chronic kidney disease (CKD) patients. This study identified VC in multiple body sites, highlighting a previously under-recognized complication in CKD patients not experiencing calciphylaxis.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Dermatology

Background:

  • Vascular calcification (VC) is common in large vessels of chronic kidney disease (CKD) patients, particularly end-stage kidney disease (ESKD) on dialysis.
  • Medial calcification in CKD contributes to arterial stiffness, increasing cardiovascular risks.
  • Skin and subcutaneous calcification in CKD, outside of calciphylaxis, is understudied.

Purpose of the Study:

  • To investigate the prevalence and characteristics of dermal and subcutaneous VC in CKD patients.
  • To compare skin calcification in CKD patients with a control cohort.
  • To explore associations with bone and mineral metabolism and specific gene expression.

Main Methods:

  • An observational study evaluated incisional skin tissue samples from three anatomical sites in CKD patients and controls.
  • Von Kossa staining assessed calcification, and RT-PCR analyzed gene expression (TNAP, RUNX2) in a subset of samples.
  • Patients with varying stages of CKD, including ESKD, were included.

Main Results:

  • Vascular calcification (VC) was found in 15 of 45 samples (33%), including 13 from 34 CKD/ESKD patients and 2 from 11 controls.
  • VC occurred in dermal and subcutaneous tissues across neck, abdomen, and arm samples, with two histological types identified.
  • No significant differences in serum parathyroid hormone, phosphate, or calcium were observed between patients with or without VC; TNAP or RUNX2 expression was not elevated.

Conclusions:

  • Dermal and subcutaneous calcification is a novel finding in 38% of advanced CKD/ESKD patients undergoing surgery, independent of calciphylaxis.
  • VC was identified in multiple anatomical locations in the skin and subcutaneous tissue.
  • The study did not find correlations between VC and standard bone/mineral markers or specific gene upregulation in this cohort.
Abstract

Keywords:
Calcific uraemic arteriolopathyChronic kidney diseaseEnd-stage kidney diseaseVascular calcification

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