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Updated: Jun 19, 2026

Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
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Pathological Analysis of Medial and Intimal Calcification in Lower Extremity Artery Disease: Impact of Hemodialysis

Tsukasa Kato1,2, Sho Torii2, Norihito Nakamura2

  • 1Department of Cardiology, Akita University School of Medicine, Akita, Japan.

JACC. Advances
|June 28, 2024
PubMed

Insights

Hemodialysis patients exhibit significantly more severe medial and intimal artery calcification, particularly below the knee, compared to non-dialysis patients. This study highlights increased vascular calcification in hemodialysis patients.

Area of Science:

  • Vascular Biology
  • Nephrology
  • Pathology

Background:

  • Lower extremity artery disease is more prevalent in hemodialysis patients.
  • Pathological features of this condition in hemodialysis patients remain understudied.

Purpose of the Study:

  • Compare lower extremity artery disease lesion characteristics between hemodialysis and non-hemodialysis patients.
  • Identify factors associated with severe medial calcification in these patients.

Main Methods:

  • Histological analysis of 77 lower limb arteries from 36 autopsy or amputation cases (21 hemodialysis, 15 non-hemodialysis).
  • Morphometric analysis and calcification measurements using ZEN software.
  • Multivariable logistic regression to identify risk factors for severe medial calcification (circumferential angle ≥180°).

Main Results:

  • Hemodialysis patients showed significantly higher medial calcification arc degrees (P < 0.0001).
  • Hemodialysis was linked to severe medial calcification in below-the-knee lesions (OR: 17.1; P = 0.02).
  • Higher intimal calcification and advanced atherosclerotic plaque prevalence were observed in above-the-knee lesions of hemodialysis patients (P = 0.02).
  • Severe bone formation was more common in hemodialysis patients (P = 0.01).

Conclusions:

  • Hemodialysis patients exhibit greater medial and intimal calcification than non-hemodialysis patients.
  • This difference is particularly pronounced in below-the-knee medial calcification.
Abstract

Keywords:
atherosclerosischronic limb-threatening ischemiahemodialysisintimal calcificationlower extremity artery diseasemedial calcification

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