CLINICAL STUDY: END-STAGE RENAL DESIGN
Cardiac calcification in adult hemodialysis patients
A link between end-stage renal disease and cardiovascular disease?
Paolo Raggi, MD*,1,
Amy Boulay, MPH ,1,
Scott Chasan-Taber, PhD ,1,
Naseem Amin, MD¶,1,
Maureen Dillon, MA,1,
Steven K. Burke, MD,1 and
Glenn M. Chertow, MD, MPH#,*,1
* Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
GelTex Pharmaceuticals, Inc, Waltham, Massachusetts, USA
Boston Biostatistics, Inc, Cambridge, Massachusetts, USA
¶ Genzyme, Inc, Cambridge, Massachusetts, USA
# Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
Manuscript received June 13, 2001;
revised manuscript received October 16, 2001,
accepted November 13, 2001.
* Reprint requests and correspondence: Glenn M. Chertow, MD, MPH, Department of Medicine Research UCSF Laurel Heights, 3333 California Street, Suite 430, San Francisco, California 94118-1211, USA.
chertowg{at}medicine.ucsf.edu
OBJECTIVES: We sought to determine clinical and laboratory correlates of calcification of the coronary arteries (CAs), aorta and mitral and aortic valves in adult subjects with end-stage renal disease (ESRD) receiving hemodialysis.
BACKGROUND: Vascular calcification is known to be a risk factor for ischemic heart disease in non-uremic individuals. Patients with ESRD experience accelerated vascular calcification, due at least in part to dysregulation of mineral metabolism. Clinical correlates of the extent of calcification in ESRD have not been identified. Moreover, the clinical relevance of calcification as measured by electron-beam tomography (EBT) has not been determined in the ESRD population.
METHODS: We conducted a cross-sectional analysis of 205 maintenance hemodialysis patients who received baseline EBT for evaluation of vascular and valvular calcification. We compared subjects with and without clinical evidence of atherosclerotic vascular disease and determined correlates of the extent of vascular and valvular calcification using multivariable linear regression and proportional odds logistic regression analyses.
RESULTS: The median coronary artery calcium score was 595 (interquartile range, 76 to 1,600), values consistent with a high risk of obstructive coronary artery disease in the general population. The CA calcium scores were directly related to the prevalence of myocardial infarction (p < 0.0001) and angina (p < 0.0001), and the aortic calcium scores were directly related to the prevalence of claudication (p = 0.001) and aortic aneurysm (p = 0.02). The extent of coronary calcification was more pronounced with older age, male gender, white race, diabetes, longer dialysis vintage and higher serum concentrations of calcium and phosphorus. Total cholesterol (and high-density lipoprotein and low-density lipoprotein subfractions), triglycerides, hemoglobin and albumin were not significantly related to the extent of CA calcification. Only dialysis vintage was significantly associated with the prevalence of valvular calcification.
CONCLUSIONS: Coronary artery calcification is common, severe and significantly associated with ischemic cardiovascular disease in adult ESRD patients. The dysregulation of mineral metabolism in ESRD may influence vascular calcification risk.
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Abbreviations and Acronyms
| | ASVD | | atherosclerotic vascular disease | | CA | | coronary artery | | CAD | | coronary artery disease | | EBT | | electron-beam tomography | | ESRD | | end-stage renal disease | | HDL | | high-density lipoprotein | | LDL | | low-density lipoprotein | | MI | | myocardial infarction | | PTH | | parathyroid hormone |
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M. R. Davies, Richard. J. Lund, S. Mathew, and K. A. Hruska
Low Turnover Osteodystrophy and Vascular Calcification Are Amenable to Skeletal Anabolism in an Animal Model of Chronic Kidney Disease and the Metabolic Syndrome
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Cinacalcet HCl, an Oral Calcimimetic Agent for the Treatment of Secondary Hyperparathyroidism in Hemodialysis and Peritoneal Dialysis: A Randomized, Double-Blind, Multicenter Study
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Cardiac Valvular Calcification as a Marker of Atherosclerosis and Arterial Calcification in End-stage Renal Disease
Arch Intern Med,
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G. M. Chertow and S. M. Moe
Calcification or Classification?
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H. H. Jung, K. R. Ma, and H. Han
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M. E. Lockhart, M. L. Robbin, M. M. McNamara, and M. Allon
Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients
Nephrol. Dial. Transplant.,
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A. S. Go, G. M. Chertow, D. Fan, C. E. McCulloch, and C.-y. Hsu
Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization
N. Engl. J. Med.,
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S. M. Moe and N. X. Chen
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Circ. Res.,
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A. A. Haydar, N. M. A. Hujairi, A. A. Covic, D. Pereira, M. Rubens, and D. J. A. Goldsmith
Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography
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S. M. Moe, K. D. O'Neill, M. Resterova, N. Fineberg, S. Persohn, and C. A. Meyer
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M. P. Reilly, N. Iqbal, M. Schutta, M. L. Wolfe, M. Scally, A. R. Localio, D. J. Rader, and S. E. Kimmel
Plasma Leptin Levels Are Associated with Coronary Atherosclerosis in Type 2 Diabetes
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G. A. Block, P. S. Klassen, J. M. Lazarus, N. Ofsthun, E. G. Lowrie, and G. M. Chertow
Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis
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G. M. London, C. Marty, S. J. Marchais, A. P. Guerin, F. Metivier, and M.-C. de Vernejoul
Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease
J. Am. Soc. Nephrol.,
July 1, 2004;
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B. Hoen
Infective endocarditis: a frequent disease in dialysis patients
Nephrol. Dial. Transplant.,
June 1, 2004;
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T. Adragao, A. Pires, C. Lucas, R. Birne, L. Magalhaes, M. Goncalves, and A. P. Negrao
A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients
Nephrol. Dial. Transplant.,
June 1, 2004;
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G. M. Chertow, P. Raggi, S. Chasan-Taber, J. Bommer, H. Holzer, and S. K. Burke
Determinants of progressive vascular calcification in haemodialysis patients
Nephrol. Dial. Transplant.,
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G. A. Block, K. J. Martin, A. L.M. de Francisco, S. A. Turner, M. M. Avram, M. G. Suranyi, G. Hercz, J. Cunningham, A. K. Abu-Alfa, P. Messa, et al.
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N. Engl. J. Med.,
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[Abstract]
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A. Yildiz, S. Tepe, H. Oflaz, H. Yazici, H. Pusuroglu, M. Besler, E. Ark, and F. Erzengin
Carotid atherosclerosis is a predictor of coronary calcification in chronic haemodialysis patients
Nephrol. Dial. Transplant.,
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L. A. Stevens, O. Djurdjev, S. Cardew, E. C. Cameron, and A. Levin
Calcium, Phosphate, and Parathyroid Hormone Levels in Combination and as a Function of Dialysis Duration Predict Mortality: Evidence for the Complexity of the Association between Mineral Metabolism and Outcomes
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March 1, 2004;
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R. Dikow and E. Ritz
Cardiovascular complications in the diabetic patient with renal disease: an update in 2003
Nephrol. Dial. Transplant.,
October 1, 2003;
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C. A. Herzog
How to Manage the Renal Patient with Coronary Heart Disease: The Agony and the Ecstasy of Opinion-Based Medicine
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G. M. London, A. P. Guerin, S. J. Marchais, F. Metivier, B. Pannier, and H. Adda
Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality
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G. M. London
Cardiovascular Calcifications in Uremic Patients: Clinical Impact on Cardiovascular Function
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G. M. Chertow
Slowing the Progression of Vascular Calcification in Hemodialysis
J. Am. Soc. Nephrol.,
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S. M. Moe, K. D. O'Neill, N. Fineberg, S. Persohn, S. Ahmed, P. Garrett, and C. A. Meyer
Assessment of vascular calcification in ESRD patients using spiral CT
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C.-C. Szeto, T. Y.-H. Wong, K.-M. Chow, C.-B. Leung, and P. K.-T. Li
Are peritoneal dialysis patients with and without residual renal function equivalent for survival study? Insight from a retrospective review of the cause of death
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A. Y.-M. Wang, M. Wang, J. Woo, C. W.-K. Lam, P. K.-T. Li, S.-F. Lui, and J. E. Sanderson
Cardiac Valve Calcification as an Important Predictor for All-Cause Mortality and Cardiovascular Mortality in Long-Term Peritoneal Dialysis Patients: A Prospective Study
J. Am. Soc. Nephrol.,
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[Abstract]
[Full Text]
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