Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2007-07, Vol.22 (7), p.2032-2037
• Main Authors: Yamada, Kazuhiro, Fujimoto, Shouichi, Nishiura, Ryosuke, Komatsu, Hiroyuki, Tatsumoto, Mariko, Sato, Yuji, Hara, Seiichiro, Hisanaga, Shuichi, Ochiai, Hideyuki, Nakao, Hiroyuki, Eto, Tanenao
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta, Abdominal - diagnostic imaging; aortic calcification; Aortic Diseases - diagnostic imaging; Biological and medical sciences; C-reactive protein; C-Reactive Protein - metabolism; Calcinosis - diagnostic imaging; calcium; Calcium - administration & dosage; Calcium - blood; Diabetes Complications; dialysate; Dialysis Solutions - chemistry; Disease Progression; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerulonephritis; haemodialysis; Humans; Intensive care medicine; Kidney Diseases - blood; Kidney Diseases - complications; Kidney Diseases - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Osmolar Concentration; premenopausal women; Premenopause; Renal Dialysis - adverse effects; Renal failure; Risk Factors; Tomography, X-Ray Computed
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm031

Background. Vascular calcification is an independent determinant of cardiovascular events in maintenance haemodialysis (HD) patients. It is not known whether acute changes of the serum calcium concentration before and after HD (▵Ca) are associated with the development of aortic calcification. Methods. We enrolled 71 patients dialysed with a dialysate with 3.0 mEq/l calcium and determined their aortic calcification index (ACI) by abdominal computed tomography twice at an interval of 3 years. To identify the factors contributing to the rate of progression of aortic calcification, we analysed the average values for clinical and laboratory data obtained between the first and second evaluations of ACI. Results. The second ACI (mean ± SD: 80.2 ± 63.9) was significantly greater than the first ACI (61.0 ± 61.0) after an interval of 35.8 ± 4.2 months. The annualized change of ACI (ΔACI/year) was significantly and directly associated with the ΔCa and C-reactive protein (CRP) (both P < 0.001, P for trend). Stepwise multivariate regression analysis revealed that ΔACI/year was positively and independently associated with CRP, presence of diabetes mellitus and ΔCa, but negatively associated with a premenopausal status in women. Similarly, ΔCa was positively and independently associated with ΔACI/year and the ultrafiltration rate, but was negatively associated with pre-HD Ca. Conclusion. The increase of serum calcium after HD was related to the rate of progression of aortic calcification. Excess calcium is transferred into patients on HD when using a dialysate of 3.0 mEq/l calcium. This may be a risk factor for the development of vascular calcification.