RADIOLOGICAL ASSESSMENT OF ABDOMINAL AORTIC CALCIFICATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE RECEIVING HEMODIALYSIS: THE FREQUENCY OF DETECTION AND ASSOCIATED FACTORS
https://doi.org/10.24884/1561-6274-2010-14-3-37-45
Abstract
THE AIM. To determine the frequency of abdominal aorta calcification (AAC) and the associated factors in patients on chronic hemodialysis (HD). Patients and Methods. In 65 patients (male / female -34/31), 52,3 ± 11,8 years, treated with HD in average 77,1 ± 76,8 months, in addition to conventional clinical and laboratory parameters there were determined C-reactive protein (CRP), intact parathyroid hormone (PTH), lipid profile, the thickness of the intima-media of carotid arteries (IMT). Monitoring of ECGand blood pressure, standard echocardiography, forearm bone mineral density (BMD), X-ray evaluation of AAC severity were made. Duration of therapy with active form of vitamin D (alfacalcidol) was evaluated. RESULTS. AAC was found in 58.5% of the patients. Correlation analysis showed that AAC was more significant in patients with: greater duration of HD, higher levels of blood calcium, PTH, CRP, lower body mass index (BMI), low BMD, thicker IMT, myocardial ischemia, frequent ventricular premature beats at ECG monitoring, large diameter and wall thickness of the right ventricle, thick wall of the left ventricle, high pulmonary artery pressure. According to multivariate methods AAC was more common in people with long duration of HD and a shorter duration of alfacalcidol therapy. CONCLUSION. AAC was detected in 58,5% of patients on HD and was associated with disorders of phosphorus-calcium metabolism, hyperparathyroidism, adverse changes of intracardiac hemodynamics. For the first time there was found an inverse relationship of severity of AAC with forearm BMD of the duration of alfacalcidol therapy.
About the Authors
M. M. Volkov
Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
Russian Federation
Russian Federation
A. V. Smirnov
Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова
Russian Federation
Russian Federation
References
1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32(5 Suppl 3):S112-119
2. Blacher J, Guerin AP, Pannier B et al. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001;38(4):938-942
3. London GM, Guerin AP, Marchais SJ et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003;18(9):1731-1740
4. Adragao T, Pires A, Lucas C et al. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant 2004;19(6):1480-1488
5. Block GA, Raggi P, Bellasi A et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007;71(5):438-441
6. Schlieper G, Kruger T, Djuric Z et al. Vascular access calcification predicts mortality in hemodialysis patients. Kidney Int 2008;74(12):1582-1587
7. Nitta K, Ogawa T. Aortic arch calcification and mortality in chronic hemodialysis patients.Rev Recent Clin Trials. 2010 May 11 [Epub ahead of print]
8. Iijima K, Hashimoto H, Hashimoto M et al. Aortic arch calcification detectable on chest X-ray is a strong independent predictor of cardiovascular events beyond traditional risk factors. Atherosclerosis. 2010; 210(1):137-144
9. Ogawa T, Ishida H, Akamatsu M et al. Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients. Int Urol Nephrol. 2010; 42(1):187-194.
10. Bellasi A, Raggi P. Vascular calcification in patients with kidney disease. Techniques and technologies to assess vascular calcification. Seminars in Dialysis 2007; 20(2): 129-133
11. Adragao T, Frazao JM. Cardiovascular risk in dialysis patients: an X-ray vision on vascular calcifications. Kidney Int 2008;74(12):1505-1507
12. Wilson PW, Kauppila LI, O’Donnell CJ et al. Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 2001; 103(11):1529-1534.
13. Kushiya F, Wada H, Sakakura M et al. Prognostic impact of aortic calcification index and ankle-arm blood pressure index in patients under hemodialysis. Clin Appl Thromb Hemost 2005;11(2):161-119
14. Bellasi A, Ferramosca E, Muntner P et al. Correlation of simple imaging tests and coronary artery calcium measured by computed tomography in hemodialysis patients. Kidney Int 2006; 70(9):1623-1628
15. Muntner P, Ferramosca E, Bellasi A et al. Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients. Nephrol Dial Transplant 2007; 22(2):508-514
16. Kauppila LI, Polak JF, Cupples LA et al. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis 1997;132(2):245-250
17. Witteman JC, Grobbee DE, Valkenburg HA et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet 1994; 343(8896):504-507
18. Hak AE, Pols HA, van Hemert AM et al. Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study. Arterioscler Thromb Vasc Biol 2000; 20(8):1926-1931
19. Taniwaki H, Ishimura E, Tabata T et al. Aortic calcification in haemodialysis patients with diabetes mellitus. Nephrol Dial Transplant 2005; 20(11):2472-2478
20. Ishimura E, Okuno S, Kitatani K et al. C-reactive protein is a significant predictor of vascular calcification of both aorta and hand arteries. Semin Nephrol 2004; 24(5):408-412
21. Kimura K, Saika Y, Otani H et al. Factors associated with calcification of the abdominal aorta in hemodialysis patients. Kidney Int Suppl 1999; 71:S238-241
22. Fabbian F, Catalano C, Orlandi V et al. Evaluation of aortic arch calcification in hemodialysis patients. J Nephrol 2005;18(3):289-293
23. Moe SM, Chen NX. Pathophysiology of vascular calcification in chronic kidney disease. Circ Res 2004; 95(6):560-567
24. Barnett E, Nordin BEC. The radiological diagnosisof osteoporosis. A new approach. Clin Radiol 1960; 11:166-174
25. Okuno S, Ishimura E, Kitatani K et al. Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients. Am J Kidney Dis 2007; 49(3):417-425
26. Nakagawa K. A study of aortic calcification uremia. Nippon Jinzo Gakkai Shi 1997; 39(2):135-143
27. Rodriguez Garcia M, Gomez Alonso C, Naves Diaz M et al. Prevalence of vertebral fractures and aortic calcifications in hemodialysis patients: comparison with a population of the same age and sex. Nefrologia 2003;23 Suppl 2:106-111
28. Iribarren C, Sidney S, Sternfeld B, Browner WS. Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 2000; 283(21):2810-2815
29. Jayalath RW, Mangan SH, Golledge J. Aortic calcification. Eur J Vasc Endovasc Surg 2005;30(5):476-488
30. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003; 63(3):793-808
31. Kovesdy CP, Anderson JE, Kalantar-Zadeh K. Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: effects of case mix and the malnutrition-inflammation-cachexia syndrome. J Am Soc Nephrol 2007; 18(1):304-311
32. Price PA, Roublick AM, Williamson MK. Artery calcification in uremic rats is increased by a low protein diet and prevented by treatment with ibandronate. Kidney Int 2006; 70(9):1577-1583
33. Kuhlmann MK, Levin NW. Potential interplay between nutrition and inflammation in dialysis patients. Contrib Nephrol 2008;161:76-82
34. Renard C, Van Obberghen E. Role of diabetes in atherosclerotic pathogenesis. What have we learned from animal models? Diabetes Metab 2006; 32(1):15-29
35. Yamada K, Fujimoto S, Nishiura R et al. Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transplant 2007; 22(7): 2032-2037
36. Imanishi Y, Kawata T, Kobayashi K et al. Vascular calcification in advanced secondary hyperparathyroidism. Clin Calcium 2005; 15 Suppl 1: 110-112
37. Neves KR, Graciolli FG, dos Reis LM et al. Vascular calcification: contribution of parathyroid hormone in renal failure. Kidney Int 2007; 71(12):1262-1270
38. Joy MS, Karagiannis PC, Peyerl FW. Outcomes of secondary hyperparathyroidism in chronic kidney disease and the direct costs of treatment. J Manag Care Pharm 2007; 13(5):397-411
39. Rashid G, Bernheim J, Green J, Benchetrit S. Parathyroid hormone stimulates endothelial expression of atherosclerotic parameters through protein kinase pathways. Am J Physiol Renal Physiol 2007; 292(4):F1215-1218
40. Kostic S, Veljkovic S, Cekic S et al. The effect of parathormone on arterial blood pressure in patients on hemodialysis. Srp Arh Celok Lek 1996; 124 Suppl 1:115-116
41. Mathieu C, Adorini L. The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents. Trends Mol Med 2002; 8(4):174-179
42. Kovesdy CP, Kalantar-Zadeh K. Vitamin D receptor activation and survival in chronic kidney disease. Kidney Int 2008; 73(12):1355-1363
43. Li YC, Kong J, Wei M et al. 1,25-Dihydroxyvitamin D 3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002; 110:229–238
44. Linhartova K, Veselka J, Sterbakova G et al. Parathyroid hormone and vitamin D levels are independently associated with calcific aortic stenosis. Circ J 2008; 72(2):245-250
45. Добронравов ВА, Волков ММ, Мнускина ММ и др. Фосфорно-кальциевый баланс и минеральная плотность костей различных отделов скелета у больных на хроническом гемодиализе. Нефрология 2006; 10(4):31-36
46. Coen G, Manni M, Mantella D et al. Are PTH serum levels predictive of coronary calcifications in haemodialysis patients? Nephrol Dial Transplant 2007 ;22(11):3262-3267
47. Волков ММ, Смирнов АВ, Добронравов ВА и др. Кальциноз сердечных клапанов у пациентов с хронической болезнью почек: связь с клинико-биохимическими показателями и влияние на внутрисердечную гемодинамику. Клиническая медицина 2009; 87(6): 31-35
48. Ogawa T, Ishida H, Akamatsu M et al. Relation of oral 1alpha-hydroxy vitamin D3 to the progression of aortic arch calcification in hemodialysis patients. Heart Vessels 2010;25(1):1-6.
49. Mathew S, Lund RJ, Chaudhary LR et al. Vitamin D receptor activators can protect against vascular calcification. J Am Soc Nephrol 2008; 19(8):1509-1519
50. Teng M, Wolf M, Lowrie E et al. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 2003; 349(5):446-456
51. Shoji T, Shinohara K, Kimoto E et al. Lower risk for cardiovascular mortality in oral 1alpha-hydroxy vitamin D 3 users in a haemodialysis population. Nephrol Dial Transplant 2004; 19(1):179-184
Review
For citations:
Volkov M.M., Smirnov A.V. RADIOLOGICAL ASSESSMENT OF ABDOMINAL AORTIC CALCIFICATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE RECEIVING HEMODIALYSIS: THE FREQUENCY OF DETECTION AND ASSOCIATED FACTORS. Nephrology (Saint-Petersburg). 2010;14(3):37-45. (In Russ.) https://doi.org/10.24884/1561-6274-2010-14-3-37-45
Views:
383
Email this article 