Nephrol Dial Transplant (2000) 15: 1014-1021
© 2000 European Renal Association-European Dialysis and Transplant Association
Arterial stiffening and vascular calcifications in end-stage renal disease
Service d'Hémodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, France
Background. Epidemiological studies have identified aortic stiffness as an independent predictor of cardiovascular mortality in end-stage renal disease (ESRD) patients. In these patients, aortic pulse wave velocity (PWV) was associated with mediacalcosis, but the influence of arterial calcifications on the viscoelastic properties of large arteries was not well characterized. The purpose of the present study was to analyse the influence of arterial calcifications on arterial stiffness in stable haemodialysed patients.
Methods. We studied 120 stable ESRD patients on haemodialysis. All patients underwent B-mode ultrasonography of common carotid artery (CCA), aorta, and femoral arteries to determine CCA distensibility, the elastic incremental modulus (Einc), and the presence of vascular calcifications. All patients underwent measurement of aortic PWV and echocardiogram. The presence of calcifications was analysed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications.
Results. Our observations indicate that arterial and aortic stiffness is significantly influenced by the presence and extent of arterial calcifications. The extent of arterial calcifications is in part responsible for increased left ventricular afterload, and is inversely correlated with stroke volume. The influence of calcifications is independent of the role of ageing and blood pressure. Arterial calcifications density increases with age, duration of haemodialysis, the fibrinogen level, and the prescribed dose of calcium-based phosphate binders.
Conclusions. The results of this study showed that the presence of vascular calcifications in ESRD patients was associated with increased stiffness of large capacity, elastic-type arteries, like the aorta and CCA. The extent of arterial calcifications increased with the use of calcium-based phosphate-binders.
Keywords: arteries; calcifications; calcium carbonate; haemodialysis; viscoelasticity
Correspondence and offprint requests to: Dr Gérard M. London, Hôpital F. H. Manhès, 8 Grande Rue, F-91712 Fleury-Mérogis, Cedex, France.
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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., October 1, 2004; 19(10): 2564 - 2569. [Abstract] [Full Text] [PDF]
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S. M. Moe and N. X. Chen Pathophysiology of Vascular Calcification in Chronic Kidney Disease Circ. Res., September 17, 2004; 95(6): 560 - 567. [Abstract] [Full Text] [PDF]
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 T. M. Doherty, L. A. Fitzpatrick, D. Inoue, J.-H. Qiao, M. C. Fishbein, R. C. Detrano, P. K. Shah, and T. B. Rajavashisth Molecular, Endocrine, and Genetic Mechanisms of Arterial Calcification Endocr. Rev., August 1, 2004; 25(4): 629 - 672. [Abstract] [Full Text] [PDF]
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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 J. Am. Soc. Nephrol., August 1, 2004; 15(8): 2208 - 2218. [Abstract] [Full Text] [PDF]
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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; 15(7): 1943 - 1951. [Abstract] [Full Text] [PDF]
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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; 19(6): 1480 - 1488. [Abstract] [Full Text] [PDF]
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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., June 1, 2004; 19(6): 1489 - 1496. [Abstract] [Full Text] [PDF]
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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 J. Am. Soc. Nephrol., March 1, 2004; 15(3): 770 - 779. [Abstract] [Full Text] [PDF]
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R. J. Lund, M. R. Davies, A. J. Brown, and K. A. Hruska Successful Treatment of an Adynamic Bone Disorder with Bone Morphogenetic Protein-7 in a Renal Ablation Model J. Am. Soc. Nephrol., February 1, 2004; 15(2): 359 - 369. [Abstract] [Full Text] [PDF]
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V. E. Andreucci, D. N. S. Kerr, and J. D. Kopple Rights of chronic renal failure patients undergoing chronic dialysis therapy Nephrol. Dial. Transplant., January 1, 2004; 19(1): 30 - 38. [Abstract] [Full Text] [PDF]
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M. J. Sarnak, A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, B. L. Kasiske, E. Kelepouris, M. J. Klag, et al. Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention Hypertension, November 1, 2003; 42(5): 1050 - 1065. [Full Text] [PDF]
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M. J. Sarnak, A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, B. L. Kasiske, E. Kelepouris, M. J. Klag, et al. Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention Circulation, October 28, 2003; 108(17): 2154 - 2169. [Full Text] [PDF]
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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 Nephrol. Dial. Transplant., September 1, 2003; 18(9): 1731 - 1740. [Abstract] [Full Text] [PDF]
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M. Hirata, K. Katsumata, K. Endo, N. Fukushima, H. Ohkawa, and M. Fukagawa In subtotally nephrectomized rats 22-oxacalcitriol suppresses parathyroid hormone with less risk of cardiovascular calcification or deterioration of residual renal function than 1,25(OH)2 vitamin D3 Nephrol. Dial. Transplant., September 1, 2003; 18(9): 1770 - 1776. [Abstract] [Full Text] [PDF]
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G. M. London Cardiovascular Calcifications in Uremic Patients: Clinical Impact on Cardiovascular Function J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S305 - 309. [Abstract] [Full Text]
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G. M. Chertow Slowing the Progression of Vascular Calcification in Hemodialysis J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S310 - 314. [Abstract] [Full Text]
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B. Cizman Hyperphosphataemia and treatment with sevelamer in haemodialysis patients Nephrol. Dial. Transplant., July 1, 2003; 18(90005): v47 - 49. [Abstract] [Full Text] [PDF]
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