Nephrol Dial Transplant (2004) 19: 885-891
Nephrol Dial Transplant Vol. 19 No. 4 © ERA-EDTA 2004; all rights reserved
Original Article
Carotid atherosclerosis is a predictor of coronary calcification in chronic haemodialysis patients
1Department of Internal Medicine, Division of Nephrology and 2Department of Cardiology, Istanbul School of Medicine, Istanbul, 3Department of Radiology, TEST Tani Merkezi, Istanbul and 4SSK Istanbul Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
Correspondence and offprint requests to: Alaattin Yildiz, MD, Vanderbilt University Medical Center, Department of Internal Medicine, Division of Nephrology, S-3223, Medical Center North, Nashville, TN 37232-2372, USA. Email: alaattiny{at}hotmail.com
Background. Coronary artery calcification scores (CACS) calculated by electron beam computed tomography (EBCT) have been correlated with atherosclerotic burden in the non-uraemic population. However, the validity of this test in chronic haemodialysis patients (HD) is currently uncertain. In the present cross-sectional study, associations between carotid atherosclerosis and coronary calcification in HD patients are investigated.
Methods. We studied 79 chronic HD patients (39 male, 40 female; mean age, 45±12 years). The mean time on HD was 68±54 months (range, 6–187 months). In these patients, we measured serum calcium, phosphorus, total cholesterol, cholesterol subgroups and iPTH levels. EBCT, echocardiography, and high-resolution B-mode carotid Doppler ultrasonography were also performed.
Results. Plaque-positive HD patients had significantly higher CACS than plaque-negative patients (851±199 vs 428±185, mean±SE, P = 0.006). Coronary calcification scores were correlated with serum phosphorus (r = 0.37; P = 0.001). Only 8 of the 24 HD patients without coronary calcification had carotid plaques (33%), whereas 34 of the 53 patients with coronary calcification had carotid plaques (64%) (P = 0.015). Carotid plaque scores were correlated with CACS (r = 0.40; P = 0.001). A stepwise linear regression (model r = 0.72; P<0.001) revealed that CACS (log-transformed data of CACS) was associated with age (P<0.001), time on dialysis (P = 0.004), serum phosphorus level (P = 0.016) and carotid plaque scores (P = 0.037).
Conclusions. Atherosclerosis is independently associated with coronary artery calcification and with hyperphosphataemia in chronic HD patients. CACS appeared to be predictive of both coronary atherosclerosis and carotid atherosclerosis.
Keywords: atherosclerosis; B-mode Doppler ultrasonography; electron beam computed tomography; haemodialysis; vascular calcification
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