NDT Advance Access originally published online on August 2, 2005
Nephrology Dialysis Transplantation 2005 20(11):2472-2478; doi:10.1093/ndt/gfi039
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Aortic calcification in haemodialysis patients with diabetes mellitus
1 Inoue Hospital, Departments of 2 Nephrology, 3 Endocrinology, Metabolism and Molecular Medicine, and 4 Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
Correspondence and offprint requests to: Dr Eiji Ishimura, MD, Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. Email: ish{at}med.osaka-cu.ac.jp
Background. Certain metabolic disorders, such as hyperphosphatemia induce vascular calcification in haemodialysis patients; it is unclear, however, whether these disorders contribute to aortic calcification in diabetic haemodialysis patients. This study examined the risk factors of aortic calcification in a large number of haemodialysis patients, and compared risk factors between diabetic and non-diabetic patients.
Methods. The subjects were 667 patients on maintenance haemodialysis: 184 with type 2 diabetes and 483 without. Aortic calcification was measured semi-quantitatively using a plain computed tomography image of the abdominal aorta, and an aortic calcification index (ACI) was calculated.
Results. The ACI of the diabetic subjects was significantly higher than that of those without diabetes (57.3±22.1 vs 44.8±28.3%, P<0.0001), although the dialysis vintage of the former was significantly shorter (P<0.001). Multiple regression analyses showed that diabetes was a significant independent risk factor for increased ACI. Multiple regression analyses, performed separately in diabetics and non-diabetics, revealed that advanced age, higher systolic blood pressure, smoking and longer haemodialysis vintage were common independent risk factors significantly associated with increased ACI in both patient groups (R2 = 0.296, P<0.0001 for non-diabetics; R2 = 0.193, P<0.0001 for diabetics). Higher serum phosphate concentration was not significantly associated with increased ACI in diabetic patients (P = 0.429), although it was a significant independent factor in non-diabetic patients (ß = 0.150, P<0.0005).
Conclusion. Aortic calcification in diabetic haemodialysis patients is more advanced, compared with non-diabetic patients, even with short haemodialysis vintage. Since disorders of mineral metabolism are not significantly associated with aortic calcification in diabetic haemodialysis patients, aortic calcification in these patients could be affected by metabolic abnormalities associated with the diabetic state per se, independent of other confounding factors; and aortic calcification may be advanced even before haemodialysis induction.
Keywords: aortic calcification; haemodialysis; phosphate; type 2 diabetes
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