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NDT Advance Access originally published online on August 25, 2008
Nephrology Dialysis Transplantation 2009 24(1):239-246; doi:10.1093/ndt/gfn466
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Vascular calcifications, vertebral fractures and mortality in haemodialysis patients

Minerva Rodríguez-García1, Carlos Gómez-Alonso1, Manuel Naves-Díaz1, Jose Bernardino Diaz-Lopez1, Carmen Diaz-Corte2, Jorge B. Cannata-Andía1 and the Asturias Study Group*

1 Bone and Mineral Research Unit 2 Nephrology Unit, Instituto Reina Sofia de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

Jorge B. Cannata-Andía, Servicio de Metabolismo Óseo y Mineral, Instituto ‘Reina Sofía’ de Investigación, Hospital Universitario Central de Asturias, Julián Clavería s/n, 33006 Oviedo, Spain. Tel: +34-985106137; Fax: +34-985106142; E-mail: cannata{at}hca.es



  Abstract

Background. Vascular calcifications and the bone fractures caused by abnormal bone fragility, also called osteoporotic fractures, are frequent complications associated with chronic kidney diseases (CKD). The aim of this study was to investigate the association between vascular calcifications, osteoporotic bone fractures and survival in haemodialysis (HD) patients.

Methods. A total of 193 HD patients were followed up to 2 years. Vascular calcifications and osteoporotic vertebral fractures (quoted just as vertebral fractures in the text) were assessed by thoracic, lumbar spine, pelvic and hand X-rays and graded according to their severity. Clinical, biochemical and therapeutic data gathered during the total time spent on HD were collected.

Results. The prevalence of aortic calcifications was higher in HD patients than in a random-based general population (79% versus 37.5%, P < 0.001). Total time on any renal replacement therapy (RRT) and diabetes were positively associated with a higher prevalence of vascular calcifications. In addition to these factors, time on HD was also positively associated with the severity of vascular calcifications, and higher haemoglobin levels were associated with a lower prevalence of severe vascular calcifications in large and medium calibre arteries. The prevalence of vertebral fractures in HD patients was similar to that of the general population (26.5% versus 24.1%). Age and time on HD showed a positive and statistically significant association with the prevalence of vertebral fractures. Vascular calcifications in the medium calibre arteries were associated with a higher rate of prevalent vertebral fractures. In women, severe vascular calcifications and vertebral fractures were positively associated with mortality [RR = 3.2 (1.0–10.0) and RR = 4.8 (1.7–13.4), respectively].

Conclusions. Positive associations between vascular calcifications, vertebral fractures and mortality have been found in patients on HD.

Keywords: haemodialysis; mortality; osteoporotic fractures; vascular calcifications; vertebral fractures

* The Asturias study group is formed by R. Forascepi, Servicio de Nefrología, Hospital de Cabueñes, Gijón; J. Megido, Cruz Roja, Gijón; P. Ruiz de Alegría and M. Céspedes, Cruz Roja, Oviedo; C. Diaz Corte, R. Álvarez and E. Gago, Servicio de Nefrologia, HUCA, Oviedo, Servicio de Nefrologia, Hospital de Jarrio, Navia; J. Guederiaga, M. Gorostidi, Servicio de Nefrologia, Hospital de San Agustín, Avilés; M. Alonso, Servicio de Nefrología, Hospital Valle del Nalón, Sama de Langreo.

Received for publication: 26.12.07
Accepted in revised form: 23. 7.08


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