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NDT Advance Access published online on August 1, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn403
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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


Abdominal aortic calcification in dialysis patients: results of the CORD study

Eero Honkanen1, Leena Kauppila2, Björn Wikström3, Pieter L. Rensma4, Jean-Marie Krzesinski5, Knut Aasarod6, Francis Verbeke7, Per Bruno Jensen8, Pierre Mattelaer9, Birgitte Volck9,* on behalf of the CORD study group

1 Division of Nephrology, Department of Medicine, Helsinki 2 Department of Rehabilitation, Helsinki University Central Hospital, Espoo, Finland 3 Department of Nephrology, Uppsala University Hospital, Uppsala, Sweden 4 Department of Internal Medicine, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands 5 Division of Nephrology, Liege University Hospital, Liege, Belgium 6 Department of Medicine, Trondheim University Hospital, Tronheim, Norway 7 Department of Nephrology, Gent University Hospital, Gent, Belgium 8 Odense University Hospital, Odense 9 Genzyme A/S, Copenhagen, Denmark

Correspondence and offprint requests to: Correspondence and offprint requests to: Eero Honkanen, Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, PO Box 263, FIN-00131, Helsinki, Finland. Tel: +35-8-9-471-88204; Fax: +35-8-9-417-88-400; E-mail: eero.honkanen{at}hus.fi



  Abstract

Background. Patients with chronic kidney disease stage 5 have a high prevalence of vascular calcification, but the specific anatomical distribution and severity of abdominal aortic calcification (AAC), in contrast to coronary calcification, is less well documented. AAC may be recorded using plain radiographs. The present report is an analysis of baseline data on AAC in patients enrolled in the CORD (Calcification Outcome in Renal Disease) study.

Methods. A total of 47 centres in six European countries participated in this cross-sectional study. Inclusion criteria were age ≥18 years and duration of dialysis ≥3 months. Lateral lumbar radiography of the abdominal aorta was used to determine the overall AAC score, which is related to the severity of calcific deposits at lumbar vertebral segments L1–L4. The reliability of the method was tested by double reading of 64 radiographs (coefficient of correlation 0.9).

Results. A lateral lumbar radiograph was obtained in 933 patients. Calcification (AAC score ≥ 1) was present in 81% of the patients; its severity increased significantly from L1 to L4 (P < 0.0001) and affected all of these segments in 51% of patients. Independent predictors for the presence and severity of calcification were age (odds ratio [OR] 1.103/year; P < 0.0001), duration of dialysis (OR 1.110/year; P = 0.002) and history of cardiovascular disease (OR 3.247; P < 0.0001).

Conclusions. AAC detected by lateral lumbar radiograph is associated with several risk factors of uraemic calcification. This semi-quantitative method is more widely available and less expensive than the current procedures for studying calcification and could form part of a pre-transplant workup and cardiovascular risk stratification.

Keywords: calcification; cardiovascular disease; chronic kidney disease; dialysis; lateral lumbar radiography

* The list of members of the CORD study group is given in the Appendix.

Received for publication: 27. 2.08
Accepted in revised form: 25. 6.08


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