NDT Advance Access originally published online on December 13, 2005
Nephrology Dialysis Transplantation 2006 21(5):1451-1452; doi:10.1093/ndt/gfi328
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Investigation of coronary artery calcification and stenosis by coronary angiography (CAG) in haemodialysis patients
Email: hiraku{at}jikei.ac.jpSir,
Coronary artery calcification is observed in many dialysis patients, and its negative impact on their prognosis and resulting cardiovascular complications has been reported [1–3]. However, vascular calcification in dialysis patients is so-called Mönckeberg's medial calcinosis, which is observed in the media of small and medium sized arteries and is not always associated with stenosis, unlike the vascular calcification complicating intimal atherosclerosis observed in non-dialysis patients [4,5]. Many studies of coronary artery calcification using electron beam computed tomography (EBCT) or multi-detector row computed tomography (MDCT) have recently been published, but they are not adequate to compare coronary artery calcification and coronary artery stenosis [6–9].
Therefore, when we performed coronary angiography (CAG), we evaluated the occurrence of coronary artery calcification (visible on X-ray before using contrast medium) and stenosis (after using contrast medium) in haemodialysis (HD) and non-HD patients, and assessed differences in the site of occurrence at each coronary artery segment [10].
The frequency of calcification and stenosis (>75% in diameter) in each coronary artery segment was examined in all 67 consecutive HD patients who underwent CAG at the Jikei University Hospital from June 2002 to March 2004. As control, 67 patients matched for age, gender, history of diabetes mellitus, hypertension, hyperlipidaemia and smoking habits were selected at random from the 1185 non-HD patients who underwent CAG.
The occurrence of coronary artery calcification was significantly more frequent in the dialysis group than in the non-HD group in 12 out of 16 segments (P<0.05 by 
2 test). However, no significant difference was observed in the occurrence of stenosis between the HD group and the non-HD group. The site with the highest frequency of calcification corresponded to that with the highest frequency of stenosis in the non-HD group, but stenosis was often observed distal to the segment where calcification was common in the HD group (Figure 1).
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The finding of no difference in the frequency of stenosis between the HD and non-HD groups, although calcification showed a higher frequency in the HD group, indicates that medial calcification is more common in the HD group, whereas the frequency of intimal calcification/stenosis is comparable in the HD and non-HD groups. However, the fact that stenosis was observed peripheral to the site where calcification was most common in the HD group suggests the possibility that a change of blood flow due to calcification might influence the development of stenosis. Therefore, it is necessary to investigate differences in pathology between the HD and non-HD groups.
Conflict of interest statement. None declared.
1 Division of Nephrology and Hypertension2 Division of Cardiology Department of Internal Medicine The Jikei University School of Medicine 3-25-8 Nishi-Shinbashi Minato-ku Tokyo, 105-8471 Japan
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