Nephrol Dial Transplant (2003) 18: 1731-1740
© 2003 European Renal Association-European Dialysis and Transplant Association
Rapid Communication
Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality
Service d’Hémodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, France
Correspondence and offprint requests to: Dr Gérard M. London, Hôpital F.H. Manhès, 8 Grande Rue, F-91712 Fleury-Mérogis Cédex, France. Email: glondon{at}club-internet.fr
Abstract
Background. Cross-sectional and follow-up studies on end-stage renal disease patients showed that arterial calcifications are associated with cardiovascular (CV) morbidity and are an independent predictor of all-cause and CV mortality. However, these studies did not examine the impact on prognosis according to the type of calcification, i.e. intimal vs medial. Arterial media calcification (AMC), a non-occlusive condition, affects haemodynamics differently from arterial intima calcification (AIC), which occurs in atherosclerotic plaques. The aim of this study was to investigate the prognostic value of AMC in relationship to all-cause or CV mortality for stable haemodialysis (HD) patients.
Methods. We included 202 such patients in the present study. At baseline, soft-tissue native radiograms of the pelvis and the thigh were analysed for the presence and type (AMC vs AIC) of arterial calcifications. All patients underwent B-mode ultrasonography of the common carotid artery to determine the presence of atherosclerotic calcified plaques, measurement of aortic pulse wave velocity and echocardiography.
Results. AIC was usually observed in older patients with a clinical history of atherosclerosis before starting HD treatment and typical risk factors associated with atherosclerotic disease. AMC was observed in young and middle-aged patients without conventional atherosclerotic risk factors. AMC was closely associated with the duration of HD and calcium–phosphate disorders, including the oral dose of elemental calcium prescribed as phosphate binder (CaCO3). Compared to patients with AIC, patients with AMC had a longer survival, but in turn their survival was significantly shorter than that of patients without calcifications.
Conclusions. AMC is a strong prognostic marker of all-cause and CV mortality in HD patients, independently of classical atherogenic factors. The principal effect of AMC on arterial function is increased arterial stiffness.
Keywords: arterial calcifications; haemodialysis; mortality
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A. Galassi, D. M. Spiegel, A. Bellasi, G. A. Block, and P. Raggi Accelerated vascular calcification and relative hypoparathyroidism in incident haemodialysis diabetic patients receiving calcium binders Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3215 - 3222. [Abstract] [Full Text] [PDF]
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 V. Persy, A. Postnov, E. Neven, G. Dams, M. De Broe, P. D'Haese, and N. De Clerck High-Resolution X-Ray Microtomography Is a Sensitive Method to Detect Vascular Calcification in Living Rats With Chronic Renal Failure Arterioscler Thromb Vasc Biol, September 1, 2006; 26(9): 2110 - 2116. [Abstract] [Full Text] [PDF]
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D. C. Wheeler, J. Floege, and N. Lameire NDT contributes to a collection of 100 seminal papers published by Oxford University Press. Nephrol. Dial. Transplant., August 1, 2006; 21(8): 2047 - 2048. [Full Text] [PDF]
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 J. R. Wu-Wong, W. Noonan, J. Ma, D. Dixon, M. Nakane, A. L. Bolin, K. A. Koch, S. Postl, S. J. Morgan, and G. A. Reinhart Role of Phosphorus and Vitamin D Analogs in the Pathogenesis of Vascular Calcification J. Pharmacol. Exp. Ther., July 1, 2006; 318(1): 90 - 98. [Abstract] [Full Text] [PDF]
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S. M. Moe and G. M. Chertow The Case against Calcium-Based Phosphate Binders Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 697 - 703. [Abstract] [Full Text] [PDF]
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S. Schwarz, B. K. Trivedi, K. Kalantar-Zadeh, and C. P. Kovesdy Association of Disorders in Mineral Metabolism with Progression of Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 825 - 831. [Abstract] [Full Text] [PDF]
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X. Qin, M. A. Corriere, L. M. Matrisian, and R. J. Guzman Matrix Metalloproteinase Inhibition Attenuates Aortic Calcification Arterioscler Thromb Vasc Biol, July 1, 2006; 26(7): 1510 - 1516. [Abstract] [Full Text] [PDF]
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M. D. Arenas, F. Alvarez-Ude, M. T. Gil, A. Soriano, J. J. Egea, I. Millan, M. L. Amoedo, S. Muray, and M. A. Carreton Application of NKF-K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease: changes of clinical practices and their effects on outcomes and quality standards in three haemodialysis units Nephrol. Dial. Transplant., June 1, 2006; 21(6): 1663 - 1668. [Abstract] [Full Text] [PDF]
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M. Ketteler, G. Schlieper, and J. Floege Calcification and Cardiovascular Health: New Insights Into an Old Phenomenon Hypertension, June 1, 2006; 47(6): 1027 - 1034. [Full Text] [PDF]
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 A. Silvestro, N. Diehm, H. Savolainen, D.-D. Do, J. Vogele, F. Mahler, S. Zwicky, and I. Baumgartner Falsely high ankle-brachial index predicts major amputation in critical limb ischemia Vascular Medicine, May 1, 2006; 11(2): 69 - 74. [Abstract] [PDF]
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C. M. Shanahan Vascular calcification--a matter of damage limitation? Nephrol. Dial. Transplant., May 1, 2006; 21(5): 1166 - 1169. [Full Text] [PDF]
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X. Li, H.-Y. Yang, and C. M. Giachelli Role of the Sodium-Dependent Phosphate Cotransporter, Pit-1, in Vascular Smooth Muscle Cell Calcification Circ. Res., April 14, 2006; 98(7): 905 - 912. [Abstract] [Full Text] [PDF]
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P. Pauletto and M. Rattazzi Inflammation and hypertension: the search for a link Nephrol. Dial. Transplant., April 1, 2006; 21(4): 850 - 853. [Full Text] [PDF]
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Y. Wang, W. Zhang, Y. Zhang, Y. Yang, L. Sun, S. Hu, J. Chen, C. Zhang, Y. Zheng, Y. Zhen, et al. VKORC1 Haplotypes Are Associated With Arterial Vascular Diseases (Stroke, Coronary Heart Disease, and Aortic Dissection) Circulation, March 28, 2006; 113(12): 1615 - 1621. [Abstract] [Full Text] [PDF]
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M. Sigrist, P. Bungay, M. W. Taal, and C. W. McIntyre Vascular calcification and cardiovascular function in chronic kidney disease Nephrol. Dial. Transplant., March 1, 2006; 21(3): 707 - 714. [Abstract] [Full Text] [PDF]
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