NDT Advance Access originally published online on October 18, 2006
Nephrology Dialysis Transplantation 2007 22(2):515-521; doi:10.1093/ndt/gfl564
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Factors involved in vascular calcification and atherosclerosis in maintenance haemodialysis patients
niak1
d1
aw Pasowicz3ek1gorzata Konieczy
ska3awa Tracz2adysaw Suowicz11Department of Nephrology, Jagiellonian University, 2Department of Cardiology and Vascular Diseases, Jagiellonian University, 3Diagnostic and Rehabilitation, John Paul II Memorial Center of Heart and Lung Diseases, Cracow, Poland and 4Necker Hospital, Paris, France
Corresponding and offprint requests to: Maciej Drod, MD, PhD, Department of Nephrology, 31-501 Krakow, ul. Kopernika 15 c, Poland. Email: mmdrozdz{at}cyf-kr.edu.pl
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Abstract |
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Background. Atherosclerosis and vascular calcifications are common causes of morbidity and mortality in maintenance haemodialysis patients. In addition to the well-known traditional risk factors, uraemia-specific factors appear to enhance dramatically the progression of the pathological processes involved. The aim of the present study was to evaluate the degree of atherosclerosis and vascular calcifications in chronic haemodialysis patients using non-invasive imaging methods, and to identify potentially involved factors.
Methods. The study included 73 patients (36 females, 37 males), aged 25–75 years, who were on haemodialysis treatment for 12–275 months (mean dialysis vintage 73.8 months). We assessed the following circulating parameters: calcium (Ca), phosphorus, ‘intact’ parathyroid hormone (iPTH), 25OH vitamin D, lipids, oxidized LDL (ox-LDL), Lp(a), homocysteine, leptin, IL-1-ß, IL-6, CRP, TGF-ß, TNF-
, (PDGF), advanced oxidation protein products (AOPP) and myeloperoxidase activity (MPO). Coronary artery calcification score (CACS) was assessed using multi-row spiral CT (MSCT). Intima–media thickness index of the common carotid artery (CCA-IMT) and presence of cervical artery atherosclerotic plaques were evaluated by ultrasonography.
Results. Coronary artery calcifications were observed in 79.5% of the patients, with CACS ranging from 0 to 4987. In univariate analysis, a positive correlation was observed between CACS and age, BMI, iPTH, CRP, IL-6 and CCA-IMT, whereas an inverse correlation existed with 25OH vitamin D, TGF-ß and PDGF. CCA-IMT ranged from 0.4 to 1.1 mm. It was positively correlated, in univariate analysis, with age, CACS, CRP and Il-6, and negatively with 25OH vitamin D, TGF-ß and PDGF. Only CACS remained as independent predictive factor of CCA-IMT in multivariate analysis. Atherosclerotic plaques were found in the carotid arteries of 53 patients (72%). The number of plaques was positively correlated with age, CACS, phosphorus, MPO, CRP and IL-6, and inversely with 25OH vitamin D in univariate analysis. In multivariate regression analysis, only age and CACS remained as independent variables.
Conclusion. In addition to classic risk factors, the degree of atherosclerosis and vascular calcification in our dialysis patient population were associated with several factors that are frequently abnormal in advanced chronic renal failure, but except age, all of them were interdependent. Notably, as in the general population, CACS was an independent predictor of the degree of atherosclerosis in haemodialysis patients.
Keywords: atherosclerosis; common carotid artery intima–media thickness (CCA-IMT); coronary artery calcification score (CACS); haemodialysis; inflammation; oxidative stress