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NDT Advance Access originally published online on March 29, 2007
Nephrology Dialysis Transplantation 2007 22(7):2032-2037; doi:10.1093/ndt/gfm031
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis

Kazuhiro Yamada1, Shouichi Fujimoto1, Ryosuke Nishiura1, Hiroyuki Komatsu1, Mariko Tatsumoto1, Yuji Sato1, Seiichiro Hara1, Shuichi Hisanaga3, Hideyuki Ochiai4, Hiroyuki Nakao2 and Tanenao Eto1

1First Department of Internal Medicine, 2Department of Public Health, Miyazaki Medical College, University of Miyazaki, 3Koga General Hospital and 4Miyazaki Junkanki Hospital, Miyazaki, Japan

Correspondence and offprint requests to: Kazuhiro Yamada, MD, First Department of Internal Medicine, Miyazaki Medical College, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan. Email: yamakazu{at}xqb.biglobe.ne.jp



  Abstract

Background. Vascular calcification is an independent determinant of cardiovascular events in maintenance haemodialysis (HD) patients. It is not known whether acute changes of the serum calcium concentration before and after HD ({triangleup}Ca) are associated with the development of aortic calcification.

Methods. We enrolled 71 patients dialysed with a dialysate with 3.0 mEq/l calcium and determined their aortic calcification index (ACI) by abdominal computed tomography twice at an interval of 3 years. To identify the factors contributing to the rate of progression of aortic calcification, we analysed the average values for clinical and laboratory data obtained between the first and second evaluations of ACI.

Results. The second ACI (mean ± SD: 80.2 ± 63.9) was significantly greater than the first ACI (61.0 ± 61.0) after an interval of 35.8 ± 4.2 months. The annualized change of ACI ({Delta}ACI/year) was significantly and directly associated with the {Delta}Ca and C-reactive protein (CRP) (both P < 0.001, P for trend). Stepwise multivariate regression analysis revealed that {Delta}ACI/year was positively and independently associated with CRP, presence of diabetes mellitus and {Delta}Ca, but negatively associated with a premenopausal status in women. Similarly, {Delta}Ca was positively and independently associated with {Delta}ACI/year and the ultrafiltration rate, but was negatively associated with pre-HD Ca.

Conclusion. The increase of serum calcium after HD was related to the rate of progression of aortic calcification. Excess calcium is transferred into patients on HD when using a dialysate of 3.0 mEq/l calcium. This may be a risk factor for the development of vascular calcification.

Keywords: aortic calcification; calcium; C-reactive protein; dialysate; haemodialysis; premenopausal women

Received for publication: 2. 3.06
Accepted in revised form: 10. 1.07


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