Skip Navigation


NDT Advance Access originally published online on October 12, 2007
Nephrology Dialysis Transplantation 2008 23(2):586-593; doi:10.1093/ndt/gfm660
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/2/586    most recent
gfm660v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in NDT
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Toussaint, N. D.
Right arrow Articles by Kerr, P. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Toussaint, N. D.
Right arrow Articles by Kerr, P. G.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease

Nigel D. Toussaint1,2, Kenneth K. Lau3, Boyd J. Strauss2,4, Kevan R. Polkinghorne1,2 and Peter G. Kerr1,2

1Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia, 2Department of Medicine, Monash University, Clayton, Victoria, Australia, 3Department of Radiology and 4Clinical Nutrition and Metabolism Unit, Monash Medical Centre, Clayton, Victoria, Australia

Correspondence and offprint requests to: Dr Nigel Toussaint, Department of Nephrology, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia. Tel: +61-03-9594-3072 (w), +61-0418-560-198 (m); E-mail: Nigel.Toussaint{at}med.monash.edu.au



  Abstract

Background. Vascular calcification (VC) and arterial stiffness are major contributors to cardiovascular (CV) disease in chronic kidney disease (CKD). Both are independent predictors of CV mortality and are inversely correlated with bone mineral density (BMD). Few studies have addressed the extent of VC in the pre-dialysis CKD population, with associated measurements of BMD and arterial compliance.

Methods. We report cross-sectional data on 48 patients with CKD (GFR 17–55 ml/min) assessing the prevalence of VC and its associations. All patients had computed tomography (CT) scans through abdominal aorta and superficial femoral arteries (SFAs) to determine VC, pulse wave velocity (PWV) using SphygmoCor device (AtCor PWV Inc., Westmead, Australia) measuring arterial stiffness, and dual-energy X-ray absorptiometry (DEXA) scans to determine BMD, as well as serum markers of renal function and mineral metabolism.

Results. Patients, 71% male, 54% diabetic, had a median age 64.5 years. Mean estimated GFR was 35.1 ± 10 ml/min. Mean PWV was 10.0 ± 4.5 m/s and mean aortic VC score was 421.5 ± 244 Hounsfield units, with 90% of subjects having some aortic VC present. In univariate linear regression analysis, aortic VC correlated positively with age (r 0.50, P < 0.001), triglycerides (r 0.47, P = 0.002) and PWV (r 0.33, P = 0.03). There was also greater VC with declining renal function (r –0.28, P = 0.05). There was no significant association between VC and serum markers of mineral metabolism, however phosphate and Ca x P correlated positively with PWV (r 0.35, P = 0.02, r 0.36, P = 0.02, respectively). There was also a positive association between PWV and triglycerides (P = 0.008), and a trend towards greater PWV with increasing age (P = 0.09). In multivariate regression analysis only increasing age and triglyceride levels were significantly associated with aortic VC and PWV. Mean spine and femoral T-scores on DEXA were 0.48 and –1.31 respectively, with 13% of subjects having femoral T-score <–2.5 (osteoporotic range). SFA VC inversely correlated with femoral T-scores (r –0.43, P = 0.004); however, there was a positive (likely false) association between spine T-scores and aortic VC (r 0.37, P = 0.01), related to the limitation of vertebral DEXA in CKD.

Conclusion. There is a high prevalence of VC in pre-dialysis CKD patients, worse with increasing age, triglycerides and reducing renal function. Correlation exists between VC and PWV and determination of one or both may be useful for CKD patient CV risk assessment. Femoral BMD is inversely associated with SFA VC, but measurement of vertebral BMD by DEXA is unreliable in CKD patients with aortic VC.

Keywords: arterial stiffness; bone mineral density; cardiovascular disease; chronic kidney disease; mineral metabolism; vascular calcification

Received for publication: 29. 7.07
Accepted in revised form: 27. 8.07


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in NDT:

In this issue ...

NDT 2008 23: i. [Extract] [FREE Full Text]  



This article has been cited by other articles:


Home page
 Nephrol Dial TransplantHome page
M. Morena, A.-M. Dupuy, I. Jaussent, H. Vernhet, G. Gahide, K. Klouche, A.-S. Bargnoux, C. Delcourt, B. Canaud, and J.-P. Cristol
A cut-off value of plasma osteoprotegerin level may predict the presence of coronary artery calcifications in chronic kidney disease patients
Nephrol. Dial. Transplant., November 1, 2009; 24(11): 3389 - 3397.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
B. D. Parker, J. H. Ix, E. C. M. Cranenburg, C. Vermeer, M. A. Whooley, and L. J. Schurgers
Association of kidney function and uncarboxylated matrix Gla protein: Data from the Heart and Soul Study
Nephrol. Dial. Transplant., July 1, 2009; 24(7): 2095 - 2101.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
G. Jean, E. Bresson, J.-C. Terrat, T. Vanel, J.-M. Hurot, C. Lorriaux, B. Mayor, and C. Chazot
Peripheral vascular calcification in long-haemodialysis patients: associated factors and survival consequences
Nephrol. Dial. Transplant., March 1, 2009; 24(3): 948 - 955.
[Abstract] [Full Text] [PDF]

Home page
 HypertensionHome page
C. M. McEniery, B. J. McDonnell, A. So, S. Aitken, C. E. Bolton, M. Munnery, S. S. Hickson, Yasmin, K. M. Maki-Petaja, J. R. Cockcroft, et al.
Aortic Calcification Is Associated With Aortic Stiffness and Isolated Systolic Hypertension in Healthy Individuals
Hypertension, March 1, 2009; 53(3): 524 - 531.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
G. M. London
Bone-Vascular Axis in Chronic Kidney Disease: A Reality?
Clin. J. Am. Soc. Nephrol., February 1, 2009; 4(2): 254 - 257.
[Full Text] [PDF]

Home page
 CJASNHome page
N. D. Toussaint, K. K. Lau, B. J. Strauss, K. R. Polkinghorne, and P. G. Kerr
Determination and Validation of Aortic Calcification Measurement from Lateral Bone Densitometry in Dialysis Patients
Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 119 - 127.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
N. D. Toussaint, G. J. Elder, and P. G. Kerr
Bisphosphonates in Chronic Kidney Disease; Balancing Potential Benefits and Adverse Effects on Bone and Soft Tissue
Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 221 - 233.
[Abstract] [Full Text] [PDF]

Home page
 jvdiHome page
A. Fales-Williams, B. Sponseller, and H. Flaherty
Idiopathic arterial medial calcification of the thoracic arteries in an adult horse
J Vet Diagn Invest, September 1, 2008; 20(5): 692 - 697.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.