Abstract
BackgroundVascular calcification is a prominent feature in chronic kidney disease (CKD) and diabetes mellitus. A recent report suggests that angiotensin II is protective to vascular calcification. Therefore, we investigated the relationship between vascular calcification and use of angiotensin-converting-enzyme inhibitor (ACEI) and/or angiotensin II receptor blocker (ARB) from a cross-sectional view.MethodsA total of 121 predialysis CKD patients (age 71 ± 12 y; male 72; estimated glomerular filtration rate (eGFR) 20.2 (11.8 - 40.3) mL/min/1.73 m2) who underwent thoracoabdominal plain computed tomography scan were included in this study. The total vascular calcification volume (Calc) was calculated with a three-dimensional imaging software and standardized by body surface area (BSA). The relevance between log [Calc/BSA] and ACEI/ARB use was investigated by multivariate linear regression analyses with or without a time-duration factor of ACEI/ARB use.ResultsThe Calc/BSA was 5.62 (2.01 - 12.7) mL/m2 in 121 patients. In multivariate analyses adjusted with age, sex, ACEI/ARB and log [eGFR], ACEI/ARB use is significantly and positively associated with log [Calc/BSA] (β = 0.2781, p = 0.0007). Even after the adjustment by age, sex, log [eGFR], phosphate, diabetes mellitus, systolic blood pressure, warfarin, hypertension, dyslipidemia, low-density lipoprotein cholesterol, diuretics and ACEI/ARB, ACEI/ARB use is significantly and positively associated with log [Calc/BSA] (β = 0.1677, p = 0.0487). When 90 patients whose time-duration of ACEI/ARB use was clear in medical records were studied, a multivariate analysis adjusted with age, sex, log [eGFR], and ACEI/ARB duration factors showed that the longer use of ACEI/ARB more than 2 years was significantly, independently and positively associated with log [Calc/BSA] (β = 0.2864, p = 0.0060).ConclusionsACEI/ARB user was associated with vascular calcification in predialysis patients with low eGFR. Prospective studies with larger numbers of patients or more in vitro studies are needed to confirm whether this phenomenon is due to the use of ACEI/ARB itself, the underlying disease condition or the prescription bias.
Highlights
Vascular calcification is a prominent feature in chronic kidney disease (CKD) and diabetes mellitus
When 90 patients whose timeduration of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) use was clear in medical records were studied, a multivariate analysis adjusted with age, sex, log [estimated glomerular filtration rate (eGFR)], and ACEI/ARB duration factors showed that the longer use of ACEI/ARB more than 2 years was significantly, independently and positively associated with log [calcification volume (Calc)/body surface area (BSA)] (β = 0.2864, p = 0.0060)
ACEI/ARB user was associated with vascular calcification in predialysis patients with low eGFR
Summary
Vascular calcification is a prominent feature in chronic kidney disease (CKD) and diabetes mellitus. Vascular calcification is often found in patients with chronic kidney disease (CKD) or diabetes mellitus (DM), and is closely associated with cardiovascular events and mortality [1, 2]. The medial layer of the vascular walls is composed of smooth muscle cells and elastin-rich extracellular matrix. Many clinical studies suggest that hypertension, DM, dyslipidemia, aging, smoking, and genetic factors, which are known as “traditional” Framingham risk factors, promote vascular calcification. Non-traditional risk factors, including inflammation, oxidative stress, advanced glycation end products, and abnormal mineral metabolism (e.g. high serum phosphate) are associated with vascular calcification [4, 5]
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