VASCULAR CALCIFICATION ON PLAIN RADIOGRAPHS IS ASSOCIATED WITH CAROTID INTIMA MEDIA THICKNESS, MALNUTRITION AND CARDIOVASCULAR EVENTS IN DIALYSIS PATIENTS

Abstract

Vascular calcification (VC) and carotid intima media thickness (CIMT) are highly correlated with cardiovascular (CV) disease. We hypothesized that significant VC on plain radiographs is associated with CIMT and CV events in dialysis patietns. In addition, we evaluated risk factors for VC progression on plain radiographs in dialysis patietns. In this two-year observational, prospective study, 67 dialysis patients were included. We checked plain radiographs at baseline and after 2 years. Laboratory tests and malnutrition score were obtained at baseline, after 1 year, and after 2 years. The mean age of dialysis patients was 56.3 ± 10.3 years and the duration of dialysis was 41.3 ± 34.5 months. The prevalence of significant VC was 61.2% and the prevalence of carotid artery atheromatous plaque was 36.6% in enrolled dialysis patients. The prevalence of carotid artery atheromatous plaque ( p = 0.025), CIMT (right: p = 0.045, left: p = 0.014), malnutrition scores and CRP were significantly higher in patients with significant VC compared to patients without significant VC. Serum albumin and total iron binding capacity were significantly lower in patients with significant VC compared to patients without significant VC. During an mean observational period of 22 months there were 6 CV deaths and 17 patients suffered from CV events. Patients without significant VC showed lower CV events by the Kaplan-Meier method ( p = 0.015). VC progression on plain radiographs was found in 35.7% among 56 patients followed up. Hemoglobin (Hb) was significantly increased according to elapsed time in patients who did not show VC progression on plain radiographs (10.3 g/dL at baseline, 10.8 g/dL after 1 year, 11.4 g/dL after 2 years). Hb (beta=−0.458, p = 0.006) after 2 years was an independent factor for VC progression on plain radiographs. In conclusion, significant VC on plain radiographs was associated with CIMT, malnutrition, inflammation and CV events in dialysis patients. Conditions maintaining adaquate Hb maybe retard VC progression on plain radiographs in dialysis patients.