Presence Of Vascular Calcifications Research Articles

MO933: are Chronic Inflammation and CKD-MBD Risk Factors of Mortality in Hemodialysis Patients?

Abstract BACKGROUND AND AIMS Haemodialysis patients are known to be susceptible to a wide range of early and long-term complications such as chronic inflammation, infections, malnutrition, mineral bone disorders (CKD-MBD) and cardiovascular disease that significantly affect the incidence of mortality.The aim of this study is to assess the presence of traditional risk factors for mortality such as diabetes mellitus or cardiovascular disease on one hand and non-traditional risk factors on the other hand (chronic inflammation, CKD-MBD). METHOD We conducted a single-centre study that included 63 CKD G5D patients (haemodialysis for 1–5 years) followed up for 48 months. All patients have been assessed at baseline, regarding cardiovascular disease (medical history, echocardiography and ECG), we performed using standard methods blood biochemistry, complete blood count and markers of inflammation (CRP, IL-6) and markers of CKD-MBD (sKlotho, iPTH, serum calcium and serum phosphorus). RESULTS After 24 months of follow-up, we found a mortality rate of 22.23%, while after 48 months, the mortality rate was of 50.73%. Baseline plasma IL-6 levels showed a strong statistically significant correlation with sKlotho (r = 0.57, P = 0.001), but no statistically significant correlation with other elements of CKD-MBD was present (serum calcium, serum phosphorus and iPTH). sKlotho showed a positive correlation with haemodialysis efficiency (eKTV) (r = 0.26, P = 0.04)., Decreased levels of sKlotho at baseline correlated significantly with the presence of signs of ischaemia on ECG (190.3 versus 381.57 pg/mL; P = 0.028). Inflammation markers (IL-6 and CRP) showed no statistically significant correlation with any of the markers of cardiovascular disease (presence of vascular calcifications and of left ventricular hypertrophy). The level of iPTH at baseline was significantly lower in the group of patients that survived the following 4 years of haemodialysis (428.08 ± 315.39 versus 666.76 ± 484.55 pg/mL, P = 0.029). In a Cox proportion-hazards regression analysis of predicting factors of mortality, only age and not inflammation markers (IL-6 and CRP) showed a statistically significant correlation with 4-year mortality (P = 0.032). Patients with higher levels of sKlotho showed a decreased risk of mortality, however not statistically significant. We found a higher risk of all-cause mortality after 24 months in patients with diabetes mellitus [OR 6.9, 95% confidence interval (95% CI) 1.6924–28.1469; P = 0.007], and after 48 months in patients with a history of cerebro-vascular disease (OR 21.8571, 95% CI 1.2018–397.5026; P = 0.0371) and with left ventricular hypertrophy (OR 2.7259, 95% CI 0.9596–7.7437; P = 0.0598). CONCLUSION In our study, although the inflammation marker IL-6 showed correlations with features of CKD-MBD, it did not lead to an increased mortality, which was influenced rather by traditional risk factors such as age, diabetes mellitus or history of cardiovascular disease, but also by CKD-MBD (iPTH).

Evaluarea rigidității vasculare secundare calcificărilor vasculare la pacienţii dializaţi ambulator

Arterial stiffness provides an indirect picture of vascular calcifications in terms of the effect they have on the systemic circulation and consequently on the heart. The present study sought to demonstrate the usefulness of outpatient investigation of vascular calcifications in dialysis patients using pulse wave velocity (PWV) determination. The aim of the study was to determine arterial resistance in patients with chronic dialysis kidney disease. The average study period was 48.5 ± 19.0 (SD) months. The study included 203 patients on dialysis with BCRT. The determination of arterial stiffness was measured at an interval of one hour after the dialysis session. The study highlighted the presence of an increased cardiovascular risk related to the presence of vascular calcifications without being able to establish a direct linear and causal link between their presence, location and the risk of cardiovascular events. The importance of highlighting calcifications and the consequences they generate means the possibility of influencing the main elements that can generate acute cardiovascular events. The results obtained and the correlations performed give an overview of the pathology studied, providing premises for therapeutic influence and risk assessment.

The role of physical activity and miRNAs in the vascular aging and cardiac health of dialysis patients.

Cardiovascular comorbidities are independent risk factors for mortality in dialysis patients. MicroRNA signaling has an important role in vascular aging and cardiac health, while physical activity is a primary nonpharmacologic treatment for cardiovascular comorbidities in dialysis patients. To identify the relationships between muscle function, miRNA signaling pathways, the presence of vascular calcifications and the severity of cardiovascular comorbidities, we initially enrolled 90 subjects on hemodialysis therapy and collected complete data from 46 subjects. A group of 26 subjects inactiv group (INC) was monitored during 12 weeks of physical inactivity and another group of 20 patients exercise group (EXC) was followed during 12 weeks of intradialytic, moderate intensity, resistance training intervention applied three times per week. In both groups, we assessed the expression levels of myo‐miRNAs, proteins, and muscle function (MF) before and after the 12‐week period. Data on the presence of vascular calcifications and the severity of cardiac comorbidities were collected from the patients’ EuCliD® records. Using a full structural equitation modelling of the total study sample, we found that the higher the increase in MF was observed in patients, the higher the probability of a decrease in the expression of miR‐206 and TRIM63 and the lower severity of cardiac comorbidities. A reduced structural model in INC patients showed that the higher the decrease in MF, the higher the probability of the presence of calcifications and the higher severity of cardiac comorbidities. In EXC patients, we found that the higher the increase in MF, the lower the probability of higher severity of cardiovascular comorbidities.

Head CT in centenarians: emergency and non-emergency findings.

Our retrospective study evaluates head CTs performed in our Hospital in the last 11years (2009-2019) in centenarian patients. To estimate the correlation between reasons for examination and CT findings in emergency and to evaluate if there was the expected involution of the brain by analyzing some non-emergency neuroradiological parameters (NENP). 62 Head CTs performed on patients aged 100 and over were reviewed. They were evaluated emergency CT findings and NENP (leukoencephalopathy, enlargement of the ventricular volume, presence of vascular calcifications). For comparison, NENP were also assessedin two relatively younger populations of 62 patients aged between 65-70 (called "65-70") and 85-90 ("85-90"). In cases of suspected traumatic brain lesions, 11.9% (n = 5/42) of centenarians showed a cerebral bleeding; as concerns suspected stroke we found a higher concordance between clinical suspicion and CT features, 46.6% (n = 7/15). As regards NENP, no significant differences were found with respect to the "85-90" population in terms of severity of leukoencephalopathy, enlargement of the ventricular volume and presence of vascular calcifications. In emergency, CT plays a pivotal role in defining an immediate diagnosis and from a medico-legal point of view, resulting together with clinical observation the main strategy in the management of centenarians. By the analysis of NENP we may support that centenarians' brains on CT are similar to those of "85-90".

High ankle-brachial index predicts cardiovascular events and mortality in hemodialysis patients with severe secondary hyperparathyroidism.

Introduction:Vascular calcification related to severe secondary hyperparathyroidism (SHPT) is an important cause of cardiovascular and bone complications, leading to high morbidity and mortality in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). The present study aimed to analyze whether ankle-brachial index (ABI), a non-invasive diagnostic tool, is able to predict cardiovascular outcomes in this population.Methods:We selected 88 adult patients on HD for at least 6 months, with serum iPTH>1,000pg/mL. We collected clinical data, biochemical and hormonal parameters, and ABI (sonar-Doppler). Calcification was assessed by lateral radiography of the abdomen and by simple vascular calcification score (SVCS). This cohort was monitored prospectively between 2012 and 2019 for cardiovascular outcomes (death, myocardial infarction (MI), stroke, and calciphylaxis) to estimate the accuracy of ABI in this setting.Results:The baseline values were: iPTH: 1770±689pg/mL, P: 5.8±1.2 mg/dL, corrected Ca: 9.7±0.8mg/dL, 25(OH)vit D: 25.1±10.9ng/mL. Sixty-five percent of patients had ABI>1.3 (ranging from 0.6 to 3.2); 66% had SVCS≥3, and 45% aortic calcification (Kauppila≥8). The prospective evaluation (51.6±24.0 months), provided the following cardiovascular outcomes: 11% of deaths, 17% of nonfatal MI, one stroke, and 3% of calciphylaxis. After adjustments, patients with ABI≥1.6 had 8.9-fold higher risk of cardiovascular events (p=0.035), and ABI≥1.8 had 12.2-fold higher risk of cardiovascular mortality (p=0.019).Conclusion:The presence of vascular calcifications and arterial stiffness was highly prevalent in our population. We suggest that ABI, a simple and cost-effective diagnostic tool, could be used at an outpatient basis to predict cardiovascular events in patients with severe SHPT undergoing HD.

Vascular Calcifications are Associated with Increased Mortality in Patients with Acute Mesenteric Ischemia

Vascular calcifications have been identified as predictors of mortality in several cardiovascular diseases but have not been investigated in context of acute mesenteric ischemia. The aim of this study was to investigate the impact of vascular calcifications in patients with acute mesenteric ischemia. Patients admitted for an acute mesenteric ischemia were retrospectively included. The presence of calcifications in the visceral aorta, the celiac trunk, the superior mesenteric artery, and the renal arteries was assessed on computed tomography scan images at the arterial phase. The calcification volumes were measured using the software Aquarius iNtuition Edition®. The all-cause mortality was 55 out of 86 patients (63.9%) for a median follow-up of 3.5days (1-243). The survival rate of patients with calcification in the superior mesenteric artery was significantly lower than that of those without calcification (22% vs. 55.6%, P=0.019). Patients who died had significantly a higher frequency of calcifications in the superior mesenteric artery, the visceral aorta, the celiac trunk, and the renal arteries. The presence of vascular calcifications in the superior mesenteric artery is associated with increased mortality in patients diagnosed with acute mesenteric ischemia. Further studies are required to identify the mechanisms underlying this association.

P1241CALCIFICATIONS IN DIFFERENT VASCULAR BEDS ACROSS THE SPECTRUM OF CHRONIC KIDNEY DISEASE INCLUDING CALCIFIC UREMIC ARTERIOLOPATHY: ARE SKIN PUNCH BIOPSIES USEFUL?

Abstract Background and Aims Accelerated vascular calcification in different vascular beds is common in patients with chronic kidney disease (CKD). A severe form of vascular calcifications is calcific uremic arteriolopathy (CUA) presenting with painful ischemic skin lesions and high mortality. The prognostic value of skin biopsies in relation to CUA is unclear and the prevalence of skin vascular calcifications in different stages of CKD is sparsely described. The aim of the study was to describe the occurence of small vesssel vascular calcifications in unaffected skin biopsies in relation to calcifications in other vascular beds across the spectrum of CKD including CUA. Method A cross-sectional cohort (total, n=39) comprising dialysis patients with current or previous CUA (CKD5D+CUA, n=9), dialysis patients without CUA (CKD5D-CUA, n=12), patients with CKD stage 3-4 (CKD3-4, n=12), and healthy kidney controls (control, n=6). The presence of vascular calcifications in the dermis and subcutis were assessed in 4 mm punch biopsies of unaffected skin from the lateral thigh. The presence of vascular calcification was evaluated by H&E, von Kossa and Alizarin staining. The presence of breast arterial calcifications (BAC) was evaluated by mammography, the abdominal aortic calcification score (AAC) by lateral lumbar X-ray and calcification propensity was measured by T50 reflecting the calcification propensity in blood. Results None of the included patients showed vascular calcifications in skin biopsies. Declining kidney function was associated with presence of BAC, increased AAC and reduced T50 (Table). No significant difference was found between CKD5D+CUA and CKD5D-CUA regarding BAC (p=1.000), AAC (p=0.815) or T50 (p=0.165). CKD5D+CUA compared to all other groups had no difference in BAC (p=0.109) and AAC (p=0.141) but reduced T50 (p=0.004). Dialysis patients (CKD5D±CUA) had significant more BAC (p=0.003), higher AAC (p<0.001) and lower T50 (p<0.001). Conclusion No vascular calcifications were found in punch biopsies from unaffected skin in patients with different stages of CKD including CUA. Despite imaging verified vessel calcification by BAC and AAC and increased calcification propensity by T50. This suggest that conventional punch biopsies cannot be used to identify skin vascular calcification and thereby patients at risk for developing CUA.

P1412CARDIO PULMONARY AND CKD-MBD INTERACTIONS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Emerging evidence suggests that pulmonary hypertension (PHT) is closely associated with cardiac, pulmonary, and mineral bone diseases in hemodialysis patients. Previous results indicated that extra osseous calcifications might be a risk factor for PHT although results in human studies about this association have been conflicting. Multiple factors including abnormal calcium phosphate levels, uremia and inflammation are known to be important in vascular calcification development. In hemodialysis patients’ vascular calcifications may be evaluated by different techniques. The utilization of plain X-ray for screening vascular calcifications has been suggested by KDOQI and KDIGO .In this study, we examined the association between PHT, peripheral vascular calcification by plain X-Ray score, and echocardiographic parameters in hemodialysis patients. Method Chronic (> 6 months) hemodialysis patients (150) on a three times per week dialysis schedule were studied. Two-dimensional trans thoracic echocardiography was performed before dialysis. Global systolic function was evaluated by left ventricular ejection fraction (LVEF). Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 35 mm Hg based on European Society of Cardiology Guideline. Vascular calcification score is evaluated in plain X-ray of pelvis and hands. Each film is divided into four sections. Any vascular calcification either in an irregular or linear pattern is considered. The presence of vascular calcifications in each section is rated as 1 and its absence as 0. Final score is the sum of all sections and ranges from 0 to 8.Demographic data and lab results including Calcium (Ca), Phosphorous (P), Ca X P product, 25OH-vitD and iPTH were collected for all enrolled patients. The effects of different peripheral vascular calcification scores in plain X-Ray, structural heart abnormalities in echocardiography and Ca-P-iPTH- vit D axis disorders on the development of pulmonary hypertension were evaluated to elucidate cardio, pulmonary and CKD-MBD interactions. Results Hemodialysis patients had a high prevalence of PHT (30%), which warrants special attention to this important complication in hemodialysis population. Severe peripheral VCs (VCs >3) were independent risk factor for PHT. In addition to the old age, duration of hemodialysis, and mitral valve disease, the presence of higher Ca- P product was another independent predictor of PHT in chronic hemodialysis patients. Conclusion Prevalence of PHT in dialysis patients seems to be high, and is closely associated with peripheral VC, mineral bone disorders and structural heart abnormalities suggesting further a strong cardio pulmonary renal interaction.

SAT-234 CARDIO-PULMUNARY AND CKD-MBD INTERACTIONS IN HEMODIALYSIS PATIENTS

Emerging evidence suggests that pulmonary hypertension (PHT) is closely associated with cardiac, pulmonary, and mineral bone diseases in hemodialysis patients. Previous results indicated that extra osseous calcifications might be a risk factor for PHT although results in human studies about this association have been conflicting. Multiple factors including abnormal calcium phosphate levels, uremia and inflammation are known to be important in vascular calcification development. In hemodialysis patients’ vascular calcifications may be evaluated by different techniques. The utilization of plain X-ray for screening vascular calcifications has been suggested by KDOQI and KDIGO. In this study, we examined the association between PHT, peripheral vascular calcification by plain X-Ray score, and echocardiographic parameters in hemodialysis patients. Chronic (> 6 months) hemodialysis patients (150) on a three times per week dialysis schedule were studied. Two-dimensional trans thoracic echocardiography was performed before dialysis. Global systolic function was evaluated by left ventricular ejection fraction (LVEF). Systolic pulmonary arterial pressure (SPAP) was recorded. Pulmonary hypertension was defined as, pulmonary artery pressure (PAP) greater than 35 mm Hg based on European Society of Cardiology Guideline. Vascularcalcification score is evaluated in plain X-ray of pelvis and hands. Each film is divided into four sections. Any vascular calcification either in an irregular or linear pattern is considered. The presence of vascular calcifications in each section is rated as 1 and its absence as 0. Final score is the sum of all sections and ranges from 0 to 8. Demographic data and lab results including Calcium (Ca), Phosphorous (P), Ca X P product, 25OH-vitD and iPTH were collected for all enrolled patients. The effects of different peripheral vascular calcification scores in plain X-Ray, structural heart abnormalities in echocardiography and Ca-P-iPTH- vit D axis disorders on the development of pulmonary hypertension were evaluated to elucidate cardio, pulmonary and CKD-MBD interactions. Hemodialysis patients had a high prevalence of PHT (30%), which warrants special attention to this important complication in hemodialysis population. Severe peripheral VCs (VCs >3) were independent risk factor for PHT. In addition to the old age, duration of hemodialysis, and mitral valve disease, the presence of higher Ca- P product was another independent predictor of PHT in chronic hemodialysis patients. View Large Image Figure ViewerDownload Hi-res image Download (PPT) Prevalence of PHT in dialysis patients seems to be high, and is closely associated with peripheral VC, mineral bone disorders and structural heart abnormalities suggesting further a strong cardio pulmonary renal interaction.

Sclerostin is not associated with cardiovascular event or fracture inkidneytransplantation candidates .

Sclerostin, a bone-derived protein, has been linked to cardiovascular calcifications in chronic kidney disease (CKD). The aim of this study was to investigate the associations between sclerostin and mineral and bone disorder in CKD, specifically whether sclerostin levels could predict cardiovascular event, fracture, or all-cause mortality. Kidney transplantation candidates (n = 157) underwent computed tomography scans of the chest, abdomen, and pelvis. Calcification scores were calculated for coronary arteries, thoracic aorta, and the aortic and mitral valves. Volumetric bone mineral density (BMD) was measured at the spine and hip. Sclerostin and markers of bone turnover were determined from fasting blood samples. Compared to patients with a calcification score of 0, sclerostin levels were higher in patients with calcifications at the coronary arteries (+23%, p < 0.001) and the thoracic aorta (+27%, p = 0.001), but not in patients with calcifications at the aortic (+1%, p = 0.85) or mitral (+8%, p=0.20) valves. During a median follow-up of 3.7 years, 28 patients had a major cardiovascular event, 19 patients sustained a fragility fracture, and 32 patients died. Sclerostin levels above the median did not predict major cardiovascular event (p=0.15), fracture (p=0.58), or mortality (p=0.65). Sclerostin was positively associated with the presence of vascular calcifications, but was not predictive of events associated with mineral and bone disorder in a cohort of kidney transplantation candidates. .

A novel ultrasound-based vascular calcification score (CALCS) to detect subclinical atherosclerosis.

To quantify non-coronary vascular calcifications (VC) in asymptomatic patients at low-intermediate cardiovascular risk by a new color Doppler ultrasound (DUS)-based score (the carotid, aortic, lower limbs calcium score, CALCs), and to correlate this score with classical parameters associated with cardiovascular risk [carotid intima media thickness (IMT), and arterial stiffness (AS)]. All consecutive asymptomatic patients who underwent a screening DUS of non-coronary circulation were evaluated and patients at low-intermediate cardiovascular risk were selected according to Framingham risk score (FRS). Among them, we enrolled 70 patients with US evidence of VC and 71 age, sex and FRS matched controls. The presence of VC was correlated with classical markers of cardiovascular risk, such as AS and intima-media thickness (IMT). AS, expressed as pulse wave velocity (PWV) and arterial distensibility, carotid IMT and CALCs were measured for both groups. AS and c-IMT were assessed by a new Radio-Frequency (RF) DUS-based method. CALCs was generated by our previously described B-mode DUS-based method according to number/size of VC in 11 non-coronary segments (range 0-33). Patients with VC presented higher AS and IMT values than controls (PWV 8.34±0.98 m/s vs. 6.74±0.68 m/s, p<0.0001; arterial distensibility 267±12 mm vs. 315±65 mm, p=0.001; IMT 687±132 mm vs. 572±91 mm, p<0.0001). Mean CALCs of patients with VC was 8.41±7.78. CALCs were significantly correlated with c-IMT (p<0.0001; r=0.3), PWV (p<0.0001; r=0.4) and arterial distensibility (p=0.002; r=-0.1). DUS-based CALCs is highly correlated with other validated markers of subclinical atherosclerosis, such as c-IMT and AS. Our results demonstrated the ability of CALCs to identify individual predictive factors beyond the traditional risk factors by quantifying an interesting and novel step of the atherogenic process. Future studies on larger series and with adequate follow up are necessary to confirm these results and to evaluate the role of this new marker in monitoring calcific atherosclerosis progression.

Impact of Vascular Calcifications on Long Femoropopliteal Stenting Outcomes

Vascular calcifications (VCs) may be a prognostic factor for outcome after endovascular treatment of peripheral arterial disease (PAD). Semiquantitative analysis with X-ray imaging is the main limiting factor for assessing VCs. The aim of the present study was to find a correlation between the amount of VC with computed tomography (CT) scan quantification and midterm results of endovascular treatment of Trans-Atlantic Inter-Society Consensus C/D femoropopliteal (FP) lesions. Patients belonging to 2 previously published registries (STELLA and STELLA PTX) and who underwent a preoperative CT scan were retrospectively included in the study. VC quantification was performed with a dedicated workstation (EndoSize, Therenva) on the basis of Hounsfield units (HU). The VC percentage was calculated as the ratio between VC volume and the volume of the region of interest. For the analysis, patients were divided into 3 groups according to VC percentage, from lowest to highest: group 1 (G1) included the first quartile of VCs, group 2 (G2) included the second and third quartiles, and group 3 (G3) included the fourth quartile. Risk of in-stent thrombosis was analysed using a multivariate model. Thirty-nine patients were included (10 in G1, 19 in G2, and 10 in G3), and mean follow-up duration was 24±14.6months. Patients in G1 and G3 had, respectively, a VC rate of <1% (no VC) and >20% (severe VC). In G2, VC was considered to be intermediate. There was no statistical difference in the cardiovascular risk factors and preoperative medication. A significant difference was found for the healthy FP diameter between G1 (4.6±0.8mm) and G3 (6.8±0.8mm, P<0.0001) and between G2 (5.2±1mm) and G3 (P<0.0001). The rate of drug-eluting stents was similar in all groups. There was no difference between groups concerning the rate of in-stent restenosis, target lesion revascularization, and target extremity revascularization. There was a higher rate of in-stent thrombosis for G1 versus G2 (P=0.037), and no difference was noted between G1 versus G3 (P=0.86) or G2 versus G3 (P=0.12). G3 was associated with early stent thrombosis (<1month), while G1 was associated with late stent thrombosis (6-24months). On multivariate analysis, only one predictive factor for stent thrombosis was found: patients with intermediate VC seemed tobe protected against in-stent thrombosis (odds ratio=0.27, 95% confidence interval: 0.1-0.77; P=0.014). The study showed that VC quantification with CT imaging is feasible and useful for comparing outcomes following PAD endovascular revascularization. Below a certain threshold, the presence of VC might be necessary for plaque stability and may protect against in-stent thrombosis.

MR imaging of iliofemoral peripheral vascular calcifications using proton density-weighted, in-phase three-dimensional stack-of-stars gradient echo.

The presence of vascular calcifications helps to determine percutaneous access for interventional vascular procedures and has prognostic value for future cardiovascular events. Unlike CT, standard MRI techniques are insensitive to vascular calcifications. In this prospective study, we tested a proton density-weighted, in-phase (PDIP) three-dimensional (3D) stack-of-stars gradient-echo pulse sequence with approximately 1 mm3 isotropic spatial resolution at 1.5 Tesla (T) and 3T to detect iliofemoral peripheral vascular calcifications and correlated MR-determined lesion volumes with CT angiography (CTA). The study was approved by the Institutional Review Board. The prototype PDIP stack-of-stars pulse sequence was applied in 12 patients with iliofemoral peripheral vascular calcifications who had undergone CTA. Vascular calcifications were well visualized in all subjects, excluding segments near prostheses or stents. The location, size, and shape of the calcifications were similar to CTA. Quantitative analysis showed excellent correlation (r2 = 0.84; P < 0.0001) between MR- and CT-based measures of calcification volume. In one subject in whom three pulse sequences were compared, PDIP stack-of-stars outperformed cartesian 3D gradient-echo and point-wise encoding time reduction with radial acquisition (PETRA). In this pilot study, a PDIP 3D stack-of-stars gradient-echo pulse sequence with high spatial resolution provided excellent image quality and accurately depicted the location and volume of iliofemoral vascular calcifications. Magn Reson Med 77:2146-2152, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Prevalência e correlatos de doença vascular no exame de ultrassom em pacientes em hemodiálise

Patients on hemodialysis present an increased risk of cardiovascular death. Intimal media thickness (IMT) and presence of arterial calcifications are well-known risk factors for cardiovascular death in hemodialysis patients.To assess the prevalence of IMT and arterial calcifications in HD patients and to correlate image findings with clinical and laboratory data.Cross-sectional study involving 75 patients on dialysis for >12 months. Patients underwent B-mode ultrasound scan (US) for determination of IMT of the distal third of the common carotid arteries. Arterial calcifications were assessed by US of carotids, femoral and tibial arteries, and labeled positive if calcification was found in any arterial site.Patients were 52±13 years old, 57% were males and 16% were diabetics. IMT > 0.9 mm was found in 57% of cases and arterial calcifications at US in 48%. Aging (decades) and smoking were associated with both increased IMT (adjusted odds ratio [aOR] = 3.4, p < 0.001; aOR = 4.4, p = 0.045, respectively) and presence of vascular calcifications (aOR = 3.0, p < 0.001; aOR = 6.8, p = 0.011, respectively). High intact parathyroid hormone levels (per each 100 pg/ml) were significantly associated with increased IMT (aOR = 1.7, p = 0.021), but not with vascular calcification. In contrast, Diabetes and time on dialysis (years) were significant determinants for calcifications at US (aOR = 15.0, p = 0.009; aOR = 1.39, p = 0.020), but not for increased IMT.Increased IMT and calcifications at US are common findings in hemodialysis patients. Aging and smoking are consistent determinants for both image alterations. Parathyroid hormone elevation is associated with increased IMT. Diabetes and time on dialysis substantially increase the risk for arterial calcification.

Vascular Calcifications Seen on Mammography: An Independent Factor Indicating Coronary Artery Disease

PURPOSEEstablish a relationship between vascular calcifications seen via mammography and coronary artery disease, estimate the risk ratios, and investigate the interrelationships between vascular calcification and other risk factors for coronary artery disease.MATERIALS AND METHODSThis was a case-control study consisting of 40 women with coronary artery disease in the case group and 40 women without any history of coronary artery disease in the control group who were matched according to age. The study was approved by the Institution’s Research Ethics Committee (consent statement was obtained). Odds ratios and confidence intervals were calculated using univariate analysis. Interrelationships among other risk factors, such as arterial hypertension, dyslipidemia, smoking and diabetes mellitus, were calculated using multivariate analysis. A p <0.05 was considered to be significant for statistical analysis.RESULTSThe mean ages for the case and control groups were 64.65 years and 63.88 years, respectively. In multivariate analysis, the only variables related to coronary artery disease were Vascular calcification [OR 4.71 (CI 1.36–16.33) p=0.014], family history [OR 5.76 (CI 1.58–21.03) p=0.008] and arterial hypertension [OR 15.92 (CI 3.12–81.14) p=0.001]. Although smoking and diabetes are important variables in the pathogenesis of coronary artery disease, these factors did not show statistically significant associations in this sample.CONCLUSIONThe presence of vascular calcifications seen via mammography was an independent risk factor for coronary artery disease, as were hypertension and a family history of coronary artery disease.

Evaluation of Vascular Calcifications in CKD Patients

In observational studies on dialysis patients, there has been a consistent association between vascular calcifications and mortality. Hyperphosphatemia and calcium treatment are some of the factors associated with development of vascular calcifications, especially in the presence of low bone turnover disease. Several non-invasive imaging techniques have been used to screen for the presence of vascular calcifications: plain X-Ray, echocardiography, ultrasonography, and computed tomography. Presence of vascular calcifications is a warning sign for increased cardiovascular risk and this information may be relevant for choosing the most suitable treatment for dialysis patients.

Cardiovascular risk in dialysis patients: an X-ray vision on vascular calcifications

In dialysis patients, there is an association between vascular calcifications and mortality. Hyperphosphatemia and calcium overload are associated with development of vascular calcifications, especially in the presence of low bone turnover. Different plain X-ray methods are now available to evaluate vascular calcifications in dialysis patients. The presence of vascular calcifications is an alert sign for increased cardiovascular risk, and this information is important for choosing the most suitable treatment for dialysis patients.

25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients

Decreased vitamin D serum levels have been recently related to arterial stiffening and vascular calcifications in haemodialysis (HD) patients, but the pathophysiology of this association is not yet clear. The aim of this study was to evaluate the relationship between vascular calcifications, cardiovascular risk factors [including brain natriuretic peptide (BNP), pulse pressure (PP) and left ventricular mass index] and 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 [1,25(OH)(2)D3] serum levels. We performed a cross-sectional study with 223 prevalent HD patients, 48% females, 27% diabetics, with the mean age of 62.7 +/- 15.3 years and the mean HD time of 42.9 +/- 39.3 months. Forty-seven percent of the patients were taking active forms of vitamin D. Serum levels of [25(OH)D3] were low (21.6 +/- 12.2 ng/mL) and negatively correlated with age (r = -0.31, P < 0.001), diabetes mellitus (DM) (r = -0.20, P = 0.004), C-reactive protein (r = -0.25, P < 0.001), log(10) BNP (r = -0.22, P = 0.002), PP > 65 mmHg (r = -0.21, P = 0.003) and vascular calcifications (r = -0.26, P < 0.001). Levels of [25(OH)D3] were positively correlated with [1,25(OH)(2)D3] (r = 0.25, P < 0.001) and albumin (r = 0.23, P = 0.001). On multivariate analysis, levels of [25(OH)D3] were independently associated with DM (P < 0.001), lower albumin levels (P = 0.003), higher BNP values (P = 0.005), PP > 65 mmHg (P = 0.006) and a higher vascular calcification score (>or= 3) (P = 0.002). These results suggest that lower levels of [25(OH)D3] are a cardiovascular risk marker in HD patients, since they are strongly associated with higher BNP levels, increased PP and with the presence of vascular calcifications. The exact role of [25(OH)D3] deficiency on cardiovascular morbi-mortality needs to be clarified in large randomized controlled trials.

Mamografía y riesgo cardionefrovascular. Estudio de las calcificaciones vasculares en la insuficiencia renal crónica

Vascular calcifications are markers of cardiovascular risk in patients with chronic renal failure, and 50% of the deaths in chronic renal failure are due to cardiovascular disease. We analyzed vascular calcifications at mammography in women with chronic renal failure, comparing the vascular calcifications seen at mammography and in skeletal x-ray examinations and analyzing their relation to cardiovascular disease and laboratory parameters. We studied the vascular calcifications seen at mammography and in skeletal x-ray examinations in 61 patients (45 dialysis and 16 pre-dialysis) and correlated them with age, time in dialysis, cardiovascular signs and symptoms, glycemia, arterial blood pressure, PTH, phosphorus, calcium, cholesterol (LDL/HDL), atherogenic index, triglycerides, and inflammatory markers. The statistical analysis was performed using SPSS 11.0 . Vascular calcifications were found in 55.7% of patients at mammography and in a similar percentage in skeletal x-ray examinations; 18% of the women had vascular calcifications at mammography but not in skeletal x-ray examinations, whereas 19.6% had vascular calcifications in skeletal x-ray examinations but not at mammography. Vascular calcifications were found in 60% of the women undergoing dialysis and in 30% of the women who had yet to undergo dialysis. Women with vascular calcifications at mammography were older (p < 0.05), had higher blood glucose (p < 0.05), PTH, phosphorus, and LDL cholesterol. They also had higher ferritin and C-reactive protein levels (p < 0.05) and had more cardiovascular events (myocardial infarction, with p < 0.05). Their HDL and albumin levels (p < 0.05) and blood pressure were lower than in women without vascular calcifications at mammography. The presence of vascular calcifications at mammography is associated to increased cardiovascular risk, and this increase is already evident before dialysis. Early diagnosis of cardiovascular risk should help reduce morbidity and mortality in these patients. The study of vascular calcifications at mammography complements skeletal x-ray examinations. Vascular calcifications at mammography are associated to abnormalities in bone metabolism, dyslipemia, and chronic inflammation.

A simple score predicts future cardiovascular events in an inception cohort of dialysis patients

Vascular calcifications are very common in dialysis patients and have been shown to be associated independently with outcome. However, all of these studies used prevalent patients on dialysis since many years. We investigated vascular calcifications in an inception cohort of dialysis patients and followed them for cardiovascular disease outcomes during an average observation period of 66 months. One hundred and fifty-four Caucasian dialysis patients were enrolled in one Austrian dialysis center. Standardized plain radiographs from the pelvis and calves were carried out in all patients at the start of dialysis therapy. Vascular calcifications were assessed by a single radiologist. At the start of renal replacement therapy, 67.5% of the patients showed vascular calcifications. During follow-up, 29.9% of patients suffered a cardiovascular event. An additive 'vascular risk score', constructed from the presence of vascular calcifications and/or previous cardiovascular events before the start of dialysis treatment, showed the strongest independent association with cardiovascular events in the Cox regression model adjusted for various risk factors. The presence of each of these two conditions was associated with a hazard ratio of 2.03 (95% confidence interval 1.19-3.46) and a hazard ratio twice as high if both conditions were present. In summary, vascular calcifications on plain X-rays of pelvis and calves are largely present in incident dialysis patients. A history of a cardiovascular event in the predialysis period together with vascular calcifications at the beginning of dialysis therapy is a more powerful predictor of a cardiovascular event than age, smoking, diabetes, or other traditional risk factors.