Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease

Abstract

Abstract-To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53Ϯ21 months (meanϮSD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval [CI], 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (PϽ0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (PϽ0.01 for both). 4 It has recently been reported that the presence of vascular calcifications in end-stage renal disease (ESRD) patients was associated with increased stiffness of large, capacitive, elastic-type arteries like the aorta and common carotid artery (CCA). 4 Because CCA incremental elastic modulus (Einc) and aortic pulse wave velocity (PWV) were both identified as strong predictors of prognosis in ESRD patients 5,6 and because, to the best of our knowledge, no prospective study has reported associations between arterial calcifications and prognosis in ESRD populations, we designed this study to test the predictive value of various arterial parameters exploring characteristics of the arterial wall at different sites. These parameters involved CCA diameter, CCA intima-media thickness (IMT), CCA compliance, CCA distensibility, CCA Einc, aortic diameter, aortic PWV, and the presence of arterial calcifications measured at the sites of the CCA, abdominal aorta, iliofemoral axis, and legs. Subsequently, we examined whether these different parameters had independent contributions to CV and all-cause mortality. Methods PatientsPatients were eligible for inclusion if they (1) had been on hemodialysis for Ն3 months (81Ϯ79 months, meanϮSD), (2) had no clinical CV disease during the 6 months preceding entry, and (3) agreed to participate in the follow-up...

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

“…Aortic calcification has previously been independently associated with arterial stiffening, isolated systolic hypertension, left ventricular (LV) hypertrophy, and diastolic dysfunction in various study populations 13, 14, 15, 16, 17, 18. However, the relationship between exercise SBP and aortic calcification, and how it might adversely impact upon health, has not been fully elucidated, even though a significant interaction might exist between aorta and SBP response during exercise.…”

Aortic pulse pressure and atherosclerotic structural alterations of coronary arteries

“…Coronary calcifications were mainly influenced by local factors as arterial occlusions or stenosis but not by traditional CV risk factors as plasma glucose or dyslipidaemia. 24,25 Perhaps for this reason the association of calcifications with increased PP was statistically of marginal (P o0.06) significance. On the opposite, the association between increased aortic PP and increased heart rate was more significant but remains difficult to explain.…”

Daily dialysis reduces pulse wave velocity in chronic hemodialysis patients

“…17,18,23 Prospective epidemiological studies have drawn attention to the arterial elastic properties as independent and strong CV risk factors and predictors of all-cause and CV death. 13,[24][25][26][27][28][29] The role of the arterial system is to dampen the pressure oscillations and obtain a stable flow to the peripheral tissues. The efficiency of this function depends on the elastic properties of the arterial walls and the geometries of the arteries.…”