Breast Arterial Calcification

Abstract

SummaryBackground and objectives Because previous studies have not distinguished between intimal (atherosclerotic) and medial vascular calcification, the prevalence and clinical significance of either condition in chronic or end-stage kidney disease (CKD or ESKD) are unknown. We hypothesized that breast arterial calcification (BAC) is exclusively medial and that mammography can serve as a useful marker of generalized medial calcification in CKD and ESKD.Design, setting, participants, & measurements Arterial calcification was identified histologically in breast tissue or visually in mammograms and radiographs of extremities from patients with CKD or ESKD.Results Medial calcification but no intimal calcification was present in all 16 specimens from patients with CKD or ESKD. In 71 women with ESKD, BAC was present on mammograms in 63% compared with 17% in women without renal insufficiency matched for age, race, and diabetes (P Ͻ 0.001). Age and ESKD duration were significant, independent predictors of BAC. BAC was also present in 36% of mammograms from the same patients performed 5.5 Ϯ 0.7 years before the onset of ESKD (P Ͻ 0.05 versus control) but in only 14% of patients with stage 3 CKD. Comparison of mammograms and extremity radiographs revealed that BAC was present in over 90% of patients with peripheral arterial calcification (PAC), and PAC was observed in less than 6% of patients without BAC.Conclusions BAC is a specific and useful marker of medial vascular calcification in CKD, and its prevalence is markedly increased in ESKD and advanced CKD.

The Risk for Medial Arterial Calcification in CKD

“…This finding suggests that preventive or therapeutic strategies may need to be implemented as early as stage 3 CKD. Although these finding are limited to intramammary arteries, we have previously shown that this calcification correlates with peripheral arterial calcification in the extremities (6). Thus, it is likely that these results indicate generalized MAC.…”

“…(6) and were used solely to define the upper range for BAC prevalence; they were not used in any other analyses. For each patient, a control participant without CKD was randomly selected from among all women undergoing screening mammography between 2006 and 2011 and was matched for age (61 year), diabetes, and, when possible, race.…”

“…This information is critical for targeting preventive measures. Arterial calcification is easily identified by mammography, and we have shown that this calcification is exclusively medial and correlates well with calcification in other peripheral arterial beds (6). Because mammography is routinely performed, breast arterial calcification (BAC) provides a convenient window into medial calcification in humans without necessitating additional radiation exposure.…”

Vascular Calcification in Predialysis CKD

“…If a practitioner chooses to perform testing for VC, KDOQI guidelines suggest the use of the plain radiography-lateral abdominal radiography, which can be quantified by the Kauppila scores like in the Górriz et al study. In addition, breast arterial calcification is thought to be specific and a useful marker of medial calcification in patients with CKD (24). Overall, the sensitivity and specificity of plain radiography in differentiating intimal and medial calcification are unknown.…”

Sodium Thiosulfate

“…Calcification of the medial layer of arteries, often termed Monckeberg's arteriosclerosis, is common in CKD and present in most patients with ESRD (1). Although it likely has detrimental long-term consequences, it is generally a chronic, asymptomatic condition.…”