Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

Jansz, Thijs T.; Reekum, Franka E. van; Özyilmaz, Akin; Jong, Pim A. de; Boereboom, F. T. J.; Hoekstra, Tiny; Verhaar, Marianne C.; Jaarsveld, Brigit C. van

doi:10.1159/000494665

Cited by 26 publications

(15 citation statements)

References 33 publications

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“…On the other hand, compared to the patients with end-stage renal disease (ESRD), especially those under maintenance hemodialysis, the degree of BWV should be modest in patients with predialysis CKD. Intriguingly, the progression of CAC in patients with ESRD is altered by the modality of renal replacement therapy ( 30 ). A recent observational study reported that peritoneal dialysis is not associated with CAC or is associated with less CAC progression than hemodialysis ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Intriguingly, the progression of CAC in patients with ESRD is altered by the modality of renal replacement therapy ( 30 ). A recent observational study reported that peritoneal dialysis is not associated with CAC or is associated with less CAC progression than hemodialysis ( 30 ). Provided that BWV is inevitable in most patients on hemodialysis, rather than in patients on peritoneal dialysis, primarily due to the discontinuous nature of hemodialysis leading to saw-tooth volume fluctuations ( 31 ), it is speculated that BWV may also be representative of ongoing CAC progression in patients with ESRD.…”

Section: Discussionmentioning

confidence: 99%

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Association of Body Weight Variability With Progression of Coronary Artery Calcification in Patients With Predialysis Chronic Kidney Disease

Suh

Choi

et al. 2022

Front. Cardiovasc. Med.

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BackgroundWe investigated whether high body weight variability (BWV) is associated with a higher prevalence of coronary artery calcification (CAC) or more rapid progression of CAC in patients with predialysis chronic kidney disease (CKD).MethodsA total of 1,162 subjects from a nationwide prospective cohort of predialysis CKD were analyzed. The subjects were divided into the tertile (T1, T2, and T3) by BWV. CAC was assessed at the baseline and a 4-year follow-up by CT scan. Rapid progression of coronary artery calcification was defined as an increase in coronary artery calcium score (CACS) more than 200 Agatston units during a 4-year follow-up.ResultsOne-way ANOVA revealed that CACS change during the follow-up period is significantly higher in the subjects with high BWV, although CACS at the baseline and 4-year follow-up was not different among the tertile groups by BWV. Logistic regression analysis revealed that compared to low BWV (T1), both moderate (T2, adjusted odds ratio (OR) 2.118, 95% CI 1.075–4.175) and high (T3, adjusted OR 2.602, 95% CI 1.304–5.191) BWV was associated with significantly increased risk of rapid progression of CAC. Importantly, the association between BWV and progression of CAC remained robust even among the subjects without significant BW gain or loss during follow-up periods (T2, adjusted OR 2.007, 95% CI 1.011–3.984; T3, adjusted OR 2.054, 95% CI 1.003–4.207).ConclusionHigh BWV is independently associated with rapid progression of CAC in patients with predialysis CKD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Body Weight Variability With Progression of Coronary Artery Calcification in Patients With Predialysis Chronic Kidney Disease

Suh

Choi

et al. 2022

Front. Cardiovasc. Med.

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“…Conventional hemodialysis was the reference group. Of note, the comparison of CAC progression in conventional hemodialysis and peritoneal dialysis is discussed elsewhere [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Progression of coronary artery calcification in conventional hemodialysis, nocturnal hemodialysis, and kidney transplantation

et al. 2020

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Introduction Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) and is strongly associated with vascular calcification. An important driver of vascular calcification is high phosphate levels, but these become lower when patients initiate nocturnal hemodialysis or receive a kidney transplant. However, it is unknown whether nocturnal hemodialysis or kidney transplantation mitigate vascular calcification. Therefore, we compared progression of coronary artery calcification (CAC) between patients treated with conventional hemodialysis, nocturnal hemodialysis, and kidney transplant recipients. Methods We measured CAC annually up to 3 years in 114 patients with ESRD that were transplantation candidates: 32 that continued conventional hemodialysis, 34 that initiated nocturnal hemodialysis (≥4x 8 hours/week), and 48 that received a kidney transplant. We compared CAC progression between groups as the difference in square root transformed volume scores per year (ΔCAC SQRV) using linear mixed models. Reference category was conventional hemodialysis. Results The mean age of the study population was 53 ±13 years, 75 (66%) were male, and median dialysis duration was 28 (IQR 12–56) months. Median CAC score at enrollment was 171 (IQR 10–647), which did not differ significantly between treatment groups (P = 0.83). Compared to conventional hemodialysis, CAC progression was non-significantly different in nocturnal hemodialysis -0.10 (95% CI -0.77 to 0.57) and kidney transplantation -0.33 (95% CI -0.96 to 0.29) in adjusted models. Conclusions Nocturnal hemodialysis and kidney transplantation are not associated with significantly less CAC progression compared to conventional hemodialysis during up to 3 years follow-up. Further studies are needed to confirm these findings, to determine which type of calcification is measured with CAC in end-stage renal disease, and whether that reflects cardiovascular risk.

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“…rences regarding the values of calcium, phosphorus and serum PTH in the 6 months prior to transplant, similar to some studies. published 23 where no differences are found regarding vascular calcification association, although there is controversy among various authors 24 .…”

Section: Originalsmentioning

confidence: 99%

Impacto de la calcificación vascular en la mortalidad y salud ósea en pacientes con trasplante renal

Castro

Montes

Alonso

et al. 2020

Rev Osteoporos Metab Miner

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Objetive: To assess the prevalence of vascular calcification and vertebral fractures in a cohort of patients undergoing kidney transplantation and its association with all graft-related causes of mortality and dysfunction, as well as the relationship with biochemical parameters of bone and mineral metabolism. Material and methods: Prospective, observational, single-center study, which included 405 patients undergoing kidney transplants, with collection of clinical, biochemical, epidemiological parameters, and of radiological vascular calcification and vertebral fractures by simple radiography at the time of transplantation, with a minimum follow-up of two years. We assessed cardiovascular mortality and all causes and decreased glomerular filtration. In addition, 39 bone densitometry studies carried out in the months prior to transplantation were reported. Results: Patient survival was significantly lower in the group of patients with vascular calcification (131±1.5 months without calcification compared to 110±3.5 months with vascular calcification, p<0.001). A greater decrease in the estimated glomerular filtration rate (GFR) was observed using the CKD-EPI formula in all patients who presented vascular calcification, this being an independent risk factor (OR=2.7; 95% CI: 1.6-4 , 4; p<0.001). The prevalence of vertebral fractures was significantly higher in the vascular calcification group (12%), independently of other risk factors (OR=9.2; 95% CI: 1.2-73.4; p=0.036). The prevalence of vertebral fractures has been associated with lower hip bone mass assessed by bone densitometry (T-score -1.2 vs. -2.4, p=0.02) Conclusions: Vascular calcification prior to transplantation, evaluated using a simple, cheap and accessible method such as plain radiography, determines the morbidity and mortality of the patient undergoing a kidney transplant and has a great impact on the evolution of graft function, regardless of other risk factors. traditional. The association between bone fragility, vascular calcification and the prognosis of the patient and the renal graft should make us think about adding bone densitometry to the protocol for inclusion in the transplant waiting list. It is relevant to promote not only the best possible vascular health but also to promote the least impact on bone tissue in the progression of chronic kidney disease before the time of transplantation.

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Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

Cited by 26 publications

References 33 publications

Association of Body Weight Variability With Progression of Coronary Artery Calcification in Patients With Predialysis Chronic Kidney Disease

Association of Body Weight Variability With Progression of Coronary Artery Calcification in Patients With Predialysis Chronic Kidney Disease

Progression of coronary artery calcification in conventional hemodialysis, nocturnal hemodialysis, and kidney transplantation

Impacto de la calcificación vascular en la mortalidad y salud ósea en pacientes con trasplante renal

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