Impacts of Coronary Artery Calcification on Intradialytic Blood Pressure Patterns in Patients Receiving Maintenance Hemodialysis

Abstract

Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressureminimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre-to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.

Coronary artery calcification is a risk factor for intradialytic hypotension in patients undergoing hemodialysis

“…16 The abdominal aortic calcification score is the most reliable predictor of coronary artery calcification in patients undergoing dialysis, 17 and aortic arch calcification is strongly associated with coronary artery calcification. 18 The discrepancy between Yeo et al's findings 9 and our findings in terms of the relationship between CACS and IDH may be due to the method used to quantify the CACS. We quantified the CACS using ECGgated CT, whereas Yeo et al used non-ECG-gated CT. 9 We consider some possible explanations for the observed relationship between CACS and IDH.…”

“…IDH is associated with abdominal aortic calcification 7 and aortic arch calcification 8 in patients undergoing HD. However, Yeo et al reported that the CACS was not correlated with the decrease in intradialytic SBP and nadir SBP in 36 patients undergoing HD 9 . The CACS in the chronic kidney disease (CKD) population may be less specific for the atherosclerotic burden and is a composite of medial and intimal calcification of the coronary arteries 14,15 .…”

“…5,6 However, there have been few reports on the association between vascular calcification and IDH. [7][8][9] Therefore, in this study, we investigated the association between IDH and coronary artery calcification (CACS) and their effects on mortality in patients undergoing HD.…”

“…Vascular calcification and IDH share some common risk factors, including age, diabetes mellitus, dialysis duration, and cardiovascular disease, in patients undergoing HD 5,6 . However, there have been few reports on the association between vascular calcification and IDH 7–9 . Therefore, in this study, we investigated the association between IDH and coronary artery calcification (CACS) and their effects on mortality in patients undergoing HD.…”

Intradialytic hypotension prediction using covariance matrix-driven whale optimizer with orthogonal structure-assisted extreme learning machine

“…High BP causes cardiovascular injury. High BP is associated with coronary artery disease ( Yeo et al, 2020 ), cardiac systolic dysfunction, and left ventricular hypertrophy ( Chao et al, 2015 ). There are cause-and-effect relationships between these factors and IDH.…”