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

Abstract

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.

Interventions To Attenuate Vascular Calcification Progression in Chronic Kidney Disease: A Systematic Review of Clinical Trials

“…Studies of SNF472, sotatercept, and oral activated charcoal each reported attenuation of VC progression, whereas studies of exercise training, spironolactone, and nicotinamide did not. We did not include in our review other studies which reported effects on VC after changes in kidney replacement therapies, such as several observational studies assessing the effect of kidney transplantation on VC 120 – 125 and several evaluating changes in VC after commencement of more frequent or longer hours of hemodialysis (such as nocturnal dialysis) 123 , 126 , 127 . These studies have predominantly reported that VC progression is attenuated by both kidney transplantation and nocturnal hemodialysis when compared with continuation of conventional hemodialysis, but not all studies have consistently shown this 119 , 124 , 125 …”

“…We did not include in our review other studies which reported effects on VC after changes in kidney replacement therapies, such as several observational studies assessing the effect of kidney transplantation on VC [120][121][122][123][124][125] and several evaluating changes in VC after commencement of more frequent or longer hours of hemodialysis (such as nocturnal dialysis). 123,126,127 These studies have predominantly reported that VC progression is attenuated by both kidney transplantation and nocturnal hemodialysis when compared with continuation of conventional hemodialysis, but not all studies have consistently shown this. 119,124,125 The strengths of this review include a systematic search of medical databases, with data extraction, analysis, and quality assessment involving two independent reviewers.…”

Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study

“…Versus Conventional Dialysis (NOCTx) study assessed annualised CAC progression in patients receiving different renal replacement therapy modalities; -renal transplant, peritoneal dialysis, conventional and nocturnal haemodialysis. CAC progression was not significantly different between treatment groups with comparable progression seen in kidney transplantation, conventional and nocturnal haemodialysis over the 3 year follow up period (Jansz TT et al, 2020). Peritoneal dialysis was associated with more CAC progression than haemodialysis as analysed by the square root transformed volume score per year (ΔCAC SQRV) 92 vs 492mm 3…”

“…A zero score is associated with a high negative predictive value and a low risk of coronary artery disease and events. Jansz et al found median CACS to be higher in haemodialysis patients than those with vs. 58 [0 -254]) CAC predicts cardiovascular risk in CKD (Jansz TT et al, 2020). A score of >400 is highly predictive in identifying significant CAD in the CKD population.…”

“…Every 100 Agatson unit increase is associated with a 20% increase in relative risk of a major coronary event (Cano-Megías M et al, 2019). Jansz et al, found no difference in CAC progression in ESRD patients over a 3 year follow up period on conventional haemodialysis and followed up those that changed modality to nocturnal haemodialysis or underwent kidney transplantation (Jansz TT et al, 2020). Niu et al, observed no difference in baseline, follow up or delta CAC scores in patients receiving peritoneal dialysis and haemodialysis.…”