Risk Factors for Cardiovascular Calcifications in Non-Diabetic Caucasian Haemodialysis Patients

Abstract

Background/Aims: Dialysis patients display an increased mortality which is associated with cardiovascular calcifications. Diabetes mellitus and ethnicity are known factors that affect the extent of cardiovascular calcifications. However, most studies have investigated mixed cohorts with diabetics and/or mixed ethnicity. Methods: Cardiovascular calcifications were assessed in non-diabetic Caucasian haemodialysis patients by the semiquantitative Adragao calcification score (X-ray pelvis and hands) and a novel composite calcification score encompassing the Adragao score as well as calcifications detected by X-ray of the fistula arm, echocardiography of heart valves and carotid ultrasound. Results: Using multivariate analysis, age, male gender, dialysis vintage, lower Kt/V, calcium-phosphate product, smoking and high-sensitivity CRP were independent risk factors for cardiovascular calcifications as assessed by the Adragao or the composite score. Pulse wave velocity was independently related to both calcification scores. Body mass index, cholesterol, triglycerides, iPTH and serum levels of fetuin-A and uncarboxylated matrix Gla protein were not associated with cardiovascular calcifications. Conclusions: In our cohort of non-diabetic Caucasian haemodialysis patients, age, male gender, dialysis vintage, smoking, calcium-phosphate product, high-sensitivity CRP and lower Kt/V were independent risk factors for cardiovascular calcifications. Whether lowering the calcium-phosphate product and increasing dialysis efficiency can reduce cardiovascular calcifications in dialysis patients remains to be determined.

Circulating Nonphosphorylated Carboxylated Matrix Gla Protein Predicts Survival in ESRD

“…Next we compared MGP levels with two semiquantitative calcification scores, namely the Adragao score 11 and the extended composite score (Adragao score plus calcifications of arteriovenous [AV] fistula and neighboring arteries, carotid arteries, and mitral and aortic heart valves). 12 These analyses showed 9 and 12% lower levels, respectively, of dpcMGP in patients with more extensive calcifications compared with patients with fewer calcifications (P ϭ 0.042 and P ϭ 0.011, respectively; Figure 2). dp-ucMGP and PIVKA-II levels did not correlate with the extent of vascular calcifications (data not shown).…”

“…27 In addition to single calcification sites, we calculated two semiquantitative calcification scores. 12 First, we determined the Adragao score by analyzing conventional x-rays of the pelvis and hands. 11 In brief, x-rays of the pelvis and both hands were divided into four sections by a median vertical line and a horizontal line just above the upper rim of the femoral heads and the metacarpal bones, respectively.…”

“…Second, we created an extended composite calcification score where not only calcifications of pelvis and hands but also calcifications of the fistula arm plus neighboring arteries, mitral, and aortic heart valves and both carotid arteries were accounted for. 12 Each site of calcification assessment was counted as 1 point. Thus, a maximum score of 15 points could be obtained: Adragao (pelvis 4, hands 4), fistula arm, i.e., fistula itself with one (upper arm) or two (lower arm) neighboring arteries (2 or 3 points), mitral plus aortic valves (2), and carotid arteries (2).…”

“…It has been shown for the Adragao score that patients with a score of 0 to 2 have a better prognosis than those with a score of 3 to 8. 11,12 Moreover, the presence of calcifications of the heart valves 28 and the AV fistula 27 have been shown to be a mortality risk factor. Bellasi et al 29 reported that simple measures of cardiovascular calcification had a very good correlation with more sophisticated measurements obtained with CT.…”

Determinants of Cardiovascular Risk in Hemodialysis Patients Without Significant Comorbidities

“…Body mass index, cholesterol, triglycerides, intact PTH, and serum levels of fetuin-A and uncarboxylated matrix Gla protein were not associated with CV calcifications. Age, male gender, dialysis vintage, smoking, calciumphosphate product, CRP, and lower Kt/V were independent risk factors for CV calcifications (Schlieper et al, 2009). Increasing dialysis efficiency and lowering calciumphosphate product can reduce CV calcifications.…”