#6037 Value of Arterial Calcification Detected by Upper Limb Doppler Ultrasound in Advanced Chronic Kidney Disease

Abstract

Background and Aims Vascular calcification is a common complication of chronic kidney disease (CKD), particularly in end-stage-renal disease (ESRD) and is predictive of subsequent cardiovascular disease and mortality. The aim of the present study was to evaluate the relationship between arterial calcification assessed by doppler ultrasound (DUS) performed by the same observer and biochemical parameters of CKD-MBD as well as the standard-of-care therapy for CKD-MBD. Method We present a retrospective study of 454 patients who were evaluated by DUS for pre-surgical vascular mapping from 2018 to 2021. Both arms brachial, radial and cubital arteries were analyzed, and vascular calcification was classified as absent, mild or moderate/severe (presence of acoustic shadowing). Laboratory serum analysis of PTH, serum Calcium (sCa), serum phosphorous (sPi) and serum magnesium (sMg) were collected (with a maximum interval of 6 months from DUS evaluation). Mortality was also registered during follow-up period. Results The demographics and biochemistry of the study population are summarized in Table 1. Arterial calcification was observed in 91.6% (n = 416) of the patients, 62.3% (n = 259) had mild calcification and 37.7% (n = 157) presented moderate/severe calcification. In univariate analysis, male gender (OR 2.2, p < 0.023), age (OR 1.03, p < 0.003), phosphate binders (OR 0.55, p value < 0.03) and cinacalcet use (OR 0.28, p < 0.019) were independently associated with the presence of arterial vascular calcification. Presence of vascular calcification on DUS was associated to mortality. In patients with vascular calcifications, moderate/severe calcification was associated with diabetes mellitus (OR 2.85, p<0.000), male gender (OR 1.69, p < 0.012), PAD (OR 2.43, p <0.001) and hemodialysis therapy for more than 5 years (OR 3.00, p< 0.010). Cinacalcet, phosphate binders, serum calcium, phosphorous, PTH and mortality did not correlate with calcification severity. In the multivariate logistic regression analysis adjusted to age, gender, PAD and serum calcium and magnesium, we found that serum PTHi (OR 1.00, p<0.040), hemodialysis for more than one year (OR 4.44, p< 0.040) and diabetes mellitus (OR 3.95, p< 0.001) were associated with moderate/severe vascular disease. Conclusion Concerning CKD-MBD related markers our study showed that only phosphate binders and cinacalcet use were predictive of absence of vascular calcifications, however no causality could be advanced with these data. For serious calcification, in our multivariable model, only PTH had statistical significance. It is widely recognized the importance of monitoring serum PTH, calcium and Pi to reduce the adverse clinical events associated with CKB-MBD. Widespread implementation of DUS in pre-surgical mapping for VA construction is also an opportunity for vascular study and features as calcifications can be a surrogate of CKD-MBD and cardiovascular burden.