Assessment of Coronary Artery Calcification in Chronic Dialysis Patients

Abstract

Coronary artery calcifications (CAC) are highly prevalent in asymptomatic maintenance dialysis patients (MHP), detection and surveillance of such coronary disease could be helpful in clinical practice. In cross-sectional study conducted in our dialysis Unit, including 49 MHP, We have assessed and quantified coronary artery calcification and theirs risk factors. Detection and quantification of coronary calcifications were made by Multi Slice Cardio Tomography (MSCT) a high-speed scanner 64 row. The total volume and the density of calcifications were assessed in six coronary arteries with determination of calcium coronary Agatston score (CCAS). Patients were classified into 2 groups: (1) No or Moderate calcification with CCAS= 0-400; and (1) Severe calcification with CCAS >400. Demographic and biological data were analyzed. Forty nine patients were enrolled in the study (26 men and 23 women), median age was 57 (49-65.00) years, the mean duration of dialysis was 80.43 (57. 00-65.00) months. Diabetes mellitus was the most frequent etiology of end stage renal disease (40.8%). The median CCAS was 22, 00 (00-201.5). 38 patients (77.6 %) showed no or moderate coronary calcification (CCAS=0-400) and severe calcification (CCAS >400) were found in 11 patients (22.4 %). Positive correlation exists between Severe calcification with (CCAS >400) and conventional cardiovascular risk factors such age (p=0, 02), male gender (p=0.05), diabetes (p=0.03) and calcémia (0.03). The AIVA was the first site of calcification (69.4%) followed by the RCA (36.7%) and the Cx A (30.6%). Calcifications were present simultaneously in two coronary arteries in 66% of cases. The number of calcified arteries increased with age (r=0.396, p=0.005). Multi Slice Cardio Tomography (MSCT) seems to be an effective, non-invasive and reusable method to assess and quantify coronary artery calcification and their progression.