Comparison of Coronary Artery Calcification in Peritoneal and Hemodialysis Patients

Lee, Chi-Ming; Chen, Pzen Wen; Leung, Ting-Kai; Wang, Hung Jung; Kung, Ching Huei; Lin, Yi Hsiang; Hsiao, Wen Tien; Chen, Ya Yen

doi:10.1016/j.jecm.2010.12.012

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…A Korean cross-sectional study did not find a significant difference in CAC score between patients on hemodialysis (n = 31, median score 30) and those on peritoneal dialysis (n = 15, median score 16) [13]. Finally, a Taiwanese study did not find significant differences in CAC score or one-year CAC progression between patients on hemodialysis (n = 18, median score increased from 110 to 175) and patients on peritoneal dialysis (n = 15, median score increased from 3 to 76) [14,24]. However, all of these studies had imbalances in age, dialysis vintage, or comorbidities between groups, which were not adjusted for statistically.…”

Section: Discussionmentioning

confidence: 82%

“…However, there have never been randomized studies on this subject, as randomization to dialysis modality is generally refused by patients [9]. Moreover, patients on peritoneal dialysis are typically younger and healthier due to the prerequisites of treatment at home [10], which has hampered previous observational research that did not attempt to statistically adjust for this [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

et al. 2018

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Background: Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in peritoneal dialysis than in hemodialysis is currently unknown. Therefore, we compared coronary artery calcification (CAC), its progression, and calcification biomarkers between patients on hemodialysis and peritoneal dialysis. Methods: We measured CAC in 134 patients who had been treated exclusively with hemodialysis (n = 94) or peritoneal dialysis (n = 40) and were transplantation candidates. In 57 of them (34 on hemodialysis and 23 on peritoneal dialysis), we also measured CAC progression annually up to 3 years and the inactive species of desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, osteoprotegerin. We compared CAC cross-sectionally with Tobit regression. CAC progression was compared in 2 ways: with linear mixed models as the difference in square root transformed volume score per year (ΔCAC SQRV) and with Tobit mixed models. We adjusted for potential confounders. Results: In the cross-sectional cohort, CAC volume scores were 92 mm³ in hemodialysis and 492 mm³ in peritoneal dialysis (adjusted difference 436 mm³; 95% CI –47 to 919; p = 0.08). In the longitudinal cohort, peritoneal dialysis was associated with significantly more CAC progression defined as ΔCAC SQRV (adjusted difference 1.20; 95% CI 0.09 to 2.31; p = 0.03), but not with Tobit mixed models (adjusted difference in CAC score increase per year 106 mm³; 95% CI –140 to 352; p = 0.40). Peritoneal dialysis was associated with higher osteoprotegerin (adjusted p = 0.02) but not with dp-ucMGP or fetuin-A. Conclusions: Peritoneal dialysis is not associated with less CAC or CAC progression than hemodialysis, and perhaps with even more progression. This indicates that vascular calcification does not develop less in peritoneal dialysis than in hemodialysis.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

et al. 2018

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“…Of the 29 included studies (32 unique cohorts), most focused on haemodialysis patients [ 10 , 17–35 ] (20 studies, 1499 patients) or kidney transplant recipients [ 30 , 33 , 36–41 ] (8 studies, 649 patients), 2 of which investigated both haemodialysis patients and kidney transplant recipients [ 30 , 33 ]. Three studies (92 patients) investigated peritoneal dialysis patients [ 29 , 42 , 43 ], one of which also investigated haemodialysis patients [ 29 ]. One study (38 patients) investigated nocturnal haemodialysis patients [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…In peritoneal dialysis cohorts, median CAC scores were also lower compared with haemodialysis, ranging from 3 to 23 at baseline and progressing to a range of 20 to 84 at follow-up, while median ages (range 52–53 years) and median dialysis vintages (range 18–24 months) were also low. At the same time, the one study that compared CAC progression between haemodialysis and peritoneal dialysis did not find significant differences in CAC progression [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

Is progression of coronary artery calcification influenced by modality of renal replacement therapy? A systematic review

Jansz

Verhaar

London

et al. 2017

Clinical Kidney Journal

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BackgroundProgression of coronary artery calcification is an important marker for cardiovascular morbidity in end-stage renal disease patients. Therefore, we reviewed the evidence on coronary artery calcification progression in different renal replacement therapies.MethodsMEDLINE (PubMed), Embase and TRIP databases were searched from 1999 – 2016. Additionally, bibliographies were searched by hand and citation tracking of key publications was performed. Prospective studies were included that examined coronary artery calcification with two or more multislice computed tomography scans ≥6 months apart in patients 18–75 years old receiving any renal replacement therapy, including kidney transplantation. Reporting of separate scores for different modalities was required. Two researchers extracted data independently with pilot-tested forms and assessed the risk of bias using a validated tool.ResultsWe identified 29 eligible studies that assessed coronary artery calcification progression in end-stage renal disease patients, of which 19 studies evaluated haemodialysis and 8 kidney transplantation. Evidence on progression in peritoneal dialysis (three studies) and nocturnal haemodialysis (one study) was limited. Meta-analysis was not possible due to diverse reporting methods of coronary artery calcification scores and definitions of progression. Median coronary artery calcification scores were considerably higher in haemodialysis cohorts at baseline, presumably due to a generally higher age and dialysis vintage. Median coronary artery calcification progressed universally. Visual inspection suggested the least progression in kidney transplant recipients.ConclusionsThere is insufficient evidence to compare the influence of renal replacement therapies on coronary artery calcification progression. We advocate the adoption of a standardized reporting method of coronary artery calcification progression.

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“…There were few studies have investigated the relationship of dialysis modality and the progression of vascular calcification. In Lee's study [17], they included 15 PD patients and 18 HD patients who were tested for CAC scores at 1 month, 6 months, and 12 months from the start of the study. They didn't find differences in CAC score between HD and PD patients.…”

Section: Discussionmentioning

confidence: 99%

The effects of dialysis modalities on the progression of coronary artery calcification in dialysis patients

Niu

Zhao

Zuo

et al. 2020

Preprint

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Objective Hemodialysis (HD) tend to have more hemodynamic changes than peritoneal dialysis (PD), which aggravates inflammation and oxidative stress. Whether HD and PD have different effects on the progression of vascular calcification? Therefore, we produced a study to explore the relationship of dialysis modalities and coronary artery calcification (CAC) progression. Methods This was a prospective cohort study. CT scans were performed at enrollment and 2 years later for each patient. Demographic and clinical data were collected. Tobit regression was used to compare delta CAC score between HD and PD patients. Results (1) 155 patients were enrolled, including 69 HD and 86 PD patients. (2) The baseline CAC scores were 97 (1, 744) in HD and 95 (0, 324) in PD; the follow-up CAC scores were 343 (6, 1379) in HD and 293 (18, 997) in PD. There were no significant differences in baseline, follow-up and delta CAC scores between 2 groups (P>0.05). (3) In Tobit regression, after adjusted for variables, there was no significant difference of CAC progression in HD and PD groups (P>0.05). (4) Logistic regression showed that older patients with diabetes and higher time-averaged serum phosphate (P) had faster progression of CAC (P<0.05), but HD wasn’t associated with faster CAC progression comparing with PD (P=0.091). Conclusions There was no evidence that different modalities have different effect on CAC progression. Older, DM and higher time-averaged P were associated with fast CAC progression.

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Comparison of Coronary Artery Calcification in Peritoneal and Hemodialysis Patients

Cited by 5 publications

References 24 publications

Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

Is progression of coronary artery calcification influenced by modality of renal replacement therapy? A systematic review

The effects of dialysis modalities on the progression of coronary artery calcification in dialysis patients

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