Histopathological assessment of radial artery calcification in patients with end-stage kidney disease

Abstract

Background A comprehensive understanding of vascular calcification pathology is significant for the development of cardiovascular disease therapy in high-risk populations. This cross-sectional study aimed to evaluate the prevalence and characteristics of radial artery calcification (RAC) and to identify the factors that are associated with RAC in end-stage kidney disease (ESKD). Methods Detailed medical histories of 180 patients with ESKD were recorded. Fragments of the radial artery obtained during the creation of arteriovenous fistula for hemodialysis access were stained with alizarin red S. Results Calcification was localized in the arterial media layer. The prevalence of positive calcification staining in the radial arteries was 21.1% ( n = 38). Patients with RAC had a higher glycated hemoglobin level ( p < 0.01), higher prevalence of dialysis duration >5 years ( p = 0.022), and diabetes mellitus ( p < 0.01) than those without RAC. Multiple logistic regression models showed dialysis duration >5 years (odds ratio [OR], 9.864; 95% confidence interval [CI], 2.666–36.502; p < 0.01) and diabetes mellitus (OR, 12.689; 95% CI, 2.796–34.597; p < 0.01) were independent risk factors for RAC in patients with ESKD. Patients with dialysis duration >5 years had a higher prevalence of RAC ( p = 0.012) than those with dialysis duration ≤5 years. Patients with diabetes mellitus had a higher prevalence of RAC ( p < 0.01) than those without diabetes mellitus. Patients with diabetes mellitus ≥15 years had a higher prevalence of RAC ( p = 0.042) than those with diabetes mellitus <15 years. Radial artery calcification level showed a significantly positive correlation with dialysis duration ( p < 0.05), diabetes mellitus duration ( p < 0.01), HbA1c level ( p < 0.01) and Calcium level ( p < 0.01). Conclusions In patients with ESKD, dialysis duration >5 years and diabetes predict RAC. Thus, the combination of prolonged dialysis and hyperglycemic conditions exerts a synergistic effect on RAC.

Deep learning‐based prediction of coronary artery calcium scoring in hemodialysis patients using radial artery calcification

“…In this study, the analysis was conducted by R (R Foundation for Statistical Computing, Vienna, Austria, Version 4.2.2) on random forest package (Version 4. [6][7][8][9][10][11][12][13][14]. The parameters for random forest were as follows: The Gini index was set as an impurity function; number of decision trees (ntree) = 500, mtry = 9 (RF model)/7 in variablerestricted RF (vrRF) model; and set as at default settings for all the other parameters (see Data S1 and S2).…”

“…12 Histology examination of radial arteries by Chen et al found that 21% of patients with hemodialysis had arteries calcifications. 13 Niu et al identified radial artery calcifications in 24.7% of peritoneal dialysis patients. 14 Moreover, Wang et al suggested that multiple risk factors could contribute to the radial artery calcification in hemodialysis patients, including deposition of osteopontin, deficient expression of alpha-smooth muscle actin, and metabolic disorder of phosphorus and calcium.…”

Association between fibrinogen/albumin ratio and severity of coronary artery calcification in patients with chronic kidney disease: a retrospective study

“…Mizuiri et al (2021) showed that many factors significantly affect the probability of CAC in patients undergoing hemodialysis treatment, such as smoking, hs-CRP, diabetes, phosphate levels, gender, time on dialysis, age and blood calcium levels. Chen, Zhou & Yang (2021) studied the factors that affect radial artery calcification in patients with end-stage renal disease and found that calcium levels, HbA1c levels, duration of diabetes and duration of dialysis treatment are positively correlated with the degree of radial artery calcification.…”

“…Unlike atherosclerosis, medial calcification is similar to osteogenesis and is mainly regulated by vascular smooth muscle cells (VSMCs) ( Ottolini & Sonkusare, 2021 ). One of the main mechanisms of VC is the accelerated rate of VSMC synthesis and senescence, decreased contractile protein expression, and gradual transdifferentiation into an osteoblastic/chondrocyte phenotype that releases matrix vesicles ( Chen, Zhou & Yang, 2021 ). When high phosphate levels are present, differentiation of VSMCs into a bone/chondrogenic phenotype can occur ( Voelkl et al, 2018 ).…”

Comparison of use of central venous catheter and arteriovenous fistula as initial vascular access in 735 patıents with end-stage renal disease

“…Calcium phosphate salts start to accumulate in vascular wall over time in ESRD patients. Furthermore, changes occur in vascular smooth muscle cells due to impaired mineral metabolism, which leads to arterial calcification[21]. This process causes a disruption in vascular structure as the duration of ESRD increases.…”