Large Artery Calcification on Dialysis Patients Is Located in the Intima and Related to Atherosclerosis

Coll, Blai; Betriu, Àngels; Martínez-Alonso, Montserrat; Amoedo, Maria Luisa; Arcidiacono, Maria Vittoria; Borràs, Mercè; Valdivielso, José M.; Fernàndez, Elvira

doi:10.2215/cjn.04290510

Cited by 66 publications

(56 citation statements)

References 30 publications

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“…This is because the KS evaluates VC in an elastic artery, such as the aorta, and therefore, is more susceptible to calcification of the intima. By contrast, AS evaluates VC in muscular (radial and digital) or predominantly muscular (iliac and femoral) arteries, which are more susceptible to the calcification of the media (14,27). Although age, diabetes, and phosphorus levels seemed to be common elements associated with both pathologic KS and AS, this study shows the different prognostic value of both indexes, which suggests that the location of calcification seems to have prognostic significance in patients not on dialysis (28).…”

Section: Discussionmentioning

confidence: 65%

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Górriz¹,

Molina²,

Cerverón³

et al. 2015

Clinical Journal of the American Society of Nephrology

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156

131

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Background and objectives Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed.Design, setting, participants, & measurements The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop .30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models.Results VC was present in 79% of patients and prominent in 47% (AS$3 or KS.6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P,0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P,0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS$3. After a median followup of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS$3 but not KS.6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P,0.001). VC did not predict renal progression.Conclusions VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.

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Section: Discussionmentioning

confidence: 65%

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Górriz¹,

Molina²,

Cerverón³

et al. 2015

Clinical Journal of the American Society of Nephrology

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156

131

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“…B-mode ultrasound of the carotid and femoral arteries was performed using the Vivid BT09 apparatus (GE Healthcare, Waukesha, WI) equipped with a 6-to 13-MHz broadband linear array probe as previously described (27). An atheromatous plaque presence analysis was performed in 10 territories (internal, bulb, and common carotids and both common and superficial femoral arteries) by a single reader in blinded fashion using semiautomatic software (EchoPAC Dimension; GE Healthcare).…”

Section: Ultrasound Imagingmentioning

confidence: 99%

Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD

Gracia

Betriu

Martínez-Alonso

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Ultrasonographic detection of subclinical atheromatosis is a noninvasive method predicting cardiovascular events. Risk factors predicting atheromatosis progression in CKD are unknown. Predictors of atheromatosis progression were evaluated in patients with CKD.Design, setting, participants, & measurements Our multicenter, prospective, observational study included 1553 patients with CKD (2009CKD ( -2011. Carotid and femoral ultrasounds were performed at baseline and after 24 months. A subgroup of 476 patients with CKD was also randomized to undergo ultrasound examination at 12 months. Progression of atheromatosis was defined as an increase in the number of plaque territories analyzed by multivariate logistic regression.Results Prevalence of atheromatosis was 68.7% and progressed in 59.8% of patients after 24 months. CKD progression was associated with atheromatosis progression, suggesting a close association between pathologies. Variables significantly predicting atheromatosis progression, independent from CKD stages, were diabetes and two interactions of age with ferritin and plaque at baseline. Given that multiple interactions were found between CKD stage and age, phosphate, smoking, dyslipidemia, body mass index, systolic BP (SBP), carotid intima-media thickness, plaque at baseline, uric acid, cholesterol, 25-hydroxy vitamin D (25OH vitamin D), and antiplatelet and phosphate binders use, the analysis was stratified by CKD stages. In stage 3, two interactions (age with phosphate and plaque at baseline) were found, and smoking, diabetes, SBP, low levels of 25OH vitamin D, and no treatment with phosphate binders were positively associated with atheromatosis progression. In stages 4 and 5, three interactions (age with ferritin and plaque and plaque with smoking) were found, and SBP was positively associated with atheromatosis progression. In dialysis, an interaction between body mass index and 25OH vitamin D was found, and age, dyslipidemia, carotid intima-media thickness, low cholesterol, ferritin, and uric acid were positively associated with atheromatosis progression.Conclusions Atheromatosis progression affects more than one half of patients with CKD, and predictive factors differ depending on CKD stage.

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“…VC occurs in both large elastic arteries and medium-size muscular arteries. Elastic arteries such as the aorta receive blood directly from the heart and are more prone to intimal calcification (17). Muscular arteries have more smooth muscle, distribute blood to various organs, and are more susceptible to medial calcification (18).…”

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confidence: 99%