Natural history of vascular calcification in dialysis and transplant patients

Moe, Sharon M.; O’Neill, Kalisha D.; Reslerova, Martina; Fineberg, Naomi S.; Persohn, Scott A.; Meyer, Cristopher A.

doi:10.1093/ndt/gfh303

Cited by 152 publications

(94 citation statements)

References 14 publications

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“…Only 3 series previously assessed the determinants of CAC, each in less than 30 prevalent RTR [4, 11, 12]. Two of them [4, 12], not surprisingly, found in paediatric RTR a lower prevalence of CAC, using the conventional threshold of 100 (27 and 26%, respectively), than in our cohort (37%).…”

Section: Discussionmentioning

confidence: 52%

“…In chronic kidney disease (CKD) and dialysed patients, many studies have assessed the prevalence and risk factors of CAC [2,3,4,5,6,7,8,9,10]. By contrast, in renal transplant recipients (RTR), only a few small-sized studies [4, 11, 12], relying on computerized tomography (CT), have assessed CAC. As our department monitors a large population of RTR and has access to up-to-date multi-slice spiral CT, we determined the prevalence and determinants not only of CAC, but also of thoracic aorta calcifications (AoC) in RTR.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and Determinants of Coronary and Aortic Calcifications Assessed by Chest CT in Renal Transplant Recipients

Nguyen

Coche²,

Goffin³

et al. 2007

Am J Nephrol

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Background: Coronary artery calcifications independently predict cardiovascular events (CVE) in the general population. We assessed the prevalence and determinants of coronary (CAC) and thoracic aorta (AoC) calcifications in renal transplant recipients (RTR). Methods: Consecutive RTR living in Belgium, with an isolated kidney graft functioning for more than 1 year, were asked to participate. They underwent a 16-slice spiral computerized tomography in order to measure calcium mass. Demographic, clinical, biochemical and urinary parameters were recorded. Results: We included 281 patients. CAC and AoC were detected in 81 and 85%, with geometric means (SD) of 52.2 (4.9) and 99.3 (8.2) mg, respectively. By multiple linear regression, independent predictors of both types of calcifications included older age, longer time on dialysis, a history of CVE, of multiple transplantations and of smoking. Other determinants of CAC were male gender, current statin use and history of parathyroidectomy, and other determinants of AoC included higher pulse pressure, shorter time under mycophenolate mofetil and current use of anti-vitamin-K. Conclusion: The prevalence of both CAC and AoC is substantial in RTR. We delineate independent determinants either common to both CAC and AoC or specific to one, and known as classic or chronic kidney disease related risk factors.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Prevalence and Determinants of Coronary and Aortic Calcifications Assessed by Chest CT in Renal Transplant Recipients

Nguyen

Coche²,

Goffin³

et al. 2007

Am J Nephrol

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“…Instead of these differences, both studies find similar progression of the CCS in 25% of renal graft recipients. The theory of some authors [27, 28] that this progression of vascular calcifications in transplant recipients is lower than that of patients remaining on hemodialysis treatment is plausible, but only a single comparative study by Mazzaferro et al [29] using hemodialysis and transplant patients has been published. This area requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Coronary Calcium Score in Renal Transplant Recipients

et al. 2009

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Background: Coronary calcium score (CCS) is established as an index for the risk of coronary heart disease (CHD). The aim of this prospective study was to assess changes in CCS in patients 1 year after kidney transplantation (KTx). Method: A total of 221 consecutive renal transplant recipients were enrolled in our prospective study (140 males/81 females). CCS was analyzed by spiral multidetector CT at baseline and 1 year after KTx. Bone mineral density (BMD) was measured in the lumbar spine (L-BMD) and femur (F-BMD). Results: The mean CCS was 539 ± 1,033 at baseline. 33% of the patients had a CCS of 0, and 33% of patients had a CCS of >401. A negative correlation was found between F-BMD and CCS, but no correlation was found between L-BMD and CCS. Using CCS, a positive correlation was found between total cholesterol and the age of patients, but no correlation of CCS was found with other biochemical markers of bone and lipid metabolism. One year after transplantation, the mean CCS was 703 ± 1,253; in 75% of patients the CCS was the same and 25% had a higher CCS. Conclusion: A high risk of CHD was found in 33% of renal graft recipients. No improvement in CCS was found 1 year after KTx.

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“…Phosphate and calcium seem to influence mortality through the induction of vascular calcification, which is especially severe and growing at coronary level in D patients, as highlighted by cardiac electron beam CT (EBCT), [19] or multi-slice CT [20]. It is well known that renal Tx patients experience a significant improvement in serum levels of divalent ions which could favorably affect the occurrence of CAC; nonetheless, available data in the literature are very limited [21] and suggest no significant effect.…”

Section: Discussionmentioning

confidence: 99%

Serum Levels of Calcification Inhibition Proteins and Coronary Artery Calcium Score: Comparison between Transplantation and Dialysis

Mazzaferro¹,

Pasquali²,

Pugliese³

et al. 2007

Am J Nephrol

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Vascular calcifications in CKD are now linked to serum alterations of both divalent ions and calcification inhibitory proteins. Due to possible biochemical differences between dialysis (D) and transplantation (Tx), we examined the entity and severity of these biochemical modifications and of coronary artery calcium score separately in these two populations. We assayed, besides standard markers of inflammation, divalent ions and serum levels of fetuin, matrix Gla protein (MGP) and osteoprotegerin (OPG), in 51 Tx patients (age 45 ± 12 years; 30 males, 21 females; previous D duration 4.8 ± 4.2 years; Tx since 6.6 ± 5.5 years; Cr 1.8 ± 0.6 mg/dl) and in 49 D patients (age 49 ± 14 years; 30 males,19 females; D duration 5.6 ± 4.8 years). Additionally, coronary calcium score (AS) was evaluated by cardiac multi-slice CT. Compared with D patients, Tx patients had better values of divalent ions and inflammation markers, and lower prevalence (65 vs. 86%; p < 0.02) and severity (AS = 570 ± 1,637 vs. 1,311 ± 3,128; p < 0.008) of coronary calcification. In addition, a tendency toward normalization for all of the three calcification inhibitory proteins was evident. In both Tx and D, AS correlated with age and OPG (Tx: r_s = 0.439, p < 0.001, and r_s = 0.510, p < 0.0001; D: r_s = 0.471, p < 0.001, and r_s = 0.403, p < 0.005, respectively); in D patients, a correlation was present also with D duration (r_s = 0.435; p < 0.002), other markers of inflammation and, notably, fetuin (r_s = –0.442; p < 0.002). Regression analysis selected previous time on D in Tx patients (r_m = 0.400; p < 0.004), and C-reactive protein and OPG in D patients (r_m = 0.518; p < 0.004) as the most predictive parameters of AS. Discriminant analysis confirmed the major role of age and D duration in the appearance of AS and evidenced male gender as a distinct risk condition. At variance, Tx duration was never associated with AS. In conclusion, as compared to D, renal Tx patients show serum levels of calcification inhibition proteins and of divalent ions closer to normal. As this is associated with a lower prevalence and severity of AS, it is suggested that Tx antagonize the accelerating role of D in the progression of vascular calcification. Assessment of both coronary calcifications and serum levels of calcification inhibitory proteins may be of value to identify those subjects at higher risk of development and progression of vascular lesions, among whom males have the highest rate.

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Natural history of vascular calcification in dialysis and transplant patients

Abstract: In this preliminary study, renal transplantation appears to slow down or arrest CAC, whereas CAC progresses in haemodialysis patients. In haemodialysis patients, CAC was greater in patients who died or were hospitalized compared with those who remained alive or were not hospitalized.

Cited by 152 publications

References 14 publications

Prevalence and Determinants of Coronary and Aortic Calcifications Assessed by Chest CT in Renal Transplant Recipients

Prevalence and Determinants of Coronary and Aortic Calcifications Assessed by Chest CT in Renal Transplant Recipients

Coronary Calcium Score in Renal Transplant Recipients

Serum Levels of Calcification Inhibition Proteins and Coronary Artery Calcium Score: Comparison between Transplantation and Dialysis

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