Progression of Coronary Artery Calcification in Renal Transplantation and the Role of Secondary Hyperparathyroidism and Inflammation

Abstract

Background and objectives: Transplantation should favorably affect coronary calcification (CAC) progression in dialysis; however, changes in CAC score in the individual patient are not reliably evaluated.Design, setting, participants & measurements: The authors used special tables of reproducibility limits for each score level to study, by multislice computed tomography and biochemistries, the 2-year changes in CAC in 41 transplant patients (age 48 ؎ 13 yr, 25 men, dialysis vintage 4.8 ؎ 4.3 yr, underwent transplant 6.2 ؎ 5.5 yr prior). Thirty balanced dialysis patients served as controls.Results: In the study group, Agatston score was stable, and C-reactive protein decreased, whereas fetuin and osteoprotegerin increased. In the control group, Agatston score increased, parathyroid hormone and phosphate decreased, and inflammation markers were persistently twice as high as in the study group. With regard to individual changes, 12.2% transplant patients worsened, compared with 56.6% of patients in dialysis (P < 0.0001). Patients without calcification at entry showed slower progression in transplantation (8.3%) than in dialysis (44.4%; P < 0.034), and the difference was similar to that observed in cases with CAC (17.6% versus 61.9%; P < 0.007). Discriminant analysis indicated parathyroid hormone, the modality of therapy (dialysis or transplantation), and erythrocyte sedimentation rate as the variables most associated with worsening.Conclusions: Renal transplantation lowers but does not halt CAC progression. Inflammation and hyperparathyroidism are associated with progression in the populations studied.

Progression of Coronary Artery Calcification and Thoracic Aorta Calcification in Kidney Transplant Recipients

“…That a higher baseline CAC score is associated with CAC progression confirms previous studies both in RTR (14) and in hemodialysis patients (13). Studies in dialysis patients as well as in renal transplant recipients have demonstrated the strong association of CVE history with CAC, the latter most likely related to atherosclerosis (23,24,25,19) (30).…”

“…Interestingly, the score increased in the dialysis group whereas it remained stable in RTR. The relatively small size of this study and limited duration of follow-up very likely accounts for the discrepancy with our results (13). The other 3 series were in incident RTR.…”

“…Only four series previously assessed the progression of CAC in RTR (13)(14)(15)(16). All these cohorts were much smaller and intervals between CT scans were shorter.…”

“…Moreover, coronary artery calcification (CAC) progression also predicts CVE and mortality in RTR (12). Only few small-sized studies relying on CT have assessed CAC progression in RTR (13)(14)(15)(16).…”

Hyperparathyroidism and New Onset Diabetes After Renal Transplantation

“…3,4 The ensuing hypercalcemia can lead to interstitial calcification in the allograft with graft dysfunction 5,6 and soft tissue calcification. 7,8 Primary hyperparathyroidism (pHPT) 9,10 and sHPT 11,12 are both associated with abnormalities in glucose metabolism, such as glucose intolerance and insufficient insulin release. Furthermore, a higher prevalence of diabetes mellitus (DM) has been reported in patients with pHPT.…”