The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis: a cross-sectional observational study

Abstract

Background: This multicenter international cross-sectional observational study characterized vascular and valvular calcification burden and correlations with pulse pressure, diabetes, hypertension, and cardiovascular diseases in prevalent hemodialysis patients. Methods: We enrolled 275 consecutive adults with end-stage renal disease on maintenance hemodialysis for ⩾3 months. Coprimary endpoints were prevalences of: (1) echocardiographic calcification in mitral valve, aortic valve or mitral annulus; (2) aortoiliac tree vascular calcifications by plain lateral lumbar X-ray. Correlations among calcification sites and with demographics and comorbidities were determined. Pulse pressures were determined. Results: Subjects' mean ± standard deviation (SD) age was 56 ± 15.9 years; mean (SD) dialysis duration was 4.5 ± 4.3 years. Overall, 100% of echocardiographically imaged patients (n = 243) had calcification in aortic valve, mitral valve, or mitral annulus; 77.8% of X-rayed patients (n = 248) had abdominal aortic calcification. Radiographic abdominal aortic calcification score correlated significantly with calcification of aortic valve (p < 0.0001) and mitral annulus (p = 0.0001) but not mitral valve. Aortic valve, mitral valve, and mitral annulus calcification correlated significantly among themselves (p < 0.0001). Moderate/severe aortic valve calcification was significantly more prevalent in patients aged ⩾65 years than <65 years, men than women, and Whites than African Americans. Pulse pressure correlated significantly with vascular calcification score (p = 0.0049) but not with valvular calcification at any site. Conclusions: Vascular and valvular calcification are highly prevalent in the hemodialysis population. Peripheral vascular calcification correlates significantly with elevated pulse pressure and can be assessed easily using lateral lumbar X-ray. Further studies investigating the interaction between pulse pressure and development or progression of vascular calcification are of interest.

Physiopathological approach to infective endocarditis in chronic hemodialysis patients: left heart versus right heart involvement

“…27–29 In some studies, the prevalence is even higher; Kraus reported a prevalence of mild/moderate mitral valve and aortic valve calcification in 275 patients with ESRD on hemodialysis of 98.8% and 94.4%, respectively. 30 …”

“… 28 , 33 , 36 Other factors contribute to the development of these valvular and perivalvular abnormalities such as advanced age, male gender, ethnicity, duration of hemodialysis, smoking, diabetes, hypercholesterolemia, iron overload, peripheral vascular disease, cardiac dysrhythmia, and arterial hypertension. 30 , 37–40…”

Abdominal aortic calcification in predialysis patients: Contribution of traditional and uremia‑related risk factors

“…VC prevalence is high in chronic hemodialysis (HD) patients. An observational multicentric study describes the presence of VC in 100% of studied patients (13).…”

Fibroblast Growth Factor 21 Predicts and Promotes Vascular Calcification in Haemodialysis Patients

“…[3,4] VC progresses rapidly in HD patients, and the occurrence of VC among HD patients is 70-90%. [5][6][7] The human broblast growth factor (FGF) family includes 22 members. [8] FGF23 and FGF21 are endocrine factors that structurally belong to the FGF19 subfamily, are released into circulation and exert systemic action.…”