Prevalence and progression of peripheral arterial calcifications in patients with ESRD.
BACKGROUND
Peripheral arterial calcifications are seen frequently in patients with end-stage renal disease (ESRD). However, prevalence and progression, as well as contributing factors, never were investigated in an unselected incident cohort of dialysis patients.


METHODS
We investigated 155 patients with ESRD at the beginning of dialysis therapy and followed them up prospectively during the first year of either hemodialysis (n = 106) or peritoneal dialysis treatment (n = 49). The prevalence and progression of arterial calcifications during the first year were graded by a single radiologist on standardized plain radiographs of the pelvis and calves. Findings were analyzed in relation to sex, age, diabetes mellitus, dialysis modality, total and high-density lipoprotein cholesterol levels, lipoprotein(a) (Lp[a]) level, apolipoprotein(a) kringle-IV repeat polymorphism, calcium level, phosphorus level, intact parathyroid hormone level, and homocysteine level.


RESULTS
Patients with peripheral arterial calcifications at the start of renal replacement therapy (RRT) (n = 104) were significantly older (P < 0.001), had diabetes more often (P < 0.001), and had greater Lp(a) concentrations (P = 0.03) and a trend to greater total cholesterol concentrations. Patients with progression of calcifications during the first year of RRT had significantly greater homocysteine levels (P = 0.036). Logistic regression analysis showed that patients without calcifications either at the beginning or after 1 year of RRT were younger (P = 0.01) and had significantly lower homocysteine (P = 0.004) and Lp(a) levels (P = 0.03) and less frequently had diabetes mellitus (P = 0.04).


CONCLUSIONS
Our observations suggest that the prevalence of peripheral arterial calcifications in patients with ESRD is related to age, diabetes mellitus, and Lp(a) and homocysteine levels. Progression of arterial calcifications might be related to high plasma homocysteine concentrations.
Kronenberg
Florian
F
Institute of Medical Biology and Human Genetics, University of Innsbruck, Austria. florian.kronenberg@uibk.ac.at
Mündle
Michael
M
Längle
Michael
M
Neyer
Ulrich
U
D002114:Calcinosis / Q000097:blood / Q000453:epidemiology* / Q000473:pathology*; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D006435:Renal Dialysis / Q000379:methods