Aortic calcification in haemodialysis patients with diabetes mellitus.
BACKGROUND
Certain metabolic disorders, such as hyperphosphatemia induce vascular calcification in haemodialysis patients; it is unclear, however, whether these disorders contribute to aortic calcification in diabetic haemodialysis patients. This study examined the risk factors of aortic calcification in a large number of haemodialysis patients, and compared risk factors between diabetic and non-diabetic patients.


METHODS
The subjects were 667 patients on maintenance haemodialysis: 184 with type 2 diabetes and 483 without. Aortic calcification was measured semi-quantitatively using a plain computed tomography image of the abdominal aorta, and an aortic calcification index (ACI) was calculated.


RESULTS
The ACI of the diabetic subjects was significantly higher than that of those without diabetes (57.3+/-22.1 vs 44.8+/-28.3%, P < 0.0001), although the dialysis vintage of the former was significantly shorter (P < 0.001). Multiple regression analyses showed that diabetes was a significant independent risk factor for increased ACI. Multiple regression analyses, performed separately in diabetics and non-diabetics, revealed that advanced age, higher systolic blood pressure, smoking and longer haemodialysis vintage were common independent risk factors significantly associated with increased ACI in both patient groups (R2 = 0.296, P < 0.0001 for non-diabetics; R2 = 0.193, P < 0.0001 for diabetics). Higher serum phosphate concentration was not significantly associated with increased ACI in diabetic patients (P = 0.429), although it was a significant independent factor in non-diabetic patients (beta = 0.150, P < 0.0005).


CONCLUSIONS
Aortic calcification in diabetic haemodialysis patients is more advanced, compared with non-diabetic patients, even with short haemodialysis vintage. Since disorders of mineral metabolism are not significantly associated with aortic calcification in diabetic haemodialysis patients, aortic calcification in these patients could be affected by metabolic abnormalities associated with the diabetic state per se, independent of other confounding factors; and aortic calcification may be advanced even before haemodialysis induction.
Taniwaki
Hiromichi
H
Inoue Hospital, Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Ishimura
Eiji
E
Tabata
Tsutomu
T
Tsujimoto
Yoshihiro
Y
Shioi
Atushi
A
Shoji
Tetsuo
T
Inaba
Masaaki
M
Inoue
Takashi
T
Nishizawa
Yoshiki
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D010710:Phosphates