Inflammation, mineral metabolism and progressive coronary artery calcification in patients on haemodialysis.
BACKGROUND
Coronary artery calcification (CAC) is an extensive and common complication in patients with end-stage renal disease (ESRD). The aim of this study was to assess prospectively the change in CAC over a 2-year period and to identify the factors that may be associated with CAC progression in ESRD patients.


METHODS
The final analysis was performed on 40 of 43 stable haemodialysis patients who initially entered into the study. The study population underwent multirow spiral computed tomography to derive CAC scores at baseline and after a minimum of 12 months (24 months in 30 patients, 18 months in four, and 12 months in the remaining six patients). To provide a stable estimate that was unbiased with respect to the baseline CAC, square root-transformed CAC scores were used for the analyses of the changes in CAC.


RESULTS
The median CAC score was 191 (range, 0-2403) mm3 at baseline and increased to 253 (range, 0-2745) mm3 at follow-up (P < 0.001) and the median annualized change in square root-transformed CAC score was 1.48 (range, -0.95-8.64) mm3/year. The annualized change of the square root-transformed CAC score positively correlated with the time-integrated levels of C-reactive protein (R = 0.521, P = 0.001), phosphorus (R = 0.433, P = 0.005) and calcium x phosphorus product (R = 0.394, P = 0.012), but did not correlate with the levels of fetuin-A or lipid parameters. Even after adjusting for age, gender and baseline CAC score, C-reactive protein levels were independently associated with CAC progression.


CONCLUSIONS
These data suggest that chronic inflammation as well as altered mineral metabolism contributes to a rapid progression of CAC in ESRD patients. Additional, larger scale studies are required to confirm our findings.
Jung
Hae Hyuk
HH
Department of Internal Medicine, Kangwon National University Hospital, Hyoja-3-dong 17-1, Chunchon, Kangwon-do 200-947, Republic of Korea. haehyuk@kangwon.ac.kr
Kim
Sang-Wook
SW
Han
Heon
H
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003331:Coronary Vessels / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007249:Inflammation; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism*; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000494:pharmacology
D008903:Minerals; D000509:alpha-Fetoproteins; D002097:C-Reactive Protein