Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis.
BACKGROUND
Vascular calcification is an independent determinant of cardiovascular events in maintenance haemodialysis (HD) patients. It is not known whether acute changes of the serum calcium concentration before and after HD (DeltaCa) are associated with the development of aortic calcification.


METHODS
We enrolled 71 patients dialysed with a dialysate with 3.0 mEq/l calcium and determined their aortic calcification index (ACI) by abdominal computed tomography twice at an interval of 3 years. To identify the factors contributing to the rate of progression of aortic calcification, we analysed the average values for clinical and laboratory data obtained between the first and second evaluations of ACI.


RESULTS
The second ACI (mean+/-SD: 80.2+/-63.9) was significantly greater than the first ACI (61.0+/-61.0) after an interval of 35.8+/-4.2 months. The annualized change of ACI (DeltaACI/year) was significantly and directly associated with the DeltaCa and C-reactive protein (CRP) (both P<0.001, P for trend). Stepwise multivariate regression analysis revealed that DeltaACI/year was positively and independently associated with CRP, presence of diabetes mellitus and DeltaCa, but negatively associated with a premenopausal status in women. Similarly, DeltaCa was positively and independently associated with DeltaACI/year and the ultrafiltration rate, but was negatively associated with pre-HD Ca.


CONCLUSIONS
The increase of serum calcium after HD was related to the rate of progression of aortic calcification. Excess calcium is transferred into patients on HD when using a dialysate of 3.0 mEq/l calcium. This may be a risk factor for the development of vascular calcification.
Yamada
Kazuhiro
K
First Department of Internal Medicine, Miyazaki Medical College, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki 889-1692, and Koga General Hospital, Japan. yamakazu@xqb.biglobe.ne.jp
Fujimoto
Shouichi
S
Nishiura
Ryosuke
R
Komatsu
Hiroyuki
H
Tatsumoto
Mariko
M
Sato
Yuji
Y
Hara
Seiichiro
S
Hisanaga
Shuichi
S
Ochiai
Hideyuki
H
Nakao
Hiroyuki
H
Eto
Tanenao
T
D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D002097:C-Reactive Protein / Q000378:metabolism; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D048909:Diabetes Complications; D015314:Dialysis Solutions / Q000737:chemistry; D018450:Disease Progression; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D017697:Premenopause; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D015314:Dialysis Solutions; D002097:C-Reactive Protein; D002118:Calcium