title: Thirty-month follow-up of coronary artery calcification in hemodialysis patients: different roles for inflammation and abnormal calcium-phosphorous metabolism?
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of death in hemodialysis (HD) patients. Coronary artery calcification (CAC) is considered a marker of atherosclerosis and coronary artery disease (CAD). The CAC progression and factors that influence it were evaluated during a 30-month period.
  
  
  METHODS
  Forty HD patients without a history of CAD were enrolled into the study. CAC score was assessed with conventional CT repeated every six months. The circulating factors of phosphorous, calcium, calcium-phosphorous product, intact parathyroid hormone, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, lipoprotein-alpha, albumin, high sensitivity C-reactive protein, and fibrinogen were measured monthly. Hypertension and calcium intake during the study period were taken into account as well.
  
  
  RESULTS
  At baseline, CAC score was correlated with age and duration of HD therapy. From all evaluated factors, CAC initiation was influenced only by older age and C-reactive protein. CAC, when it was started, was aggravated continuously and was influenced only by elevated serum phosphorous and calcium-phosphorous product. Hypertension, lipid profile, and calcium intake did not affect CAC initiation or progression.
  
  
  CONCLUSIONS
  Once CAC progression starts, it is an uninterrupted process. The roles of inflammation and abnormal calcium-phosphorous metabolism in CAC differ. Inflammation is the major factor that contributes in CAC initiation. Elevated serum phosphorous and calcium-phosphorous product accelerates CAC progression.
authors.affiliation: Department of Nephrology, 2nd IKA Hospital, Thessaloniki, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Patsalas
authors.forename: Theodoros
authors.initials: T
authors.lastname: Eleftheriadis
authors.forename: Sofia
authors.initials: S
authors.lastname: Spaia
authors.forename: Hariklia
authors.initials: H
authors.lastname: Theodoroglou
authors.forename: Georgia
authors.initials: G
authors.lastname: Antoniadi
authors.forename: Vassilis
authors.initials: V
authors.lastname: Liakopoulos
authors.forename: Ploumis
authors.initials: P
authors.lastname: Passadakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Vayonas
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vargemezis
mesh_terms: D002114:Calcinosis / Q000209:etiology*; D002128:Calcium Metabolism Disorders / Q000150:complications*; D003327:Coronary Disease / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010760:Phosphorus Metabolism Disorders / Q000150:complications*; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013997:Time Factors