High-dose calcitriol therapy and progression of cardiac vascular calcifications.
BACKGROUND
Dialysis patients show a very high prevalence of cardiovascular complications, affected as they are with abnormal and accelerated vascular calcifications and, eventually, calcium and phosphorous metabolism disorders. Multislice computed tomography (MSCT) provides a reproducible, high-resolution imaging of calcium contained in cardiac arteries, measured by Agatston score. The aim of the present study was to evaluate the influence of high-dose and low-dose calcitriol therapy on the progression of cardiac vascular calcifications in dialyzed patients.


METHODS
We enrolled 36 dialyzed patients in a prospective study, including an interventional period of 12 months and a follow-up period of 12 months. Eighteen protocol patients received intravenous pulses of high-doses calcitriol at the end of dialytic treatment and sevelamer hydrochloride therapy. Control patients received low-dose calcitriol and sevelamer hydrochloride as well. Two MSCT scans were performed: 1 at the start of the study and 1 at the end of follow-up, and Agatston score was calculated at both examinations.


RESULTS
At first examination, protocol patients showed almost the same level of cardiac vascular calcification as control patients. At the second MSCT, statistically significantly higher values of Agatston score were recorded for all patients. Indeed, patients who showed higher baseline values developed worse calcifications as recorded at the end of follow-up, both in the protocol and control group.


CONCLUSIONS
Our data show that baseline level is strongly predictive of vascular calcification progression, and, moreover, there is no association between calcitriol administered doses and the progression of cardiac vascular calcification.
Morosetti
M
M
Nephrology and Dialysis Department, 'G.B. Grassi' Hospital - Ostia Lido, Rome - Italy. morosetti@med.uniroma2.it
Jankovic
L
L
Palombo
G
G
Cipriani
S
S
Dominijanni
S
S
Balducci
A
A
Splendiani
G
G
Simonetti
G
G
Romagnoli
A
A
Coen
G
G
D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002114:Calcinosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002117:Calcitriol / Q000008:administration & dosage* / Q000009:adverse effects; D003327:Coronary Disease / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D050071:Bone Density Conservation Agents; D002117:Calcitriol