Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients.
BACKGROUND
Heart and coronary calcifications in hemodialysis patients are of very common occurrence and linked to cardiovascular events and mortality. Several studies have been published with similar results. Most of them were mainly cross-sectional and some of the prospective protocols were aimed to evaluate the results of the control of altered biochemical parameters of mineral disturbances with special regard to serum calcium, phosphate and CaxP with the use of calcium containing and calcium free phosphate chelating agents. The aim of the present study was to evaluate in hemodialysis patients classic and some non classic risk factors as predictors of calcification changes after one year and to evaluate the impact of progression on survival.


METHODS
81 patients on hemodialysis were studied, with a wide age range and HD vintage. Several classic parameters and some less classic risk factors were studied like fetuin-A, CRP, 25-OHD and leptin. Calcifications, as Agatston scores, were evaluated with Multislice CT basally and after 12-18 months.


RESULTS
Coronary artery calcifications were observed in 71 of 81 patients. Non parametric correlations between Agatston scores and Age, HD Age, PTH and CRP were significant. Delta increments of Agatston scores correlated also with serum calcium, CaxP, Fetuin-A, triglycerides and serum albumin. Logistic regression analysis showed Age, PTH and serum calcium as important predictors of Delta Agatston scores. LN transformation of the not normally distributed variables restricted the significant correlations to Age, BMI and CRP. Considering the Delta Agatston scores as dependent, significant predictors were Age, PTH and HDL. A strong association was found between basal calcification scores and Delta increment at one year. By logistic analysis, the one year increments in Agatston scores were found to be predictors of mortality. Diabetic and hypertensive patients have significantly higher Delta scores.


CONCLUSIONS
Progression of calcification is of common occurrence, with special regard to elevated basal scores, and is predictive of survival. Higher predictive value of survival is linked to the one year increment of calcification scores. Some classic and non classic risk factors play an important role in progression. Some of them could be controlled with appropriate management with possible improvement of mortality.
Coen
Giorgio
G
Nephrology and Hypertension Unit, Ospedale Israelitico, Rome, Italy. giorgio.coen@gmail.com
Pierantozzi
Andrea
A
Spizzichino
Daniele
D
Sardella
Daniela
D
Mantella
Daniela
D
Manni
Micaela
M
Pellegrino
Luigi
L
Romagnoli
Andrea
A
Pacifici
Roberta
R
Zuccaro
Piergiorgio
P
Digiulio
Salvatore
S
D000328:Adult; D000368:Aged; D015415:Biomarkers; D001798:Blood Proteins / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002112:Calcifediol / Q000097:blood; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000097:blood / Q000453:epidemiology; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D012720:Severity of Illness Index; D016019:Survival Analysis; D036542:Tomography, Spiral Computed; D060749:alpha-2-HS-Glycoprotein
C556354:AHSG protein, human; D015415:Biomarkers; D001798:Blood Proteins; D020738:Leptin; D060749:alpha-2-HS-Glycoprotein; D002097:C-Reactive Protein; D002112:Calcifediol