title: Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients.
abstract: 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.
authors.affiliation: Nephrology and Hypertension Unit, Ospedale Israelitico, Rome, Italy. giorgio.coen@gmail.com
authors.forename: Giorgio
authors.initials: G
authors.lastname: Coen
authors.forename: Andrea
authors.initials: A
authors.lastname: Pierantozzi
authors.forename: Daniele
authors.initials: D
authors.lastname: Spizzichino
authors.forename: Daniela
authors.initials: D
authors.lastname: Sardella
authors.forename: Daniela
authors.initials: D
authors.lastname: Mantella
authors.forename: Micaela
authors.initials: M
authors.lastname: Manni
authors.forename: Luigi
authors.initials: L
authors.lastname: Pellegrino
authors.forename: Andrea
authors.initials: A
authors.lastname: Romagnoli
authors.forename: Roberta
authors.initials: R
authors.lastname: Pacifici
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Zuccaro
authors.forename: Salvatore
authors.initials: S
authors.lastname: Digiulio
mesh_terms: 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
chemical_list: C556354:AHSG protein, human; D015415:Biomarkers; D001798:Blood Proteins; D020738:Leptin; D060749:alpha-2-HS-Glycoprotein; D002097:C-Reactive Protein; D002112:Calcifediol