title: Cardiac calcifications are more prevalent in children receiving hemodialysis than peritoneal dialysis.
abstract: BACKGROUND
  Children receiving maintenance dialysis exhibit high cardiovascular (CV) associated mortality. We and others have shown high prevalence of cardiac calcifications (CC) in children with endstage renal disease (ESRD). However, no pediatric study has examined modality difference in CC prevalence. The current study was conducted to assess for a difference in CC prevalence between hemodialysis (HD) and peritoneal dialysis (PD) in children with ESRD.
  
  
  METHODS
  38 patients (19 female, 19 male; mean age 15.5 ± 4.1 years) receiving dialysis (21 HD, 17 PD) were included in the study. CC were assessed by ultrafast gated CT and quantified by Agatston score. Patients received thrice weekly HD for 3 - 3.5 hours or daily continuous cycler PD (CCPD). FGF 23, IL-6, IL-8, and CRP levels were obtained at time of CT. Time-averaged (6 months prior to CT) serum Ca, P, Alb, iPTH, and cholesterol levels were obtained. Patients on aspirin, with evidence of infection, underlying collagen vascular disease were excluded.
  
  
  RESULTS
  CC were present in 11/38 patients, but more prevalent in HD vs. PD (9/21 vs. 2/17, p = 0.04). Subjects with CC were older (p = 0.0003), had longer dialysis vintage (p = 0.02) and higher serum phosphorus (p = 0.02) and FGF 23 levels (p = 0.03). HD patients also had significantly higher phosphorus (p = 0.02), FGF 23 (p = 0.009), and IL-8 levels (p = 0.02) when compared to PD patients. Residual renal function was not different between modalities or patients with CC. On a multinomial regression model, modality, and age remained independent associations for CC prevalence.
  
  
  CONCLUSIONS
  We have shown that pediatric patients receiving CCPD have lower CC prevalence conferring lower CV risk. The better control of mineral imbalance in patients receiving PD may play an important role in lower CC prevalence.
authors.affiliation: Department of Pediatrics, Renal Section, Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, and Cincinnati Children's Hospital Medical Center, Section of Nephrology and Hypertension, Cincinnati, OH, USA.
authors.forename: Poyyapakkam
authors.initials: P
authors.lastname: Srivaths
authors.forename: Rajesh
authors.initials: R
authors.lastname: Krishnamurthy
authors.forename: Lori
authors.initials: L
authors.lastname: Brunner
authors.forename: Barbara
authors.initials: B
authors.lastname: Logan
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett
authors.forename: Qing
authors.initials: Q
authors.lastname: Ma
authors.forename: Rene
authors.initials: R
authors.lastname: VanDeVoorde
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002097:C-Reactive Protein / Q000378:metabolism; D002114:Calcinosis / Q000209:etiology* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010758:Phosphorus / Q000097:blood; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: C000717427:FGF23 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D010758:Phosphorus; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002097:C-Reactive Protein