title: The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis: a cross-sectional observational study.
abstract: BACKGROUND
  This multicenter international cross-sectional observational study characterized vascular and valvular calcification burden and correlations with pulse pressure, diabetes, hypertension, and cardiovascular diseases in prevalent hemodialysis patients.
  
  
  METHODS
  We enrolled 275 consecutive adults with end-stage renal disease on maintenance hemodialysis for ⩾3 months. Coprimary endpoints were prevalences of: (1) echocardiographic calcification in mitral valve, aortic valve or mitral annulus; (2) aortoiliac tree vascular calcifications by plain lateral lumbar X-ray. Correlations among calcification sites and with demographics and comorbidities were determined. Pulse pressures were determined.
  
  
  RESULTS
  Subjects' mean ± standard deviation (SD) age was 56 ± 15.9 years; mean (SD) dialysis duration was 4.5 ± 4.3 years. Overall, 100% of echocardiographically imaged patients (n = 243) had calcification in aortic valve, mitral valve, or mitral annulus; 77.8% of X-rayed patients (n = 248) had abdominal aortic calcification. Radiographic abdominal aortic calcification score correlated significantly with calcification of aortic valve (p < 0.0001) and mitral annulus (p = 0.0001) but not mitral valve. Aortic valve, mitral valve, and mitral annulus calcification correlated significantly among themselves (p < 0.0001). Moderate/severe aortic valve calcification was significantly more prevalent in patients aged ⩾65 years than <65 years, men than women, and Whites than African Americans. Pulse pressure correlated significantly with vascular calcification score (p = 0.0049) but not with valvular calcification at any site.
  
  
  CONCLUSIONS
  Vascular and valvular calcification are highly prevalent in the hemodialysis population. Peripheral vascular calcification correlates significantly with elevated pulse pressure and can be assessed easily using lateral lumbar X-ray. Further studies investigating the interaction between pulse pressure and development or progression of vascular calcification are of interest.
authors.affiliation: Division of Nephrology and Hypertension, John H. Stroger Jr Hospital of Cook County, 627 South Wood Street, Suite 621, Chicago, IL 60612, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kraus
authors.affiliation: Renal Unit, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
authors.affiliation: Formerly of Biostatistics, Sanofi, Cambridge, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hunter
authors.affiliation: Formerly of Renal Global Medical Affairs, Sanofi, Cambridge, MA, USA.
authors.forename: José
authors.initials: J
authors.lastname: Menoyo
authors.affiliation: Section of Nephrology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Stankus
keywords: chronic kidney disease; echocardiography; hemodialysis; lumbar X-ray; valvular calcification; vascular calcification