Atrial fibrillation and low vitamin D levels are associated with severe vascular calcifications in hemodialysis patients.
Vascular calcifications (VCs) and fractures are major complications of chronic kidney disease. Hemodialysis patients have a high prevalence of atrial fibrillation (AF) and an increased risk of thromboembolism, which should be prevented with warfarin, a drug potentially causing increased risk of VCs and fractures. Aim of this study is evaluating, in hemodialysis patients with and without AF, the prevalence of VCs and fractures, as well as identifying the associated risk factors.



A total of 314 hemodialysis patients were recruited, 101 with documented AF and 213 without AF. Comorbidities, chronic kidney disease mineral and bone disorder blood tests and therapies were collected. Vertebral quantitative morphometry was carried out centrally for the detection of fractures, defined as vertebral body reduction by ≥20 %. In the same radiograph, the length of aortic calcification was also measured. Logistic regression models were applied for evaluating the independent predictors of presence of VCs and vertebral fractures.



In our population VCs were very common (>85 %). Severe VCs (>10 cm) were more common in patients with AF (76 %) than in patients without (33 %). Vertebral fractures were present in 54 % of patients. Multivariable analysis showed that AF (OR 5.41, 95 % CI 2.30-12.73) and 25(OH) vitamin D <20 ng/mL (OR 2.05, 95 % CI 1.10-3.83) were independent predictors of VCs. Age (OR 1.04/year, 95 % CI 1.01-1.07) and male gender (OR 1.76, 95 % CI 1.07-2.90) predicted vertebral fractures.



Hemodialysis patients had an elevated prevalence of severe VCs, especially when affected by AF. Low vitamin D levels were strongly associated with severe VCs. Prevalence of vertebral fractures was also remarkably high and associated with older age and male gender.
National Research Council (CNR) Neuroscience Institute, Padua, Italy.
Maria
M
Fusaro
Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy.|Department of Biomedical and Clinical Sciences, "Luigi Sacco"-University of Milan, Milan, Italy.
Maurizio
M
Gallieni
Department of Statistics, University of Milan Bicocca, Milan, Italy.
Paola
P
Rebora
Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy.|Department of Biomedical and Clinical Sciences, "Luigi Sacco"-University of Milan, Milan, Italy.
Maria Antonietta
MA
Rizzo
Department of Health Sciences, University of Milan Bicocca, Via Cadore 48, 20900, Monza, Italy.
Maria Carmen
MC
Luise
Department of Health Sciences, University of Milan Bicocca, Via Cadore 48, 20900, Monza, Italy.
Hilary
H
Riva
Nephrology Unit, IRCCS Multimedica, Sesto S. Giovanni, Italy.
Silvio
S
Bertoli
Nephrology Unit, Uboldo Hospital, Cernusco Sul Naviglio, Italy.
Ferruccio
F
Conte
Department of Health Sciences, University of Milan Bicocca, Via Cadore 48, 20900, Monza, Italy.|Nephrology Unit, San Gerardo Hospital, Monza, Italy.
Andrea
A
Stella
Nephrology Unit, Ospedali Riuniti Hospital, Bergamo, Italy.
Patrizia
P
Ondei
Department of Statistics, University of Milan Bicocca, Milan, Italy.
Emanuela
E
Rossi
Department of Statistics, University of Milan Bicocca, Milan, Italy.
Maria Grazia
MG
Valsecchi
Nephrology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
Antonio
A
Santoro
Department of Health Sciences, University of Milan Bicocca, Via Cadore 48, 20900, Monza, Italy. simonetta.genovesi@unimib.it.|Nephrology Unit, San Gerardo Hospital, Monza, Italy. simonetta.genovesi@unimib.it.
Simonetta
S
Genovesi
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D061205:Vascular Calcification / Q000209:etiology*; D014807:Vitamin D / Q000097:blood*
D014807:Vitamin D
Atrial fibrillation; Fractures; Hemodialysis; Vascular calcifications; Vitamin D; Warfarin