title: A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors.
abstract: Accurate identification of risk factors for calcific uremic arteriolopathy (CUA) is necessary to develop preventive strategies for this morbid disease. We investigated whether baseline factors recorded at hemodialysis initiation would identify patients at risk for future CUA in a matched case-control study using data from a large dialysis organization. Hemodialysis patients with newly diagnosed CUA (n=1030) between January 1, 2010, and December 31, 2014, were matched by age, sex, and race in a 1:2 ratio to hemodialysis patients without CUA (n=2060). Mean ages for patients and controls were 54 and 55 years, respectively; 67% of participants were women and 49% were white. Median duration between hemodialysis initiation and subsequent CUA development was 925 days (interquartile range, 273-2185 days). In multivariable conditional logistic regression analyses, diabetes mellitus; higher body mass index; higher levels of serum calcium, phosphorous, and parathyroid hormone; and nutritional vitamin D, cinacalcet, and warfarin treatments were associated with increased odds of subsequent CUA development. Compared with patients with diabetes receiving no insulin injections, those receiving insulin injections had a dose-response increase in the odds of CUA involving lower abdomen and/or upper thigh areas (odds ratio, 1.49; 95% confidence interval, 1.03 to 2.51 for one or two injections per day; odds ratio, 1.88; 95% confidence interval, 1.30 to 3.43 for 3 injections per day; odds ratio, 3.74; 95% confidence interval, 2.28 to 6.25 for more than three injections per day), suggesting a dose-effect relationship between recurrent skin trauma and CUA risk. The presence of risk factors months to years before CUA development observed in this study will direct the design of preventive strategies and inform CUA pathobiology.
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; snigwekar@mgh.harvard.edu.
authors.forename: Sagar U
authors.initials: SU
authors.lastname: Nigwekar
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Division of Nephrology, University of North Carolina Kidney Center, Chapel Hill, North Carolina; and.
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Medical office, Fresenius Medical Care North America, Waltham, Massachusetts.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hymes
authors.affiliation: Medical office, Fresenius Medical Care North America, Waltham, Massachusetts.
authors.forename: Franklin W
authors.initials: FW
authors.lastname: Maddux
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ravi I
authors.initials: RI
authors.lastname: Thadhani
authors.affiliation: Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.|Medical office, Fresenius Medical Care North America, Waltham, Massachusetts.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Chan
mesh_terms: D001160:Arterioles; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D014511:Uremia / Q000453:epidemiology* / Q000209:etiology*; D061205:Vascular Calcification / Q000453:epidemiology* / Q000209:etiology*
keywords: clinical epidemiology; diabetes mellitus; end stage kidney disease; hemodialysis; obesity; vascular calcification