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Atrial fibrillation and low vitamin D levels are associated with severe vascular calcifications in hemodialysis patients

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Abstract

Background/Aims

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.

Methods

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.

Results

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.

Conclusions

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.

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Author information

Authors and Affiliations

  1. National Research Council (CNR) Neuroscience Institute, Padua, Italy

    Maria Fusaro

  2. Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy

    Maurizio Gallieni & Maria Antonietta Rizzo

  3. Department of Biomedical and Clinical Sciences, “Luigi Sacco”-University of Milan, Milan, Italy

    Maurizio Gallieni & Maria Antonietta Rizzo

  4. Department of Statistics, University of Milan Bicocca, Milan, Italy

    Paola Rebora, Emanuela Rossi & Maria Grazia Valsecchi

  5. Department of Health Sciences, University of Milan Bicocca, Via Cadore 48, 20900, Monza, Italy

    Maria Carmen Luise, Hilary Riva, Andrea Stella & Simonetta Genovesi

  6. Nephrology Unit, IRCCS Multimedica, Sesto S. Giovanni, Italy

    Silvio Bertoli

  7. Nephrology Unit, Uboldo Hospital, Cernusco Sul Naviglio, Italy

    Ferruccio Conte

  8. Nephrology Unit, San Gerardo Hospital, Monza, Italy

    Andrea Stella & Simonetta Genovesi

  9. Nephrology Unit, Ospedali Riuniti Hospital, Bergamo, Italy

    Patrizia Ondei

  10. Nephrology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy

    Antonio Santoro

Authors
  1. Maria Fusaro
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  2. Maurizio Gallieni
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  4. Maria Antonietta Rizzo
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  5. Maria Carmen Luise
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  11. Emanuela Rossi
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  13. Antonio Santoro
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  14. Simonetta Genovesi
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Corresponding author

Correspondence to Simonetta Genovesi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Fusaro, M., Gallieni, M., Rebora, P. et al. Atrial fibrillation and low vitamin D levels are associated with severe vascular calcifications in hemodialysis patients. J Nephrol 29, 419–426 (2016). https://doi.org/10.1007/s40620-015-0236-7

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  • DOI: https://doi.org/10.1007/s40620-015-0236-7

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