Skip to main content
SpringerLink
Log in

Determinants of coronary artery calcification in maintenance hemodialysis patients

  • Original Article
  • Artificial Kidney / Dialysis
  • Published:
Journal of Artificial Organs Aims and scope Submit manuscript

Abstract

In addition to the well-known traditional risk factors, uremia-related so-called novel risk factors and medications appear to affect coronary artery calcification in hemodialysis patients. This study was performed to evaluate coronary artery calcification score (CACS) in maintenance hemodialysis (MHD) patients, and to identify significantly related factors. We assessed CACS using Agatston Score by MDCT, sex, age, dialysis vintage, presence of diabetes mellitus, smoking history, presence of ≥100 ml urine volume/day, normalized protein catabolic rate, geriatric nutritional risk index, administration of active vitamin D3, cinacalcet, phosphate binders or antihypertensive agents, and circulation parameters including creatinine, albumin, corrected calcium and phosphate in 207 MHD patients. Coronary artery calcifications were observed in 192 patients (92.8 %). In multivariate analysis, CACS showed direct associations with age (p < 0.001), dialysis vintage (p < 0.001) and presence of diabetes mellitus (p < 0.01), and an inverse association only with active vitamin D3 administration (p < 0.001) in MHD patients. Patients with active vitamin D3 showed significantly lower CACS than in those without it (1349.6 ± 1635.0 vs. 2475.6 ± 2646.6 H, p < 0.05). Older age, longer duration of dialysis and diabetes mellitus are risk factors and administration of active vitamin D3 is protective factor for coronary artery calcification in MHD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goodman WG, Goldin J, Kuizon BD, et al. Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342:1478–83.

    Article  CAS  PubMed  Google Scholar 

  2. Zheng CM, Lu KC, Wu CC, Hsu YH, Lin YF. Association of serum phosphate and related factors in ESRD-related vascular calcification. Int J Nephrol. 2011;. doi:10.4061/2011/939613.

    PubMed Central  PubMed  Google Scholar 

  3. Pencak P, Czerwieńska B, Ficek R, et al. Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients. BMC Nephrol. 2013;. doi:10.1186/1471-2369-14-10.

    PubMed Central  PubMed  Google Scholar 

  4. Mathew S, Lund RJ, Chaudhary LR, Geurs T, Hruska KA. Vitamin D receptor activators can protect against vascular calcification. J Am Soc Nephrol. 2008;19:1509–19.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Raggi P, Chertow GM, Torres PU, et al. The ADVANCE study: a randomized study to evaluate the effects of cinacalcet plus low-dose vitamin D on vascular calcification in patients on hemodialysis. Nephrol Dial Transplant. 2011;26:1327–39.

    Article  CAS  PubMed  Google Scholar 

  6. Chertow GM, Block GA, Correa-Rotter R, et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367:2482–94.

    Article  CAS  PubMed  Google Scholar 

  7. Ogawa T, Ishida H, Akamatsu M, et al. Relation of oral 1alpha-hydroxy vitamin D3 to the progression of aortic arch calcification in hemodialysis patients. Heart Vessel. 2010;25:1–6.

    Article  Google Scholar 

  8. Toussaint ND, Lau KK, Polkinghorne KR, Kerr PG. Attenuation of aortic calcification with lanthanum carbonate versus calcium-based phosphate binders in haemodialysis: a pilot randomized controlled trial. Nephrol (Carlton). 2011;16:290–8.

    Article  CAS  Google Scholar 

  9. Drüeke TB, Massy ZA. Phosphate binders in CKD: bad news or good news? J Am Soc Nephrol. 2012;23:1277–80.

    Article  PubMed  Google Scholar 

  10. Park MY, Choi SJ, Kim JK, et al. Use of multidetector computed tomography for evaluating coronary artery disease in patients undergoing dialysis. Nephrol Carlton. 2011;16:285–9.

    Article  Google Scholar 

  11. Fukagawa M, Yokoyama K, Koiwa F, et al. Clinical practice guideline of chronic kidney disease-mineral and bone disorder. Ther Apher Dial. 2013;17:247–88.

    Article  PubMed  Google Scholar 

  12. Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87:106–13.

    CAS  PubMed  Google Scholar 

  13. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.

    Article  CAS  PubMed  Google Scholar 

  14. Floege J, Ketteler M. Vascular calcification in patients with endstage renal disease. Nephrol Dial Transplant. 2006;19:V59–66.

    Article  Google Scholar 

  15. Ribeiro S, Ramos A, Brandao A, et al. Cardiac valve calcification in haemodialysis patients: role of calcium–phosphate metabolism. Nephrol Dial Transplant. 1998;13:2037–40.

    Article  CAS  PubMed  Google Scholar 

  16. Shoji T, Abe T, Matsuo H, et al. Committee of renal and peripheral arteries, Japan atherosclerosis society: chronic kidney disease, dyslipidemia, and atherosclerosis. J Atheroscler Thromb. 2012;19:299–315.

    Article  CAS  PubMed  Google Scholar 

  17. März W, Genser B, Drechsler C, et al. German diabetes and dialysis study investigators. Atorvastatin and low-density lipoprotein cholesterol in type 2 diabetes mellitus patients on hemodialysis. Clin J Am Soc Nephrol. 2011;6:1316–25.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Shroff R, Long DA, Shanahan C. Mechanistic insights into vascular calcification in CKD. J Am Soc Nephrol. 2013;24:179–89.

    Article  CAS  PubMed  Google Scholar 

  19. Nitta K. Vascular calcification in patients with chronic kidney disease. Ther Apher Dial. 2011;15:513–21.

    Article  CAS  PubMed  Google Scholar 

  20. Nitta K, Akiba T, Suzuki K, et al. Assessment of coronary artery calcification in hemodialysis patients using multi-detector spiral CT scan. Hypertens Res. 2004;27:527–33.

    Article  PubMed  Google Scholar 

  21. Ohtake T, Ishioka K, Honda K, et al. Impact of coronary artery calcification in hemodialysis patients: risk factors and associations with prognosis. Hemodial Int. 2010;14:218–25.

    Article  PubMed  Google Scholar 

  22. Lau WL, Leaf EM, Hu MC, et al. Vitamin D receptor agonists increase klotho and osteopontin while decreasing aortic calcification in mice with chronic kidney disease fed a high phosphate diet. Kidney Int. 2012;82:1261–70.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Teng M, Wolf M, Ofsthun MN, et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol. 2005;16:1115–25.

    Article  CAS  PubMed  Google Scholar 

  24. Zittermann A, Schleithoff SS, Koerfer R. Vitamin D and vascular calcification. Curr Opin Lipidol. 2007;18:41–6.

    Article  CAS  PubMed  Google Scholar 

  25. Fishbane S, Shapiro WB, Corry DB, et al. Cinacalcet HCl and concurrent low-dose vitamin D improves treatment of secondary hyperparathyroidism in dialysis patients compared with vitamin D alone: the ACHIEVE study results. Clin J Am Soc Nephrol. 2008;3:1718–25.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Torres PU. Cinacalcet HCl: a novel treatment for secondary hyperparathyroidism caused by chronic kidney disease. J Ren Nutr. 2006;16:253–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Masahiro Ishine and Mr. Kenji Mizuno for the expert imaging techniques. This study was supported by the private foundation of Ichiyokai Harada Hospital.

Conflict of interest

All the authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan

    Yoshiko Nishizawa, Chieko Hamada & Yasuhiko Tomino

  2. Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-Cho, Saeki-Ku, Hiroshima, 731-5134, Japan

    Yoshiko Nishizawa & Sonoo Mizuiri

  3. Hiroshima Kidney Organization, Hiroshima, Japan

    Noriaki Yorioka

Authors
  1. Yoshiko Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonoo Mizuiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Noriaki Yorioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chieko Hamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasuhiko Tomino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiko Nishizawa.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishizawa, Y., Mizuiri, S., Yorioka, N. et al. Determinants of coronary artery calcification in maintenance hemodialysis patients. J Artif Organs 18, 251–256 (2015). https://doi.org/10.1007/s10047-015-0823-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10047-015-0823-3

Keywords

Search

Navigation