Journal of Nephrology

, Volume 29, Issue 2, pp 241–250 | Cite as

Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development

  • Xoana Barros
  • Timm Dirrichs
  • Ralf Koos
  • Sebastian Reinartz
  • Nadine Kaesler
  • Rafael Kramann
  • Ulrich Gladziwa
  • Markus Ketteler
  • Jürgen Floege
  • Nikolaus Marx
  • José V. Torregrosa
  • András Keszei
  • Vincent M. Brandenburg
Original Article



Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk.


Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52–105).


Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23–1181) and for AVC was 0 (IQR 0–25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR −10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival.


EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.


Epicardial adipose tissue Hemodialysis Coronary artery calcification Survival 



Data were presented in part as an abstract at the ASN Renal Week congress 2014 in Philadelphia. The work performed by Xoana Barros at University Hospital of the RWTH Aachen was possible thanks to the Long-Term ERA-EDTA Fellowship Exchange Programme.

Compliance with the ethical standards

Conflict of interest

The authors declare they have no competing interests.

Ethical approval

The study was approved by the ethical committee of the RWTH Aachen University Hospital.

Informed consent

Patients were included after written and informed consent.


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Copyright information

© Italian Society of Nephrology 2015

Authors and Affiliations

  • Xoana Barros
    • 1
    • 7
  • Timm Dirrichs
    • 2
  • Ralf Koos
    • 3
  • Sebastian Reinartz
    • 2
  • Nadine Kaesler
    • 1
  • Rafael Kramann
    • 1
  • Ulrich Gladziwa
    • 4
  • Markus Ketteler
    • 5
  • Jürgen Floege
    • 1
  • Nikolaus Marx
    • 6
  • José V. Torregrosa
    • 7
  • András Keszei
    • 8
  • Vincent M. Brandenburg
    • 6
  1. 1.Department of NephrologyUniversity Hospital of the RWTH AachenAachenGermany
  2. 2.Department of RadiologyUniversity Hospital of the RWTH AachenAachenGermany
  3. 3.Department of CardiologyStädtische Kliniken Mönchengladbach GmbH, Elisabeth-Krankenhaus RheydtRheydtGermany
  4. 4.Dialysis CenterKuratorium für Heimdialyse (KfH)WürselenGermany
  5. 5.Department of NephrologyKlinikum CoburgCoburgGermany
  6. 6.Department of CardiologyUniversity Hospital of the RWTH AachenAachenGermany
  7. 7.Department of NephrologyHospital ClinicBarcelonaSpain
  8. 8.Department of Medical InformaticsUniversity Hospital of the RWTH AachenAachenGermany

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