Vascular calcification progression in patients with end-stage chronic kidney disease

Background: Intima media thickness (IMT), vascular calcifications and ankle-brachial pressure index (ABPI) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients.

Methods: Between January 2018 and March 2019, a physician-initiated, nonrandomized, prospective study was conducted. Carotid IMT, vascular calcifications analysis values and measurements of the ABPI, were made at baseline and after 1-year of follow-up.

Results: A total of 284 patients, 152 patients with dialysis (100 hemodialysis (HD) and 52 CAPD (continuous ambulatory peritoneal dialysis)) and 132 patients with stage 4 chronic kidney disease (control group), were included (55% male, 67 [29-88] years). The values of carotid IMT at baseline were higher in the HD group than in the CAPD group (1.10±0.08 mm vs 0.08±0.04 mm, p=0.004). Adragao and Kauppila scores were higher in the HD group than in the CAPD group (2.56±2.10 vs 1.08±2.02, p=0.009; and 7.40±6.86 vs 4.44±5.26, p<0.001; respectively). These differences remained after 1-year of follow-up. Pathological ABPI after 1-year follow-up was more prevalent in the HD group than in the CAPD or control groups (32.0% vs 19.4% vs 7.7%, respectively, p=0.042). Multivariate regression analysis revealed that age, gender, dialysis type and LDLc were independent predictors for carotid IMT increase; age, dialysis type and smoking for vascular calcifications increase on Adragao score; and dialysis type on Kauppila score. Only the dialysis type was the independent predictor for all vascular calcifications markers.

Conclusions: Dialysis, particularly HD, is an independent risk factor for cardiovascular calcification increase in ESRD patients.