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Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Patients with end-stage kidney disease on hemodialysis (HD) have an increased risk of death due to the high prevalence of cardiovascular disease. Vascular calcification (VC) is predictive of cardiovascular disease and mortality. We conducted a study to evaluate the prevalence and risk factors for VC in dialysis patients in Qatar.

Methods: This is a retrospective nationwide study including all chronic ambulatory dialysis patients in Qatar from 2020 to 2022. We used our national electronic medical record to track demographics, clinical characteristics, comorbidities, laboratory values, and diagnostic data for each patient. Calcifications were assessed by echocardiography (routinely done for all our dialysis population per national protocol), computed tomography, X-ray, and ultrasound. The study protocol was approved by the local medical research ethics committee (MRC-01-20-377).

Results: 842 HD patients were included in this study. Vascular calcifications (VC) were prevalent in 52.6% of patients. The main site of VC was Mitral valve calcifications in 55.5% of patients. Patients with VC were significantly older and had more prevalence of diabetes mellitus ( = 0.001 and = 0.006, respectively). There was no statistically significant difference between patients with calcifications and patients without calcifications regarding serum calcium, phosphorus, and PTH level. In multivariate analysis, age and diabetes significantly increased the risk factor for calcification (95% CI 1.033–1.065, < 0.0001, and 95% CI 1.128–2.272, < 0001, respectively). Moreover, higher vitamin D levels and higher doses of IV Alfacalcidol were significant risk factors for calcifications (95% CI 1.005–1.030, < 0.007, and 95% CI 1.092–1.270, < 0.0001, respectively).

Conclusion: Our study found that vascular calcification was widespread among our dialysis population in Qatar. Implementing the practice of echocardiography in dialysis patients was extremely helpful and the most productive in detecting vascular calcification. Diabetes mellitus almost doubles the risk for vascular calcifications in dialysis patients. These results are beneficial in identifying risk factors for vascular calcification, which can help stratify dialysis patients’ risk of cardiovascular disease and optimize prevention efforts.

© 2024 Ghonimi, Hamad, Fouda, Alali, Ezzat, Awad Et Al., Licensee HBKU Press.
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2024-03-14
2024-12-21
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References

  1. Ohtake, T., Kobayashi, S. Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatment. Ren Replace Ther. 2017; 3:13. doi: 10.1186/s41100-017-0094-y
     [Google Scholar]
  2. Demer LL, Tintut Y. Vascular calcification: pathobiology of a multifaceted disease. Circulation. 2008; 117:(22):2938–48.
     [Google Scholar]
  3. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al. Coronary-artery calcification in young adults with endstage renal disease who are undergoing dialysis. N Engl J Med. 2000; 342:1478–83.
     [Google Scholar]
  4. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001; 38:938–42.
     [Google Scholar]
  5. London GM, Guerin AP, Marchais SJ, et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003; 18:(9):1731–40. doi: 10.1093/ndt/gfg414
     [Google Scholar]
  6. Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW. New indices to classify location, severity and progression of calcifc lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis. 1997; 132:(2):245–50.
     [Google Scholar]
  7. Giachelli CM. The emerging role of phosphate in vascular calcification. Kidney Int.. 2009; 75:(9):890–7.
     [Google Scholar]
  8. Wilson PW, Kauppila LI, O’Donnell CJ, Kiel DP, Hannan M, Polak JM, et al. Abdominal aortic calcifc deposits are an important predictor of vascular morbidity and mortality. Circulation. 2001; 103:(11):1529–34. doi: 10.1161/01.cir.103.11.1529
     [Google Scholar]
  9. van der Meer IM, Bots ML, Hofman A, del Sol AI, van der Kuip DA, Witteman JC. Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam study. Circulation. 2004; 109:(9):1089–94. doi: 10.1161/01.CIR.0000120708.59903
     [Google Scholar]
  10. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifcations, arterial stifness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001; 38:(4):938–42. doi: 10.1161/hy1001.096358
     [Google Scholar]
  11. Cho A, Jung HY, Park HC, Oh J, Kim J, Lee YK. Relationship between abdominal aortic calcifcation on plain radiograph and coronary artery calcifcation detected by computed tomography in hemodialysis patients. Clin Nephrol. 2020; 93:(3):123–9. doi: 10.5414/CN109988
     [Google Scholar]
  12. Toussaint ND, Lau KK, Strauss BJ, Polkinghorne KR, Kerr PG. Determination and validation of aortic calcifcation measurement from lateral bone densitometry in dialysis patients. Clin J Am Soc Nephrol. 2009; 4:(1):119–27. doi: 10.2215/CJN.03410708
     [Google Scholar]
  13. Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC. Electron beam computed tomography in the evaluation of cardiac calcifcation in chronic dialysis patients. Am J Kidney Dis. 1996; 27:(3):394–401. doi: 10.1016/s0272-6386(96)90363-7
     [Google Scholar]
  14. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31:(4):607–17. doi: 10.1053/ajkd.1998.v31.pm9531176
     [Google Scholar]
  15. Ketteler M, Westenfeld R, Schlieper G, et al. Role of fetuin-A in calcification inhibition. Circulation. 2008; 117:(17):2477–84.
     [Google Scholar]
  16. Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant. 2000; 15:(7):1014–21.
     [Google Scholar]
  17. Aaltonen L, Koivuviita N, Seppänen M, Kröger H, Tong X, Löyttyniemi E. Association between bone mineral metabolism and vascular calcification in end-stage renal disease. BMC Nephrol. 2022; 23:12. doi: 10.1186/s12882-021-02652-z
     [Google Scholar]
  18. Asim M, Alkadi M, Hamad A, Othman M, Abuhelaiqa E, Fituri O, et al. Restructuring nephrology services to combat COVID-19 pandemic: report from a Middle Eastern country. World J Nephrol. 2020 Nov 29; 9:(2):9–17. doi: 10.5527/wjn.v9.i2.9
     [Google Scholar]
  19. Hamad AI, Asim M, Othman MA, Abuhelaiqa EA, Shurrab A, Elmadhoun IT, et al. National response to the COVID-19 Omicron variant crisis in the ambulatory hemodialysis service in the State of Qatar. Qatar Med J. 2022 Aug 23; 2022:(3):38. doi: 10.5339/qmj.2022.38
     [Google Scholar]
  20. Hamad A, Mefleh Al Halabi A, Ghazouani H, Habas EM, Mohamed Borham A, Mohamed Ismail S, et al. Time-series forecasting of hemodialysis population in the State of Qatar by 2030. Qatar Med J. 2023 Feb 20; 2023:(1):6. doi: 10.5339/qmj.2023.6
     [Google Scholar]
  21. Kristen L. Jablonski and Michel Chonchol. Vascular calcification in end-stage renal disease. Hemodial Int. 2013; 17:S17–21.
     [Google Scholar]
  22. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011). 2017;7, 1–59. doi: 10.1016/j.kisu.2017.04.001
     [Google Scholar]
  23. London GM, Guerin AP, Marchais SJ, Métivier F, Pannier B, Adda H. Calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18:1731–40. doi: 10.1093/ndt/gfg414
     [Google Scholar]
  24. Toussaint ND, Pedagogos E, Lau KK, Heinze S, Becker GJ, Beavis J, et al. Lateral lumbar X-ray assessment of abdominal aortic calcification in Australian haemodialysis patients. Nephrology. 2011; 16:389–95. doi: 10.1111/j.1440-1797.2010.01420.x
     [Google Scholar]
  25. Watanabe S, Fujii H, Kono K, Watanabe K, Goto S, Nishi S. Influence of oxidative stress on vascular calcification in the setting of coexisting chronic kidney disease and diabetes mellitus. Sci Rep. 2020 Nov 26; 10:(1):20708. doi: 10.1038/s41598-020-76838-0
     [Google Scholar]
  26. Chertow GM, Raggi P, Chasan-Taber S, Bommer J, Holzer H, Burke SK. Determinants of progressive vascular calcification in hemodialysis patients. Nephrol Dial Transplant. 2004; 19:1489–96. doi: 10.1093/ndt/gfh125
     [Google Scholar]
  27. Phan O, Joki N. Vascular Calcification in Diabetic Kidney Disease. Kidney Dial. 2022; 2:(4):595–606. doi: 10.3390/kidneydial2040054
     [Google Scholar]
  28. Ishimura E, Okuno S, Kitatani K, Kim M, Shoji T, t al. Different risk factors for peripheral vascular calcification between diabetic and non-diabetic haemodialysis patients – importance of glycaemic control. Diabetologia. 2002; 45:1446–8. doi: 10.1007/s00125-002-0920-8
     [Google Scholar]
  29. Kimura K, Saika Y, Otani H, Fujii R, Mune M, Yukawa S. Factors associated with calcification of the abdominal aorta in hemodialysis patients. Kidney Int Suppl. 1999; 71:S238–41. doi: 10.1046/j.1523-1755.1999.07163.x
     [Google Scholar]
  30. Wang AY, Wang M, Woo J, Lam CW, Li PK, Lui SF, et al. Cardiac valve calcification as an important predictor for allcause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol. 2003; 14:159–68.
     [Google Scholar]
  31. Kauppila Ll, Polak JF, Cupples LA. New indices to classify location, severity and progression of calcific lesion in the abdominal aorta 25-years follow-up study. Atherosclerosis. 1997; 132:245–50. doi: 10.1016/s0021-9150(97)00106-8
     [Google Scholar]
  32. Adragao T, Pires A, Lucas C, Birne R, Magalhaes L, Gonçalves M, et al. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant. 2004; 19:1480–8. doi: 10.1093/ndt/gfh217
     [Google Scholar]
  33. García-Canton C, Bosch E, Ramírez A, Gonzalez Y, Auyanet I, Guerra R, et al. Vascular calcification and 25-hydroxyvitamin D levels in non-dialysis patients with chronic kidney disease stages 4 and 5. Nephrol Dial Transplant. 2011; 26:2250–6. doi: 10.1093/ndt/gfq650
     [Google Scholar]
  34. Górriz JL, Molina P, Cerverón MJ, Vila R, Bover J, Nieto J, et al. Vascular calcifica¬tion in patients with nondialysis CKD over 3 years. Clin J Am Soc Nephrol. 2015; 10:654–66. doi: 10.2215/CJN.07450714
     [Google Scholar]
  35. Honkanen E, Kauppila L, Wikstrom B, Rensma P, Krzesinski J, Aasarod K, et al. Abdominal aortic calcification in dialysis patients: results of the CORD study. Nephrol Dial Transplant. 2008; 23:4009–15.
     [Google Scholar]
  36. Jean G, Bresson E, Terrat J, Vanel T, Hurot J, Lorriaux C, et al. Peripheral vascular calcification in long-haemodialysis patients: associated factors and survival consequences. Nephrol Dial Transplant. 2009; 24:948–55.
     [Google Scholar]
  37. SciELO Argentina. Medicina (B. Aires) vol.77 no.3 Ciudad Autónoma de Buenos Aires jun. 2017; Buenos Aires: SciELO Argentina.
     [Google Scholar]
  38. London GM, Guerin AP, Verbeke FH, Pannier B, Boutouyrie P, Marchais SJ, Metivier F: Mineral metabolism and arterial functions in end-stage renal disease: Potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol. 2007; 18:(2):613–620. doi: 10.1681/ASN.2006060573
     [Google Scholar]
/content/journals/10.5339/qmj.2024.18
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Cardiovascular calcification in hemodialysis patients: A Qatar-based prevalence and risk factors study
Qatar Medical Journal 2024, 18 (2024); https://doi.org/10.5339/qmj.2024.18
/content/journals/10.5339/qmj.2024.18
/content/journals/10.5339/qmj.2024.18
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  • Article Type: Research Article
Keyword(s): Bone mineral disease, calcifications, dialysis and ESRD

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