Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients
<i>Background</i>: It is estimated that chronic kidney disease (CKD) accounts globally for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Traditional as well as non-traditional CV risk factors such as vascular calcification are believed to drive this disprop...
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MDPI AG
2021-05-01
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| Serija: | Cells |
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| Online pristup: | https://www.mdpi.com/2073-4409/10/5/1091 |
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| author | Antonio Bellasi Luca Di Lullo Domenico Russo Roberto Ciarcia Michele Magnocavallo Carlo Lavalle Carlo Ratti Mario Cozzolino Biagio Raffaele Di Iorio |
| author_facet | Antonio Bellasi Luca Di Lullo Domenico Russo Roberto Ciarcia Michele Magnocavallo Carlo Lavalle Carlo Ratti Mario Cozzolino Biagio Raffaele Di Iorio |
| author_sort | Antonio Bellasi |
| collection | DOAJ |
| description | <i>Background</i>: It is estimated that chronic kidney disease (CKD) accounts globally for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Traditional as well as non-traditional CV risk factors such as vascular calcification are believed to drive this disproportionate risk burden. We aimed to investigate the association of coronary artery calcification (CAC) progression with all-cause mortality in patients new to hemodialysis (HD). <i>Methods</i>: Post hoc analysis of the Independent study (NCT00710788). At study inception and after 12 months of follow-up, 414 patients underwent computed tomography imaging for quantification of CAC via the Agatston methods. The square root method was used to assess CAC progression (CACP), and survival analyses were used to test its association with mortality. <i>Results</i>: Over a median follow-up of 36 months, 106 patients died from all causes. Expired patients were older, more likely to be diabetic or to have experienced an atherosclerotic CV event, and exhibited a significantly greater CAC burden (<i>p</i> = 0.002). Survival analyses confirmed an independent association of CAC burden (hazard ratio: 1.29; 95% confidence interval: 1.17–1.44) and CACP (HR: 5.16; 2.61–10.21) with all-cause mortality. CACP mitigated the risk associated with CAC burden (<i>p</i> = 0.002), and adjustment for calcium-free phosphate binder attenuated the strength of the link between CACP and mortality. <i>Conclusions</i>: CAC burden and CACP predict mortality in incident to dialysis patients. However, CACP reduced the risk associated with baseline CAC, and calcium-free phosphate binders attenuated the association of CACP and outcomes, suggesting that CACP modulation may improve survival in this population. Future endeavors are needed to confirm whether drugs or kidney transplantation may attenuate CACP and improve survival in HD patients. |
| first_indexed | 2024-03-10T11:43:53Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2073-4409 |
| language | English |
| last_indexed | 2024-03-10T11:43:53Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cells |
| spelling | doaj.art-f69481622ff9441ca547665c0a3de4862023-11-21T18:15:22ZengMDPI AGCells2073-44092021-05-01105109110.3390/cells10051091Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis PatientsAntonio Bellasi0Luca Di Lullo1Domenico Russo2Roberto Ciarcia3Michele Magnocavallo4Carlo Lavalle5Carlo Ratti6Mario Cozzolino7Biagio Raffaele Di Iorio8Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6900 Lugano, SwitzerlandDepartment of Nephrology and Dialysis, Ospedale Parodi, Delfino, Colleferro, 00034 Rome, ItalyDepartment of Nephrology, School of Medicine, University of Naples Federico II, 80137 Naples, ItalyDepartments of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80137 Naples, ItalyDepartment of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Roma, ItalyDepartment of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Roma, ItalyDepartment of Cardiology, Ospedale Ramazzini Carpi, 41012 Carpi, ItalyRenal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, 20122 Milan, ItalyNefrology and Dialysis, AORN “San Giuseppe Moscati”, 83100 Avellino, Italy<i>Background</i>: It is estimated that chronic kidney disease (CKD) accounts globally for 5 to 10 million deaths annually, mainly due to cardiovascular (CV) diseases. Traditional as well as non-traditional CV risk factors such as vascular calcification are believed to drive this disproportionate risk burden. We aimed to investigate the association of coronary artery calcification (CAC) progression with all-cause mortality in patients new to hemodialysis (HD). <i>Methods</i>: Post hoc analysis of the Independent study (NCT00710788). At study inception and after 12 months of follow-up, 414 patients underwent computed tomography imaging for quantification of CAC via the Agatston methods. The square root method was used to assess CAC progression (CACP), and survival analyses were used to test its association with mortality. <i>Results</i>: Over a median follow-up of 36 months, 106 patients died from all causes. Expired patients were older, more likely to be diabetic or to have experienced an atherosclerotic CV event, and exhibited a significantly greater CAC burden (<i>p</i> = 0.002). Survival analyses confirmed an independent association of CAC burden (hazard ratio: 1.29; 95% confidence interval: 1.17–1.44) and CACP (HR: 5.16; 2.61–10.21) with all-cause mortality. CACP mitigated the risk associated with CAC burden (<i>p</i> = 0.002), and adjustment for calcium-free phosphate binder attenuated the strength of the link between CACP and mortality. <i>Conclusions</i>: CAC burden and CACP predict mortality in incident to dialysis patients. However, CACP reduced the risk associated with baseline CAC, and calcium-free phosphate binders attenuated the association of CACP and outcomes, suggesting that CACP modulation may improve survival in this population. Future endeavors are needed to confirm whether drugs or kidney transplantation may attenuate CACP and improve survival in HD patients.https://www.mdpi.com/2073-4409/10/5/1091coronary artery calcificationprogressionhemodialysisrisk prediction |
| spellingShingle | Antonio Bellasi Luca Di Lullo Domenico Russo Roberto Ciarcia Michele Magnocavallo Carlo Lavalle Carlo Ratti Mario Cozzolino Biagio Raffaele Di Iorio Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients Cells coronary artery calcification progression hemodialysis risk prediction |
| title | Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients |
| title_full | Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients |
| title_fullStr | Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients |
| title_full_unstemmed | Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients |
| title_short | Vascular Calcification Progression Modulates the Risk Associated with Vascular Calcification Burden in Incident to Dialysis Patients |
| title_sort | vascular calcification progression modulates the risk associated with vascular calcification burden in incident to dialysis patients |
| topic | coronary artery calcification progression hemodialysis risk prediction |
| url | https://www.mdpi.com/2073-4409/10/5/1091 |
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