Advanced CKD May Be a Risk Factor for Medial Arterial Calcification
In a study, progression of calcification did not increase until eGFR falls below 40 mL/min/1.73 m2.
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SAN DIEGO—Advanced chronic kidney disease (CKD) may increase the risk for medial arterial calcification, according to findings from 2 new studies presented at the American Society of Nephrology's 2018 Kidney Week meeting.
Calcification of breast arteries is a marker of generalized medial calcification. W. Charles O'Neill, MD, and colleagues at Emory University in Atlanta studied women with CKD (estimated glomerular filtration rate [eGFR] less than 90 mL/min/1.73 m2) and without CKD (controls) who underwent at least 2 mammograms with tallying of calcified arterial segments in each breast (expressed as total length in millimeters). Warfarin users were excluded.
Progression of calcification occurred in 60 controls and 137 patients with CKD. In controls, calcification progressed linearly and did not relate with age. Breast arterial calcification increased 3.9 mm/breast/year in controls compared with 3.3 and 4.2 mm/breast/year in the CKD group with an eGFR 53 to 90 and 40 to 52 mL/min/1.73 m2, respectively. Women with advanced CKD (eGFR less than 40 mL/min/1.73 m2) experienced a much faster rate of progression: 8.1 mm/breast/year. Hemodialysis patients fared the worst: 20 mm/breast/year.
Diabetes significantly increased progression by 2-fold in advanced CKD and 4-fold in ESRD. Diabetes alone, without renal impairment, did not increase risks, however.
“CKD is a risk factor for medial arterial calcification but only when advanced,” Dr O'Neill told Renal & Urology News. “This is consistent with hyperphosphatemia rather than earlier derangements in mineral metabolism as a contributing factor. The markedly increased rate in hemodialysis patients suggests that hemodialysis itself may promote calcification.”
In a related study presented at Kidney Week, Dr O'Neill and colleagues found that medial arterial calcification significantly slows after kidney transplantation but does not regress in women without diabetes. “This irreversibility emphasizes the importance of strategies to prevent vascular calcification during CKD and ESRD,” he said.
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