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PERITONEAL DIALYSIS IN LATIN AMERICA |
1 Nephrology Division, Federal University of São Paulo; 2 The Lipid Clinic of the Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
Correspondence to: M.E.F. Canziani, Nephrology Division, Federal University of
São Paulo, 282 Pedro de Toledo Street, São Paulo 04039-000
Brazil.
dialisefor{at}uol.com.br
Background: Progression of coronary artery calcification
(CAC) has been described in hemodialysis patients, and severe CAC has been
associated with the occurrence of cardiovascular events in this population.
Little information is available regarding peritoneal patients. Aim: To prospectively evaluate peritoneal dialysis
patients in order to identify the variables associated with the rate of CAC
progression, as well as to determine the impact that baseline CAC has on
clinical outcomes over a 1-year follow-up period. Methods: Using multislice coronary tomography, calcium
scores were estimated at baseline and after 12 months in 49 peritoneal
dialysis patients. Patients with and without CAC progression were compared
with respect to clinical characteristics and biochemical variables, including
lipid profile, parameters of mineral metabolism, and markers of inflammation.
Cardiovascular events, hospitalizations, and all-cause mortality were
recorded. Results: At baseline, 29 patients (59%) presented CAC and
a median calcium score of 234.7 (range 10.3-2351) Agatston units. Progression
of CAC was observed in 13 patients (43%) who, in comparison with those
presenting no CAC progression, were older, presented higher baseline calcium
scores, and had higher mean glucose levels, lower mean high density
lipoprotein cholesterol levels, and more months using low calcium peritoneal
solution. We also observed a trend toward more often presenting with a history
of hypertension, exhibiting more hyperphosphatemic and hyperglycemic events,
and having lower albumin levels. In multiple logistic regression, only
baseline calcium score was independently associated with progression of CAC. A
shorter cardiovascular event-free time and a trend toward lower survival rates
were observed in the group with CAC. Hospitalization event-free time did not
differ between the groups. Conclusion: Determining CAC provides important prognostic
data in peritoneal dialysis patients. Baseline calcium score and disturbances
in glucose, mineral, and lipid metabolism were indicative of higher risk of
CAC progression in this population.
KEY WORDS: KEY WORDS:; Vascular calcification; mortality; cardiovascular disease; atherosclerosis; coronary tomography; inflammation; mineral metabolism.
Received 8 January 2007; accepted 5 February 2007.
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