Coronary Artery Calcification Predicts Microcalcificaion of Vascular Access in Hemodialysis Patients

Background: We have reported that arterial micro-calcification (AMC) of vascular access has a negative impact on access patency and cardiovascular mortality in hemodialysis (HD) patients. Because AMC is diagnosed by histologic examination, it cannot be commonly performed. Coronary artery calcification (CAC) is quite common and known risk factors of cardiovascular mortality in HD patients. It can be easily detected by noninvasive computed tomography. Therefore we evaluated which CAC may predict AMC in nondiabetic HD patients, because we excluded impact of diabetes mellitus on CAC and AMC. Methods: Forty non diabetic incident HD patients who received vascular access operation were included in this study. The AMC was diagnosed by pathologic examination of arterial specimen by von Kossa stain, which was acquired during the operation. All patients underwent a multi-detector computed tomography (MDCT) imaging procedure and coronary artery calcium score (CACS) was calculated. Patients were classified into two groups, according to the CACS, as low (<100), in 23 patients, and high (≥100), in 17 patients. We compared CACS between the patients with and without AMC. Results:Mean age was 63.4±16.5 years and the male gender was 24 (60.0%). The incidence of AMC was 35.0% (n=14). The mean CACS was 185.9±299.4 (0-1421.7), and the median value was 54.1. Patients with high CACS group were older than low CACS group(74.1±9.7 211vs 55.5±16.1, p<0.05). High CACS showed higher incidence of AMC compared to low CACS group (58.8% vs 17.4%, p<0.05). By binary logistic regression, high CACS was independently associated with positive AMC (OR 8.381, 95% CI 1.725-40.732, p<0.05). Conclusions: The present study suggests that CAC predicts AMC of vascular access in nondiabetic HD patients.