Role of aortic calcification, stiffness and wave reflections in cardiovascular risk in dialysis patients: Baseline data from the CORD study

Verbeke, Francis; Vanholder, Raymond; Rensma, Pieter L.; Wikström, Björn; Jensen, Per Bruno; Krzesinski, Jean-Marie; Rasmussen, Merete; Van Biesen, Wim; Honkanen, Eero; on behalf of the CORD Study investigators,

doi:10.1016/j.artres.2010.06.004

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Volume 4, Issue 3 , Pages 81-90, September 2010

Role of aortic calcification, stiffness and wave reflections in cardiovascular risk in dialysis patients: Baseline data from the CORD study

Francis Verbeke
- Department of Internal Medicine, Nephrology Section, Gent University Hospital, Gent, Belgium
- Corresponding author at: Gent University Hospital, Department of Internal Medicine, Nephrology section, De Pintelaan 185, B-9000 Gent, Belgium. Tel.: +32 9 332 45 12; fax: +32 9 332 38 47.
Raymond Vanholder
- Department of Internal Medicine, Nephrology Section, Gent University Hospital, Gent, Belgium
Pieter L. Rensma
- Department of Nephrology, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands
Björn Wikström
- Renal Section, Department of Medicine, Uppsala University Hospital, Uppsala, Sweden
Per Bruno Jensen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
Jean-Marie Krzesinski
- Department of Nephrology, Liege University Hospital, Liege, Belgium
Merete Rasmussen
- Genzyme A/S, Copenhagen, Denmark
Wim Van Biesen
- Department of Internal Medicine, Nephrology Section, Gent University Hospital, Gent, Belgium
Eero Honkanen
- Division of Nephrology Helsinki University Central Hospital, Helsinki, Finland
on behalf of the CORD Study investigators
- See appendix section.

Received 23 April 2010; received in revised form 9 June 2010; accepted 17 June 2010. published online 15 July 2010.

Abstract

Background

Accurate cardiovascular risk estimation in dialysis patients remains challenging because different pathogenetic mechanisms act simultaneously in this heterogeneous population. Radiographic calcification, aortic stiffness and wave reflection, have each individually been proven to be reliable surrogate markers for outcome. We aimed to explore to what extent these parameters intermutually provide complementary or overlapping information.

Methods

Abdominal aortic calcification scoring of a plain lateral abdominal X-ray, carotid-femoral pulse wave velocity (PWV), and central augmentation index (AIx) were measured in 1084 dialysis patients, recruited from 47 European dialysis centers.

Results

Abdominal calcification correlated well with PWV (R = 0.44, P < 0.001) but poorly with AIx (R = 0.07, P = 0.04). Next to abdominal calcification, tertiles of PWV were associated with a stepwise increase age, blood pressure, and cardiovascular history, and tertiles of AIx with age, heart rate, and anthropometric factors. In multivariate analysis, only PWV remained significantly associated with calcification score. In addition to age and blood pressure, stiffness was mainly related to diabetes and calcification score (R² = 0.39, P < 0.001), whereas AIx was more dependent on anthropometry, gender and heart rate (R² = 0.36, P < 0.001).

Conclusions

Information on aortic calcification and arterial abnormalities can be obtained by simple and inexpensive methodologies. Variation in wave reflections was mainly explained by anthropometric parameters. Stiffness and calcification partly provided complementary information, particularly in low-risk patients. In this group, likely to benefit most from preventive strategies and commonly considered for renal transplantation, evaluation of cardiovascular risk could be made more accurate by the assessment of both aortic calcification and arterial stiffness.

Keywords: Calcification, Pulse wave velocity, Stiffness, Augmentation index, Dialysis