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. 2022 Jun;291(6):813-823.
doi: 10.1111/joim.13459. Epub 2022 Feb 11.

Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation

Helen Erlandsson  1 , Abdul Rashid Qureshi  2   3 , Jonaz Ripsweden  4   5 , Ida Haugen Löfman  6 , Magnus Söderberg  7 , Lars Wennberg  1 , Torbjörn Lundgren  1 , Annette Bruchfeld  2   3 , Torkel B Brismar  4   5 , Peter Stenvinkel  2   3
Affiliations

Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation

Helen Erlandsson et al. J Intern Med. 2022 Jun.

Abstract

Background: Progression of vascular calcification causes cardiovascular disease, which is the most common cause of death in chronic kidney failure and after kidney transplantation (KT). The prognostic impact of the extent of medial vascular calcification at KT is unknown.

Methods: In this prospective cohort study, we investigated the impact of medial calcification compared to a mix of intimal and medial calcification represented by coronary artery calcification (CAC score) and aortic valve calcification in 342 patients starting on kidney failure replacement therapy. The primary outcomes were cardiovascular events (CVE) and death. The median follow-up time was 6.4 years (interquartile range 3.7-9.6 years). Exposure was CAC score and arteria epigastrica medial calcification scored as none, mild, moderate, or severe by a pathologist at time of KT (n = 200). We divided the patients according to kidney failure replacement therapy during follow-up, that is, living donor KT, deceased donor KT, or dialysis.

Results: Moderate to severe medial calcification in the arteria epigastrica was associated with higher mortality (p = 0.001), and the hazard ratio for CVE was 3.1 (95% confidence interval [CI] 1.12-9.02, p < 0.05) compared to no or mild medial calcification. The hazard ratio for 10-year mortality in the dialysis group was 33.6 (95% CI, 10.0-113.0, p < 0.001) compared to living donor recipients, independent of Framingham risk score and prevalent CAC.

Conclusion: Scoring of medial calcification in the arteria epigastrica identified living donor recipients as having 3.1 times higher risk of CVE, independent of traditional risk factors. The medial calcification score could be a reliable method to identify patients with high and low risk of CVE and mortality following KT.

Keywords: cardiovascular events; coronary artery calcification; kidney failure; medial calcification; mortality.

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Conflict of interest statement

Peter Stenvinkel serves on scientific advisory boards for AstraZeneca, Baxter Healthcare, Reata Pharmaceuticals, Vifor, and Fresenius Medical Care. Annette Bruchfeld reports personal fees from AstraZeneca, Bayer, ChemoCentryx, and Vifor.

Figures

Fig. 1
Fig. 1
Schematic study protocol.
Fig. 2
Fig. 2
Biopsy of inferior epigastric artery during transplantation. The inferior epigastric artery is routinely transected at kidney transplantation to facilitate access to the urinary bladder. A part of the artery is taken for research as shown in the figure. Drawn by courtesy of Dr. John Sandberg.
Fig. 3
Fig. 3
Comparison of baseline median and interquartile range (IQR) coronary artery calcium (CAC) score in patients receiving living donor allograft (LDKT), deceased donor allograft (DDKT), and patients remaining in dialysis (CKD G5D).
Fig. 4
Fig. 4
Multivariate Cox regression analysis of medial calcification [3.10 (1.12–9.02)] p < 0.05 and coronary artery calcium (CAC) [1.83 (0.46–7.28)] association with cardiovascular (CV) events in living donor kidney transplantation (LDKT).
See this image and copyright information in PMC

References

    1. Stenvinkel P. Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. J Intern Med. 2010;268:456–67. 10.1111/j.1365-2796.2010.02269.x - DOI - PubMed
    1. Sarnak MJ, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, et al. Chronic kidney disease and coronary artery disease: JACC state‐of‐the‐art review. J Am Coll Cardiol. 2019;74(14):1823–38. 10.1016/j.jacc.2019.08.1017 - DOI - PubMed
    1. Dai L, Qureshi AR, Witasp A, Lindholm B, Stenvinkel P. Early vascular ageing and cellular senescence in chronic kidney disease. Comput Struct Biotechnol J. 2019;17:721–9. 10.1016/j.csbj.2019.06.015 - DOI - PMC - PubMed
    1. Gregg LP, Hedayati SS. Management of traditional cardiovascular risk factors in CKD: what are the data? Am J Kidney Dis. 2018;72(5):728–44. 10.1053/j.ajkd.2017.12.007 - DOI - PMC - PubMed
    1. Shanahan CM, Cary NR, Salisbury JR, Proudfoot D, Weissberg PL, Edmonds ME. Medial localization of mineralization‐regulating proteins in association with Monckeberg's sclerosis: evidence for smooth muscle cell‐mediated vascular calcification. Circulation. 1999;100:2168–76. 10.1161/01.cir.100.21.2168 - DOI - PubMed

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