ABSTRACT
The main aim of the study was to determine the prevalence of vascular calcifications in patients with chronic kidney disease on dialysis in our population assessed by X-ray. The secondary objectives were to determine the cardiovascular risk factors associated with the presence of vascular calcifications and to evaluate the complementary use of the echocardiogram in a cross-sectional, observational, multicentric study. We included patients with chronic kidney disease on dialysis, age =18 years with at least 3 months of renal replacement therapy in 8 dialysis centres in Argentina. The degree of vascular calcification was determined using Adragao and Kauppila scores. The presence of valvular calcifications was established through a trans-thoracic doppler echocardiogram. Univariate and multivariate analysis were undertaken, considering the degree of vascular calcification as the dependent variable; 443 adult patients were evaluated at 8 centres across 5 provinces in Argentina. The prevalence of vascular calcifications by the X-rays was 63%, while 73% presented calcifications in hands and pelvis, with an Adragao score >3, and 60% presented calcifications in the abdominal aorta with a Kauppila score >4. The prevalence of valvular calcifications: 28%. We have shown a higher rate of vascular calcifications with the use of plain X-rays when compared to the prevalence of valvular calcifications obtained with echocardiograms. In this regard, valvular calcifications were present particularly in those patients with a severe level of radiological vascular calcification.
El objetivo primario del estudio fue determinar la prevalencia de calcificaciones vasculares en pacientes con enfermedad renal crónica (ERC) en diálisis, a través de métodos accesibles y reproducibles. Como objetivo secundario: determinar los factores de riesgo cardiovascular asociados a la presencia de calcificaciones vasculares y evaluar la utilidad complementaria del ecocardiograma. Fue un estudio prospectivo, transversal y multicéntrico sobre pacientes prevalentes con ERC en diálisis. Se les realizaron radiografía de columna lumbar, de manos y panorámica de pelvis, para la determinación de las escalas de Adragao y Kauppila. La presencia de calcificaciones valvulares fue establecida por ecocardiograma doppler color transtorácico. Se obtuvieron los datos de 30 variables determinadas para el análisis uni y multivariado (regresión logística) de los factores de riesgo asociados. Se evaluaron 443 pacientes adultos de 8 centros de 5 provincias de la Argentina. La prevalencia de calcificaciones vasculares, determinada por las radiografías, fue 63%. La prevalencia de calcificaciones valvulares fue 28%. Las calcificaciones valvulares estuvieron presentes en aquellos pacientes con graves calcificaciones radiológicas. Las calcificaciones estuvieron asociadas a la edad (>55 años), sexo masculino, diabetes, tiempo de diálisis, tabaquismo y la presencia de enfermedad vascular periférica. Este es el estudio con mayor número de pacientes evaluados en Latinoamérica. Se encuentra alta prevalencia de calcificaciones vasculares en Argentina, fácilmente medibles con técnicas no invasivas como la radiografía simple, que resulta más sensible que el ecocardiograma. Ambos estudios deben ser utilizados de manera complementaria.
Subject(s)
Humans , Male , Middle Aged , Cardiovascular Diseases/epidemiology , Renal Dialysis/statistics & numerical data , Renal Insufficiency, Chronic/complications , Vascular Calcification/epidemiology , Argentina/epidemiology , Echocardiography , Radiography , Cardiovascular Diseases/etiology , Cardiovascular Diseases/diagnostic imaging , Prevalence , Cross-Sectional Studies , Risk Factors , Renal Insufficiency, Chronic/epidemiology , Vascular Calcification/classification , Vascular Calcification/etiology , Vascular Calcification/diagnostic imagingABSTRACT
Introducción: las calcificaciones vasculares y valvulares son un hallazgo común en los pacientes en diálisis y se vinculan con una incrementada morbi-mortalidad. Varios métodos radiológicos (TAC multicorte y con emisión de electrones) han sido utilizados para investigar la presencia de calcificaciones vasculares en esta población, pero solo unos pocos trabajos se han focalizado en la radiología simple. Objetivos: Los objetivos de este estudio son evaluar calcificaciones vasculares mediante índice de Kauppila en pacientes prevalentes en hemodiálisis, identificar factores de riesgo vinculados con las mismas y establecer su asociación con calcificación de válvulas cardiacas. Material y métodos: Se estudiaron 95 pacientes estables en hemodiálisis durante un periodo igual o mayor a 6 meses. A todos se les realizó Rx simple perfil de abdomen para evaluar calcificación de la aorta abdominal mediante índice de Kauppila y ecocardiograma bidimensional para detectar calcificaciones valvulares. Se recolectaron datos sobre sexo, edad, diabetes, HTA, tabaquismo, dislipemia y metabolismo óseo-mineral. Resultados: Se demostraron calcificaciones vasculares en el 64,5 % de los pacientes. El índice de Kauppila promedio fue 6,25 La edad y el tiempo en diálisis correlacionaron con calcificación vascular. En 31,6 % de los individuos se objetivaron calcificaciones valvulares, las cuales presentaron asociación significativa con diabetes e índice de Kauppila. Conclusiones: Las calcificaciones vasculares y valvulares fueron frecuentes en la población estudiada. El índice de Kauppila correlacionó con edad, tiempo en diálisis y calcificaciones valvulares. La calcificación de válvulas cardiacas se asoció con diabetes.
Introduction: vascular and valvular calcifications are a frequent complication in dialyzed patients and are connected to an increased morbi-mortality. Many radiological methods (TAC multiple slices and with electrons emission) have been used to investigate the presence of vascular calcifications in this population, but only few works have been focused on simple radiology. Objectives: The objectives of this work are to evaluate vascular calcifications by means of Kauppila index in hemodialysis prevalent patients, identify linked risk factors and determine their association with heart valves calcification. Methods: 95 stable patients under hemodialysis were surveyed during a period of 6 months longer. Abdominal Rx simple profile were performed on all patients to evaluate calcification of abdominal aorta by Kauppila index and twodimensional echocardiogram to detect valvular calcifications. Data were collected about sex, age, diabetes, Hypertension, tabaquism, dislipemia and bone-mineral metabolism. Results: 64.5% of the patients showed vascular calcifications. Average Kauppila index was 6.25. Age and time on dialysis correlated with vascular calcifications. In 31.6 % of individuals valvular calcifications were found, which presented significant association with diabetes and Kauppila Index. Conclusions: Vascular and valvular calcifications were frequent in the surveyed population. Kauppila index correlated with age, time on dialysis and valvular calcifications. Heart valves calcification was associated with diabetes.
Subject(s)
Humans , Calcinosis , Heart Valve Diseases , Renal Dialysis/adverse effects , Vascular DiseasesABSTRACT
As doenças cardiovasculares são a causa mais frequente de morte em pacientes em hemodiálise (HD). A calcificação vascular (CV) é extremamente comum nesses pacientes, e está associada com vários desfechos clínicos, como isquemia cardíaca e mortalidade cardiovascular. A CV está associada com fatores de risco tradicionais como aterosclerose, idade, hipertensão arterial, diabetes mellitus (DM) e dislipidemia, e a fatores de risco não tradicionais, como inflamação, hiperfosfatemia e hiperparatireoidismo. Este estudo de coorte prospectivo observacional teve como objetivo avaliar em pacientes em HD a presença e progressão da CV e a evolução nutricional, assim como identificar variáveis associadas com a progressão da CV e depleção do estado nutricional. Também foi determinado, após 24 meses, o impacto da CV e de variáveis clínicas, demográficas e nutricionais sobre a ocorrência de eventos cardiovasculares e óbito. Quarenta e nove pacientes em HD por no mínimo 90 dias foram incluídos. Ao início do seguimento e após 12 meses foi estimado o escore de calcificação vascular (ECV) pelos métodos de Kauppila e de Adragão, assim como avaliados marcadores clínicos, nutricionais, dialíticos, bioquímicos, hemotológicos e inflamatórios. Duas análise foram realizadas, a primeira com todos os pacientes e a segunda, incluindo apenas aqueles com menos de 60 anos. O modelo de regressão logística foi utilizado para avaliar preditores independentes da presença, progressão e velocidade de progressão da CV, assim como da depleção do estado nutricional, definido pela variação negativa do ângulo de fase (Â) obtido pela biompedância ou mudança da classificação do estado nutricional de bem nutrido para desnutrido pela avaliação subjetiva global (SGA). O modelo múltiplo de regressão de Cox foi utilizado para identificar...
Cardiovascular diseases are the most frequent causes of death in hemodialysis (HD) patients. Vascular calcification (VC) is very common in these patients, and it is associated with many adverse clinical outcomes, including ischemic cardiac events and subsequent cardiovascular mortality. VC has been associated with numerous traditional‟ risk factors to atherosclerosis such as aging, hypertension, diabetes or dyslipidemia, as well as with nontraditional‟ risk factors, such as inflammation, hyper phosphatemia, and hyperparathyroidism. This prospective observational cohort study was designed in order to evaluate HD patients regarding the presence and progression of VC, nutritional evolution, as well as to identify variables associated with VC progression rate and nutritional impairment. Also, we aimed to determine the impact of VC and nutritional characteristics on cardiovascular outcomes and death risk. Forty-nine patients on regular HD over at least 90 days were included. At baseline and after 12 months, VC scores (VCS) were estimated by Kauppila and Adragão methods; nutritional and clinical assessment were performed, dialytic, biochemical, hematologic, and inflammatory markers were obtained. After the follow-up, cardiovascular events and deaths from all causes were recorded over an additional 24 month period. Two analyses were performed, the first with all patients and the second involving those younger than 60 years old. Binary logistic regression models were constructed to evaluate independent predictors of VC presence, progression, and progression rate as well as nutritional impairment, defined by the negative variation of phase angle (A0) in the electrical bioimpedance or subjective global assessment (SGA) change from well-nourished to malnourished...