Outcomes of a multidisciplinary mechanical circulatory support network in cardiogenic shock in a centre without heart transplant program: A successful interprofessional coordination model.

BACKGROUND AND OBJECTIVE: Cardiogenic shock (CS) mortality remains very high and mechanical circulatory support (MCS) may provide an effective alternative of treatment in selected patients. The aim of this study is to analyse the results of a multidisciplinary team care program (including anaesthesiologists, cardiologists, cardiothoracic surgeons, and intensivists) in CS patients who required MCS, in a tertiary centre without a heart transplant (HT) program. METHODS: Prospective observational study that sought to analyse the characteristics and survival to discharge predictors in a consecutive CS patients cohort treated with MCS. RESULTS: A total of 48 patients were included. Mean age was 61 ± 14 years. Before MCS, 45.8% of the patients presented with cardiac arrest. A 54.2% 30-day survival and 45.8% overall survival to discharge, was found. Age and vasoactive-inotropic score were independent predictors of mortality. CONCLUSIONS: A multidisciplinary team-care based MCS program in CS patients is feasible and may achieve favourable results in a centre without HT program.

Resultados de un programa multidisciplinar de soporte circulatorio mecánico en shock cardiogénico en un centro sin programa de trasplante cardiaco: un modelo exitoso de coordinación entre profesionales / Outcomes of a multidisciplinary mechanical circulatory support network in cardiogenic shock in a centre without heart transplant program: A successful interprofessional coordination model

Antecedentes y objetivo: El shock cardiogénico (SC) conlleva una elevada mortalidad, y algunos pacientes pueden beneficiarse del uso de soporte circulatorio mecánico (SCM). El objetivo de este estudio es analizar los resultados de un programa multidisciplinar (constituido por anestesiología y reanimación, cardiología, cirugía cardiaca y medicina intensiva) de atención a pacientes en SC que precisaron SCM en un hospital terciario sin programa de trasplante cardiaco. (TC). Materiales y métodosEstudio prospectivo observacional que analiza las características y predictores de supervivencia hospitalaria de los pacientes con SC que precisaron SCM. Resultados: Se incluyeron 48 pacientes. Edad media 61±14años. El 45,8% presentaron parada cardiaca previa al implante. La supervivencia a 30días fue del 54,2% y la supervivencia al alta hospitalaria, del 45,8%. La edad y la escala de vasoactivos inotrópicos fueron predictores independientes de mortalidad. Conclusiones: La instauración de un programa multidisciplinar de SCM en un centro sin programa de TC es factible y aplicable a pacientes con SC, con resultados favorables en cuanto a supervivencia hospitalaria.(AU)

Background and objective: Cardiogenic shock (CS) mortality remains very high and mechanical circulatory support (MCS) may provide an effective alternative of treatment in selected patients. The aim of this study is to analyse the results of a multidisciplinary team care program (including anaesthesiologists, cardiologists, cardiothoracic surgeons, and intensivists) in CS patients who required MCS, in a tertiary centre without a heart transplant (HT) program. Methods: Prospective observational study that sought to analyse the characteristics and survival to discharge predictors in a consecutive CS patients cohort treated with MCS. Results: A total of 48 patients were included. Mean age was 61 ± 14 years. Before MCS, 45.8% of the patients presented with cardiac arrest. A 54.2% 30-day survival and 45.8% overall survival to discharge, was found. Age and vasoactive-inotropic score were independent predictors of mortality. Conclusions: A multidisciplinary team-care based MCS program in CS patients is feasible and may achieve favourable results in a centre without HT program.(AU)

Incidencia y evolución de la miocardiopatía séptica en una cohorte de pacientes con sepsis y shock séptico / Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock

OBJETIVO: El objetivo de este estudio fue determinar la incidencia de miocardiopatía séptica (MS) en pacientes con sepsis y shock séptico, describir sus características y comprobar su evolución. DISEÑO: Estudio prospectivo sobre una cohorte. PARTICIPANTES: Se incluyeron 57 pacientes consecutivos ingresados en Unidad de Cuidados Intensivos, con criterios de sepsis y shock séptico. Variables de interés principales: Se analizaron variables clínicas y bioquímicas. Se realizó un ecocardiograma en las primeras 24h de ingreso, determinando parámetros de función cardiaca, y si los pacientes presentaban una fracción de eyección de ventrículo izquierdo (FEVI)<50%, se realizó un ecocardiograma evolutivo. Ámbito: Servicio de Medicina Intensiva médico-quirúrgico de adultos en Hospital Universitario. RESULTADOS: La edad media de los pacientes fue de 62,1±16,3 años, el 58% fueron varones. El 22,8% presentaron disfunción de ventrículo izquierdo. La FEVI media en los pacientes con MS fue inferior respecto a los que no la tenían (34,1±10,6 vs. 60,7±6,94%; p < 0,001), con recuperación completa de la misma, en los supervivientes, tras el evento agudo (FEVI al alta 56,1±6,3%; p = 0,04). Los pacientes con MS, presentaban mayores niveles de procalcitonina (47,1±35,4 vs. 18,9±24,5; p = 0,02) y puntuación en la escala Sequential Organ Failure Assessment (SOFA) (9,91±3,82 vs. 7,47±3,41; p = 0,037). La mortalidad no fue significativamente diferente entre ambos grupos (4 [30,8%] vs. 4 [9,1%]; p = 0,07). CONCLUSIONES: La MS no es infrecuente, se relaciona con mayor puntuación en las escalas de gravedad. En los supervivientes, la FEVI se normalizó tras la recuperación del evento agudo

OBJECTIVE: The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution. DESIGN: Prospective cohort study. PARTICIPANTS: We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock. Principal variables of interest: Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed. Ambit: Intensive medical and surgical Care Service for Adults in University Hospital. RESULTS: The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07]. CONCLUSIONS: SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event

Incidence and evolution of sepsis-induced cardiomyopathy in a cohort of patients with sepsis and septic shock. / Incidencia y evolución de la miocardiopatía séptica en una cohorte de pacientes con sepsis y shock séptico.

OBJETIVE: The aim of this study was to establish the incidence of septic cardiomyopathy (SM) in patients with sepsis and septic shock, to describe its characteristics and testing its evolution. DESIGN: Prospective cohort study. PARTICIPANTS: We included 57 consecutive patients admitted to Intensive Care Unit, who met criteria of sepsis and septic shock. PRINCIPAL VARIABLES OF INTEREST: Clinical and biochemical variables were analyzed. An echocardiogram was performed in the first 24hours of admission, determining myocardial function parameters, and if the patients had left ventricular ejection fraction (LVEF)<50%) a second echocardiogram was performed. AMBIT: Intensive medical and surgical Care Service for Adults in University Hospital. RESULTS: The mean age of the patients was 62,1±16,3 years. 58% were males. 22.8% had left ventricular dysfunction. The mean LVEF in patients with MS was lower than those without SM (34.1±10.6 vs 60.7±6.94%, P<.001), with complete recovery, in survivors, after the acute event (LVEF at discharge 56.1±6.3%, P=.04). Patients with SM had higher levels of procalcitonin (47.1±35.4 vs 18.9±24.5; P=.02) and higher score on the Sequential Organ Failure Assessment (SOFA score) (9.91±3.82 vs 7.47±3.41; P=.037). Mortality was not significantly different between both groups [4 (30.8%) vs 4 (9.1%); P=.07]. CONCLUSIONS: SM is not uncommon and is related to a higher scores on the severity scales. In the survivors, LVEF normalized after the recovery of the acute event.

Relación entre el gradiente alveolo-arterial de oxígeno y la PaO2/FiO2 introduciendo la PEEP en el modelo / Relationship between the alveolar-arterial oxygen gradientand PaO2/FiO2-introducing peep into the model

Objetivo: Valorar si el gradiente alveolo-arterial de oxígeno (Grad[A-a]O2) ayuda a confirmar la influencia de la PEEP en la PaFi (PaO2/FiO2). Diseño: Estudio observacional; usamos una regresión lineal para realizar un estudio multivariable y mejorar la fórmula de la PaFi teniendo en cuenta la PEEP. Ámbito: Hospital terciario. Pacientes: Todos los pacientes de cuidados intensivos, con o sin daño pulmonar. Variables de interés principal: Registramos los antecedentes personales, juicio clínico, datos durante ingreso en UCI, puntuaciones de severidad en el primer día y durante evolución; dos variables calculadas: PaFi and Grad(A-a)O2. Resultados: Un total de 956 patientes incluidos; 63,9% hombres; edad mediana 68 años. Primer día, 31,8% no tienen ventilación mecánica (VM), 13,1% tienen VM no invasiva y 55,1% VM invasiva. PaFi: 32,9% 0-200, 32,2% 201-300, y 34,8% >300. PEEP: 0-5 69,8%, 6-10 27,5% y >10 2,6%. Observamos una correlación (Pearson) entre el Grad(A-a)O2 y la PaFi de -0,84 (p<0,001). Realizamos una regresión múltiple (variable dependiente: Grad(A-a)O2Grad[A-a]O2); variables incluidas en el modelo: PaFi, PEEP, APACHE IV y SOFA; coeficiente de determinación (R2) de 0,62 sin PEEP y 0,72 con PEEP. Cambiamos la fórmula de la PaFi, denominándola PaFip (PaFi más PEEP): Ln (PaFi/[PEEP+12]). El índice de correlación entre PaFip y Grad(A-a)O2: -0,9 (p<0,001). Realizamos una regresión lineal (variable dependiente: Grad[A-a]O2) y utilizamos PaFip en vez de la PaFi. Solo la PaFi permanece en el modelo, y es discretamente complementada por APACHE IV; R2 0,8. Conclusiones: Añadiendo la PEEP a la PaFi, creamos una variable (PaFip) que mejora el modelo, demostrando mayor capacidad de bondad de ajuste (AU)

Objectives To determine whether the alveolar-arterial oxygen gradient (Grad[A-a]O2) helps confirm the influence of PEEP on PaFi (PaO2/FiO2). Design: Observational study; we used linear regression to perform a multivariate study to improve the PaFi formula by taking PEEP into account. Setting: Tertiary hospital. Patients: We included all patients who were admitted to the intensive care unit, regardless of pulmonary damage. Variables: We recorded personal history, clinical judgment, intensive care data, severity scores on the first day and progression. Two calculated variables: PaFi and Grad(A-a)O2. Results: A total of 956 patients were included: 63.9% men; median age 68 years. On the first day, 31.8% did not have mechanical ventilation (MV), 13.1% had non-invasive MV and 55.1% had invasive MV. PaFi values: 32.9% 0-200, 32.2% 201-300, and 34.8% >300. PEEP values: 0-5 69.8%, 6-10 27.5% and >10 2.6%. We observed a correlation (Pearson) between Grad(A-a)O2 and PaFi of -0.84 (p<0.001). On performing multiple regression (dependent variable: Grad[A-a]O2), the following variables were included in the model: PaFi, PEEP, APACHE IV and SOFA; coefficient of determination (R2) of 0.62 without PEEP and 0.72 with PEEP. We changed the PaFi formula, referring to it as PaFip (PaFi plus PEEP): Ln (PaFi/[PEEP+12]). Correlation index between PaFip and Grad(A-a)O2: -0.9 (p<0.001). We performed linear regression (dependent variable: Grad[A-a]O2) and used PaFip instead of PaFi. Only PaFi remained in the model, and was discretely complemented by APACHE IV; R2=0.8. Conclusions: By adding PEEP to the PaFi model (PaFip), we clearly improve the latter, as reflected by a better goodness of fit (AU)

Variación esperable de parámetros medidos en el implante y seguimiento de electrodos de fijación activa de marcapasos definitivos / Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes

Objetivos: Analizar la variación de parámetros relativos al electrodo de fijación activa en el implante y seguimiento posterior durante 6 meses de fase aguda de implante. Diseño: Estudio descriptivo, analítico, prospectivo, observacional sobre cohorte de casos sucesivos durante 8 meses (abril-diciembre de 2010). Ámbito: Unidad de electro-estimulación cardiaca de un Servicio de Medicina Intensiva. Pacientes o participantes: Pacientes sometidos a implante de marcapasos definitivo con electrodos de fijación activa, implantados en aurícula y ventrículo, Intervenciones: medición de variables descritas con analizador de umbrales durante la fijación de electrodo y en los diferentes momentos del estudio, Variables principales que se comparan; umbral, impedancia y actividad intrínseca tanto auricular como ventricular antes y después de la fijación del electrodo, a las 48h, al mes y 6 meses de seguimiento, Se realizaron comparaciones utilizando test T-student para datos pareados; con significación si p<0,05 y un test ANOVA para analizar los cambios sucesivos del seguimiento ambulatorio. Resultados: Se analizan 40 pacientes, 19 electrodos auriculares y 40 ventriculares, En la fijación del electrodo varía de forma significativa la impedancia del electrodo auricular (1,188,53±397,26 vs 610,69±326,30 ohmnios, p<0,0001) y ventricular (1,512,93±718,07 vs 768,80±224,90 ohmnios, p>0,0001), A las 48h se suma una disminución del umbral de (..) (AU)

Objectives: To analyze the variations in the parameters relative to active fixation electrodes at the time of implantation and over subsequent follow-up during 6 months of the acute phase of implantation. Design: A descriptive, analytical, prospective, observational cohort study was made of consecutive cases over a period of 8 months (April-December 2010). Setting: Pacing unit of an Intensive Care Unit. Patients or participants: Patients undergoing permanent pacemaker implantation with active fixation electrodes, implanted in both atrium and ventricle, Interventions: Measurement of variables described with a threshold analyzer during electrode fixation and at different times during the study, Main compared variables: threshold, impedance and intrinsic activity (both atrial and ventricular) before and after fixation, at 48hours, at one month and 6 months, Comparisons were made using the Student t-test for paired data, assuming significance for p<0,05, and ANOVA to analyze the successive changes over ambulatory follow-up. Results: We analyzed 40 patients, with 19 atrial and 40 ventricular electrodes, In fixation, the electrodes showed significant variation in the impedance (..) (AU)

[Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes]. / Variación esperable de parámetros medidos en el implante y seguimiento de electrodos de fijación activa de marcapasos definitivos.

OBJECTIVES: To analyze the variations in the parameters relative to active fixation electrodes at the time of implantation and over subsequent follow-up during 6 months of the acute phase of implantation. DESIGN: A descriptive, analytical, prospective, observational cohort study was made of consecutive cases over a period of 8 months (April-December 2010). SETTING: Pacing unit of an Intensive Care Unit. PATIENTS OR PARTICIPANTS: Patients undergoing permanent pacemaker implantation with active fixation electrodes, implanted in both atrium and ventricle, Interventions: Measurement of variables described with a threshold analyzer during electrode fixation and at different times during the study, Main compared variables: threshold, impedance and intrinsic activity (both atrial and ventricular) before and after fixation, at 48 hours, at one month and 6 months, Comparisons were made using the Student t-test for paired data, assuming significance for p<0,05, and ANOVA to analyze the successive changes over ambulatory follow-up. RESULTS: We analyzed 40 patients, with 19 atrial and 40 ventricular electrodes, In fixation, the electrodes showed significant variation in the impedance values of the atrial lead (1,188,53 ± 397,26 vs 610,69 ± 326,30 ohms, p<0,0001) and ventricular lead (1,512,93 ± 718,07 vs 768,80 ± 224,90 ohms, p>0,0001), In the first 48 hours it was coupled with a decrease in ventricular (0,86 ± 0,35 vs 0,48 ± 0,23 volts, p = 0,0001) and atrial pacing threshold (1,10 ± 0,39 vs 0,43 ± 0,23 volts, p = 0,0003), and p-wave sensing (3,61 ± 2,25 vs 2,32 ± 1,09 mV, p = 0,0463), Over follow-up we found the parameters to be stable, with no significant changes. CONCLUSIONS: After active lead fixation, a fall in impedance of the antrial and ventricular is expected, Over the next 48 hours improvement in atrial and ventricular threshold may occur, in contrast to the sensitivity of the intrinsic activity, which reached significance at the P wave measured after 48 hours, These values stabilize over patient follow-up and do not differ significantly in the studied acute patient course.

[Relationship between the alveolar-arterial oxygen gradient and PaO2/FiO2-introducing PEEP into the model]. / Relación entre el gradiente alveolo-arterial de oxígeno y la PaO2/FiO2 introduciendo la PEEP en el modelo.

OBJECTIVES: To determine whether the alveolar-arterial oxygen gradient (Grad[A-a]O2) helps confirm the influence of PEEP on PaFi (PaO2/FiO2). DESIGN: Observational study; we used linear regression to perform a multivariate study to improve the PaFi formula by taking PEEP into account. SETTING: Tertiary hospital. PATIENTS: We included all patients who were admitted to the intensive care unit, regardless of pulmonary damage. VARIABLES: We recorded personal history, clinical judgment, intensive care data, severity scores on the first day and progression. Two calculated variables: PaFi and Grad(A-a)O2. RESULTS: A total of 956 patients were included: 63.9% men; median age 68 years. On the first day, 31.8% did not have mechanical ventilation (MV), 13.1% had non-invasive MV and 55.1% had invasive MV. PaFi values: 32.9% 0-200, 32.2% 201-300, and 34.8% >300. PEEP values: 0-5 69.8%, 6-10 27.5% and >10 2.6%. We observed a correlation (Pearson) between Grad(A-a)O2 and PaFi of -0.84 (p<0.001). On performing multiple regression (dependent variable: Grad[A-a]O2), the following variables were included in the model: PaFi, PEEP, APACHE IV and SOFA; coefficient of determination (R²) of 0.62 without PEEP and 0.72 with PEEP. We changed the PaFi formula, referring to it as PaFip (PaFi plus PEEP): Ln (PaFi/[PEEP+12]). Correlation index between PaFip and Grad(A-a)O2: -0.9 (p<0.001). We performed linear regression (dependent variable: Grad[A-a]O2) and used PaFip instead of PaFi. Only PaFi remained in the model, and was discretely complemented by APACHE IV; R²=0.8. CONCLUSIONS: By adding PEEP to the PaFi model (PaFip), we clearly improve the latter, as reflected by a better goodness of fit.

[Cardiovascular risk in women with chronic renal failure: mammographic study of vascular calcifications]. / Mamografía y riesgo cardionefrovascular. Estudio de las calcificaciones vasculares en la insuficiencia renal crónica.

OBJECTIVES: Vascular calcifications are markers of cardiovascular risk in patients with chronic renal failure, and 50% of the deaths in chronic renal failure are due to cardiovascular disease. We analyzed vascular calcifications at mammography in women with chronic renal failure, comparing the vascular calcifications seen at mammography and in skeletal x-ray examinations and analyzing their relation to cardiovascular disease and laboratory parameters. MATERIALS AND METHODS: We studied the vascular calcifications seen at mammography and in skeletal x-ray examinations in 61 patients (45 dialysis and 16 pre-dialysis) and correlated them with age, time in dialysis, cardiovascular signs and symptoms, glycemia, arterial blood pressure, PTH, phosphorus, calcium, cholesterol (LDL/HDL), atherogenic index, triglycerides, and inflammatory markers. The statistical analysis was performed using SPSS 11.0 . RESULTS: Vascular calcifications were found in 55.7% of patients at mammography and in a similar percentage in skeletal x-ray examinations; 18% of the women had vascular calcifications at mammography but not in skeletal x-ray examinations, whereas 19.6% had vascular calcifications in skeletal x-ray examinations but not at mammography. Vascular calcifications were found in 60% of the women undergoing dialysis and in 30% of the women who had yet to undergo dialysis. Women with vascular calcifications at mammography were older (p < 0.05), had higher blood glucose (p < 0.05), PTH, phosphorus, and LDL cholesterol. They also had higher ferritin and C-reactive protein levels (p < 0.05) and had more cardiovascular events (myocardial infarction, with p < 0.05). Their HDL and albumin levels (p < 0.05) and blood pressure were lower than in women without vascular calcifications at mammography. CONCLUSIONS: The presence of vascular calcifications at mammography is associated to increased cardiovascular risk, and this increase is already evident before dialysis. Early diagnosis of cardiovascular risk should help reduce morbidity and mortality in these patients. The study of vascular calcifications at mammography complements skeletal x-ray examinations. Vascular calcifications at mammography are associated to abnormalities in bone metabolism, dyslipemia, and chronic inflammation.

Mamografía y riesgo cardionefrovascular. Estudio de las calcificaciones vasculares en la insuficiencia renal crónica / Cardiovascular risk in women with chronic renal failure: mammographic study of vascular calcifications

Objetivos. Las calcificaciones vasculares (CV) son marcadores de riesgo cardiovascular en la insuficiencia renal crónica (IRC). El 50% de las muertes en la IRC son por patología cardiovascular. Analizamos las CV en la mamografía (MX) en mujeres con IRC comparando con las presentes en la serie ósea (SO), su relación con la patología cardiovascular y con parámetros analíticos. Materiales y métodos. Estudiamos las CV en MX y en SO en 61 pacientes (45 diálisis y 16 prediálisis) y las correlacionamos con la edad, el tiempo en diálisis, la clínica cardiovascular, la glucemia, la presión arterial, la hormona paratiroidea (PTH), el fósforo, el calcio, el colesterol ligado a lipoproteínas de baja densidad (LDL) y de alta densidad (HDL), el índice aterogénico, los triglicéridos y los marcadores inflamatorios. El análisis estadístico se llevó a cabo con el progama SPSS 11.0 . Resultados. El 55,7% presentaron CV en la MX con porcentaje similar en la SO. Un 18% de las mujeres han tenido CV en la MX, pero no en la SO. Este porcentaje es de 19,6% para las mujeres con CV en SO y no en mamografía. Las CV aparecieron en más del 60% de las mujeres en diálisis y en el 30% en prediálisis. La edad media con CV en la MX fue superior (p < 0,05) con cifras mayores de glucemia (p < 0,05), PTH, fósforo y colesterol LDL. Los niveles de proteína C reactiva y de ferritina fueron más elevados (p < 0,05) y presentaron más eventos cardiovasculares (infarto de miocardio con p < 0,05). Niveles inferiores de HDL y albúmina (p < 0,05) y de presión arterial aparecieron en mujeres con CV en la MX. Conclusiones. La presencia de CV en la MX se asocia a mayor riesgo cardiovascular, que aparece ya aumentado en prediálisis. Su diagnóstico precoz debe contribuir a disminuir la morbimortalidad. El estudio de las CV por MX es un método complementario a la SO. Las CV en la MX se asocian a anormalidades en el metabolismo óseo, a un estado dislipémico e inflamatorio crónico

Objectives. Vascular calcifications are markers of cardiovascular risk in patients with chronic renal failure, and 50% of the deaths in chronic renal failure are due to cardiovascular disease. We analyzed vascular calcifications at mammography in women with chronic renal failure, comparing the vascular calcifications seen at mammography and in skeletal x-ray examinations and analyzing their relation to cardiovascular disease and laboratory parameters. Materials and methods. We studied the vascular calcifications seen at mammography and in skeletal x-ray examinations in 61 patients (45 dialysis and 16 pre-dialysis) and correlated them with age, time in dialysis, cardiovascular signs and symptoms, glycemia, arterial blood pressure, PTH, phosphorus, calcium, cholesterol (LDL/HDL), atherogenic index, triglycerides, and inflammatory markers. The statistical analysis was performed using SPSS 11.0 . Results. Vascular calcifications were found in 55.7% of patients at mammography and in a similar percentage in skeletal x-ray examinations; 18% of the women had vascular calcifications at mammography but not in skeletal x-ray examinations, whereas 19.6% had vascular calcifications in skeletal x-ray examinations but not at mammography. Vascular calcifications were found in 60% of the women undergoing dialysis and in 30% of the women who had yet to undergo dialysis. Women with vascular calcifications at mammography were older (p < 0.05), had higher blood glucose (p < 0.05), PTH, phosphorus, and LDL cholesterol. They also had higher ferritin and C-reactive protein levels (p < 0.05) and had more cardiovascular events (myocardial infarction, with p < 0.05). Their HDL and albumin levels (p < 0.05) and blood pressure were lower than in women without vascular calcifications at mammography. Conclusions. The presence of vascular calcifications at mammography is associated to increased cardiovascular risk, and this increase is already evident before dialysis. Early diagnosis of cardiovascular risk should help reduce morbidity and mortality in these patients. The study of vascular calcifications at mammography complements skeletal x-ray examinations. Vascular calcifications at mammography are associated to abnormalities in bone metabolism, dyslipemia, and chronic inflammation