ABSTRACT
Several biomolecules potentially serve as promoters or inhibitors of calcification in dialysis patients which include fetuin A, matrix gla protein, osteopontin, osteoprotegerin, etc. The primary aim was to compare the biomarkers of coronary artery calcification (CAC) and to study its role as predictors of CAC in hemodialysis (HD) patients. Of 126 patients undergoing chronic HD, 100 patients completed the study. Blood samples were drawn for serum creatinine, electrolytes, calcium, phosphorus, Vitamin D3, parathyroid hormone (PTH), lipid profile, high sensitivity C-reactive protein, ferritin, fetuin A, and fibroblast growth factor-23 (FGF-23). Non-contrast Computed Tomography scan of the coronary arteries was conducted on all participants. Participants who were positive for CAC (P group) were compared with those negative for CAC (N group) using two sample t-test. Multiple logistic regression analysis was conducted to determine the predictors of CAC. The prevalence of vascular calcification (VC) was 60% with higher prevalence seen in males (71%), older age group, patients with dialysis vintage >5 years (27%), and diabetic population (62%). Mean serum phosphorus was significantly higher (P <0.001) and fetuin A (P <0.001) was significantly lower in the P group. Age (OR: 1.2, P = 0.004), serum phosphorus (OR: 1.8, P = 0.024), and fetuin A (OR: 0.0006, P = 0.001) were found as predictors of CAC. CAC was more prevalent in males, patients with higher age group and in those with longer dialysis vintage and diabetic population. Participants with CAC exhibited significantly high phosphorus and low fetuin A levels. Age, phosphorus level, and fetuin A were found to be predictors of CAC in dialysis patients. FGF-23 could not predict CAC.
Subject(s)
Coronary Artery Disease , Kidney Failure, Chronic , Renal Dialysis , Vascular Calcification , Adult , Biomarkers/blood , Coronary Artery Disease/blood , Coronary Artery Disease/diagnosis , Coronary Artery Disease/epidemiology , Coronary Artery Disease/etiology , Coronary Vessels/physiopathology , Cross-Sectional Studies , Female , Fibroblast Growth Factor-23 , Humans , India , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Vascular Calcification/blood , Vascular Calcification/diagnosis , Vascular Calcification/epidemiology , Vascular Calcification/etiologyABSTRACT
BACKGROUND: Appropriate use criteria (AUC) for single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to include 15 new clinical scenarios. We assessed multivariable predictors and overall appropriateness of MPI studies performed in a rural tertiary care setting. HYPOTHESIS: We hypothesized that appropriate utilization rates of SPECT MPI imaging in a rural tertiary care center are similar for cardiology and non cardiology providers. METHODS: We reviewed all SPECT MPI studies performed for over a 6-month period at our center. Using 67 scenarios in AUC, we categorized these studies as appropriate, inappropriate, uncertain, or unclassifiable. RESULTS: Of 328 MPI studies, 287 (88%) studies were classified as appropriate, 18 (5.5%) as inappropriate, 23 (7%) as uncertain, and none as unclassifiable. Preoperative testing accounted for 44% of the inappropriate studies; 61% of uncertain tests were ordered for cardiovascular risk assessment in patients with prior normal coronary angiography or normal stress tests. The ordering provider specialty did not show any relation with appropriateness of the test (P = 0.46). Patients with inappropriate and uncertain studies were younger than patients with appropriate studies (P = 0.007). CONCLUSIONS: We found that a majority of MPI studies are performed for appropriate indications regardless of ordering provider specialty. Few common scenarios accounted for the majority of the inappropriate or uncertain studies.
