[Vascular and tissue calcifications of hemodialysis patients]. / Calcificaciones vasculares y de tejidos de pacientes en hemodiálisis.

The present paper aims to assess radiographic vascular and soft parts calcifications occurrence and its correlation with biochemical profiles. The study was performed in 47 patients (ten diabetic patients), 49 years old, who had been on dialysis for a period of 51 months. Vascular calcifications (VCs) were classified as proximal, distal and soft tissues. In addition, Ca, P, CaxP values in the six months prior to the recruitment period, PTH, FAL and calcium carbonate, calcium acetate, and vitamin D3 intake were determined. A higher frequency of VCs was observed in diabetics, yielding a significant association with proximal 60% (p = 0.05) and almost significant with distal calcifications 70% (p = 0.07). Likewise, a lower CaxP was noted for diabetic VCs in comparison to that seen in non-diabetic VCs (p < 0.05). Proximal and distal VCs in the non-diabetics population were 25% and 20%, respectively; and tissue calcifications were 24%. Age was correlated with proximal and distal VCs (p < 0.01). A higher CaxP was observed in patients with VCs and it yielded an even higher value for tissue calcifications. Lastly, calcium acetate and overall calcium intake was higher in patients with tissue calcifications (p = 0.05). VCs were more frequent in diabetics and they also showed a lower CaxP. VCs in non-diabetics were correlated with CaxP values, whereas tissue calcifications were associated with calcium intake. Therefore, the management of renal osteodystrophy should be changed in order to prevent calcifications as well as to decrease morbidity in hemodialysis patients.

Calcificaciones vasculares y de tejidos de pacientes en hemodiálisis / Vascular and tissue calcifications in haemodialysis patients

Las calcificaciones de los tejidos se han clasificado como metastásicas debido a la elevación de Ca, P, CaxP y PTH o distróficos por anormalidad en los tejidos. La marcada rapidez con que ocurren en los pacientes con IRC sugiere que ambos mecanismos están presentes y contribuyen entre sí. Nuestro objetivo fue establecer mediante Rx la incidencia de calcificaciones vasculares y de partes blandas y relacionarlos con perfiles bioquímicos. Material y métodos: Se incluyeron 47 pacientes (24 mujeres y 23 varones), 10 diabéticos, con edad de 49 años, con un tiempo en HD de 51 ± 31 meses. Se les realizó Rx de manos, pies y hombros bilateral, abdomen, pelvis y tórax. Se clasificó a las calcificaciones vasculares (CV) en proximales (aorta, ilíacas, femoral) y distales (digitales) y de tejidos blandos a las musculares, periarticulares o de órganos. Se determinó Ca, P, CaxP durante 6 meses previos, PTH, fosfatasa alcalina e ingesta de carbonato de Ca, acetato de Ca y vitamina D3. Se estudió la relación entre diabéticos y no diabéticos y luego estos últimos fueron excluidos del análisis. Se aplicó test de Fisher, test de Kruskal-Wallis y test de Mann-Whitney. Resultados: Las CV fueron más frecuentes en diabéticos, resultando significativa la asociación de la calcificación proximal 60% (p = 0,05) y casi significativa en la distal 70% (p = 0,07) en relación a los no diabéticos. El CaxP en los diabéticos con CV fue menor que en los no diabéticos con CV (p < 0,05). En la población no diabética las CV proximal y distal fueron del 25% y 20% respectivamente y la de tejidos del 24%: la edad se correlacionó con las CV proximal (p = 0,006) y distal (p = 0,0006). El CaxP fue mayor en pacientes con CV y aún más en calcificaciones de tejidos. La ingesta de acetato de Ca y el Ca total fue mayor en pacientes con calcificación de tejidos (p < 0,0045). Conclusiones: Las CV fueron más frecuentes en diabéticos y con CaxP menor. En no diabéticos, las CV y de tejidos se relacionaron con CaxP y las de tejidos con la ingesta de Ca. Es necesario un cambio en el manejo de la osteodistrofia renal para prevenir las calcificaciones y de esta manera disminuir la morbilidad de los pacientes en hemodiálisis (AU)

The present paper aims to assess radiographic vascular and soft parts calcifications occurrence and its correlation with biochemical profiles. The study was performed in 47 patients (ten diabetic patients), 49 years old, who had been on dialysis for a period of 51 months. Vascular calcifications (VCs) were classified as proximal, distal and soft tissues. In addition, Ca, P, CaxP values in the six months prior to the recruitment period, PTH, FAL and calcium carbonate, calcium acetate, and vitamin D3 intake were determined. A higher frequency of VCs was observed in diabetics, yielding a significant association with proximal 60% (p = 0.05) and almost significant with distal calcifications 70% (p = 0.07). Likewise, a lower CaxP was noted for diabetic VCs in comparison to that seen in non-diabetic VCs (p < 0.05). Proximal and distal VCs in the non-diabetics population were 25% and 20%, respectively; and tissue calcifications were 24%. Age was correlated with proximal and distal VCs (p < 0.01). A higher CaxP was observed in patients with VCs and it yielded an even higher value for tissue calcifications. Lastly, calcium acetate and overall calcium intake was higher in patients with tissue calcifications (p = 0.05). VCs were more frequent in diabetics and they also showed a lower CaxP. VCs in non-diabetics were correlated with CaxP values, whereas tissue calcifications were associated with calcium intake. Therefore, the management of renal osteodystrophy should be changed in order to prevent calcifications as well as to decrease morbidity in hemodialysis patients (AU)