Journal Article

Aortic calcification in haemodialysis patients with diabetes mellitus

Hiromichi Taniwaki, Eiji Ishimura, Tsutomu Tabata, Yoshihiro Tsujimoto, Atushi Shioi, Tetsuo Shoji, Masaaki Inaba, Takashi Inoue and Yoshiki Nishizawa

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 20, issue 11, pages 2472-2478
Published in print November 2005 | ISSN: 0931-0509
Published online August 2005 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfi039
Aortic calcification in haemodialysis patients with diabetes mellitus

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Background. Certain metabolic disorders, such as hyperphosphatemia induce vascular calcification in haemodialysis patients; it is unclear, however, whether these disorders contribute to aortic calcification in diabetic haemodialysis patients. This study examined the risk factors of aortic calcification in a large number of haemodialysis patients, and compared risk factors between diabetic and non-diabetic patients.

Methods. The subjects were 667 patients on maintenance haemodialysis: 184 with type 2 diabetes and 483 without. Aortic calcification was measured semi-quantitatively using a plain computed tomography image of the abdominal aorta, and an aortic calcification index (ACI) was calculated.

Results. The ACI of the diabetic subjects was significantly higher than that of those without diabetes (57.3±22.1 vs 44.8±28.3%, P<0.0001), although the dialysis vintage of the former was significantly shorter (P<0.001). Multiple regression analyses showed that diabetes was a significant independent risk factor for increased ACI. Multiple regression analyses, performed separately in diabetics and non-diabetics, revealed that advanced age, higher systolic blood pressure, smoking and longer haemodialysis vintage were common independent risk factors significantly associated with increased ACI in both patient groups (R2 = 0.296, P<0.0001 for non-diabetics; R2 = 0.193, P<0.0001 for diabetics). Higher serum phosphate concentration was not significantly associated with increased ACI in diabetic patients (P = 0.429), although it was a significant independent factor in non-diabetic patients (β = 0.150, P<0.0005).

Conclusion. Aortic calcification in diabetic haemodialysis patients is more advanced, compared with non-diabetic patients, even with short haemodialysis vintage. Since disorders of mineral metabolism are not significantly associated with aortic calcification in diabetic haemodialysis patients, aortic calcification in these patients could be affected by metabolic abnormalities associated with the diabetic state per se, independent of other confounding factors; and aortic calcification may be advanced even before haemodialysis induction.

Keywords: aortic calcification; haemodialysis; phosphate; type 2 diabetes

Journal Article.  4014 words.  Illustrated.

Subjects: Nephrology

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