[Non invasive evaluation of vascular calcifications in patients on hemodyalisis].

INTRODUCTION: Cardiovascular diseases are one of the main causes of morbidity and mortality in dialysis patients. High incidence of cardiovascular diseases in patients with chronic kidney disease (CKD) can not soley be explained by traditional risk factors. Several studies have confirmed association between vascular calcification and increased mortality.

MATERIALS AND METHODS: This study included total of 44 patients on chronic hemodialysis program, 18 women and 26 men, with average age of 50.66 +/- 11.62 years and average duration of treatment of 100.25=52.83 months. We analyzed socio-demographic parameters and standard laboratory findings. X-ray of hand and pelvis was obtained from each patient along with echocardiography and carotid ultrasound imaging. To estimate the level of vascular calcifications on the X-rays, we used the simple vascular score (sVC).

RESULTS: Using noninvasive methods, we found vascular calcifications in 26 (59%) patients. In 22 (45%) patients, vascular calcifications were found in X-rays. Four (9%) patients with vascular calcifications lacked any abnormality on X-rays but had calcified plaques on carotid arteries or hart valves. In the group of patients that had vascular calcifications, 3 (14%) patients had sVC score of 2,2 (9%) had score of 3,7 (32%) had score of 4,4 (18%) had score of 6, and 6 (27%) had sVC score of 8. Comparing the group of patients with and without vascular calcifications, we found statistically significant age difference (p<0.05) as well as difference in the duration of hemodialysis (p<0.05). There were no other significant differences found between the two groups. There is a statistically significant correlation between sVC score and level of calcium (p<0.09) and iPTH (p<0.05). Using regression model for increase of sVC score, we found significant correlation with duration of hemodialysis (p<0.05).

CONCLUSION: Existence of vascular calcifications represents warning sign of increased cardiovascular risk. Simple vascular score is an easy method for assessing that risk. In our study, increased frequency of vascular calcifications was directly correlated with older age and length of hemodialysis. Standard X-rays, echocardiography and ultrasound imaging can be used in screening of vascular calcifications. Among these methods, X-ray has advantage because it is widely available and easy to interpret.