Vascular Calcification Can Predict Mortality in Predialysis Chronic Kidney Disease

Dr. José L. Górriz Department of Medicine and Nephrology Valencia Hospital Universitario Valencia. Interview with:
Dr. José L. Górriz
Department of Medicine and Nephrology
Valencia Hospital Universitario
Valencia. Spain

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Górriz: The background of the study is that several studies have reported on the high prevalence of vascular calcification in chronic kidney disease (CKD) patients not on dialysis. Vascular calcification (VC) has been associated with high cardiovascular mortality in patients on dialysis, but there are no studies in patients in stages before dialysis which analyse the prognostic significance of the presence of Vascular calcification assessed by simple X-ray.

Vascular calcification can occur in both the intima and media of the vessel wall. Intimal calcification is an indicator of atherosclerosis and is associated with ischemic heart disease and medial calcification is associated with arterial stiffness, systolic hypertension, and left ventricular hypertrophy.

Although Vascular calcification can be assessed by various methods, such as ultrasonography, tomography, and arteriography, simple radiology has the advantages of being simple, inexpensive, and commonly applicable in daily clinical practice.

OSERCE 2 is an observational, multicentre and 3-year prospective study performed in 39 Nephrology centres in Spain, which analyzes the presence of Vascular calcification in CKD patients stages 3 and 4 (eGFR between 15-59 ml/min/1,73 m2) and its effect on morbimortality (death, hospitalization and renal progression).

The main findings of the study were that Vascular calcification is highly prevalent in patients with chronic kidney disease, and Vascular calcification assessment using AS independently predicts death and time to hospitalization.

Therefore, it could be a useful index to identify patients with chronic kidney disease at high risk of death and morbidity as previously reported in patients on dialysis.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Górriz: Using X-ray assessment, they are two indexes which analyse Vascular calcification, Kauppila score (aortic calcification of lumbar aorta) and Adragao score (detects VC in iliac, femoral, radial, and digital arteries). Our study demonstrates the Kauppila is mainly related to atherosclerotic traditional risk factors and age and don’t predict mortality after adjusting by age. But Adragao score predicts mortality and risk of hospitalization in chronic kidney disease patients. When we analysed only Vascular calcification in hands (Adragado score-hands) we can predict mortality, since Vascular calcification in hand only affects to muscular arteries and it is related to alterations in mineral metabolism due to CKD. A simple X-ray of the hands can predict mortality in chronic kidney disease patients.

The main message of the study is that Vascular calcification is common in predialysis CKD, can predict mortality and hospitalization. The study supports the importance of differentiating intimal and medial calcification because participants with medial calcification had a higher risk of all-cause and cardiovascular mortality, but patients with intimal calcification did not (based on plain radiography).

This information may be used to update the guidelines and management of CKD-MBD and improve its diagnosis, treatment, and prognosis through a multidisciplinary approach.

The nephrology community needs to focus on studies of Vascular calcification as a way of improving outcomes for our patients.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Górriz: Concerning the assessment of Vascular calcification, it would be of interest to validate our results with other more complex imaging techniques such as vascular ultrasonography, carotid ultrasonography or computed tomography in other territories (i.e. coronary arteries)

On the other hand, once we have assessed the importance of Vascular calcification and chronic kidney disease we need clinical trials to assess if interventions to slow the progression of Vascular calcification in this population may be feasible, especially interventions in chronic kidney disease-mineral bone disorders markers (calcium, phosphorus, parathyroid hormone, vitamin D and other) that were not fully evaluated in the study.


Vascular Calcification in Patients with Nondialysis CKD over 3 Years.

José L. Górriz, Pablo Molina, M. Jesús Cerverón, Rocío Vila, Jordi Bover, Javier Nieto, Guillermina Barril, Alberto Martínez-Castelao, Elvira Fernández, Verónica Escudero, Celestino Piñera, Teresa Adragao, Juan F. Navarro-Gonzalez, Luis M. Molinero, Cristina Castro-Alonso, Luis M. Pallardó, and Sophie A. Jama

CJASN CJN.07450714; published ahead of print March 13, 2015, doi:10.2215/CJN.07450714 Interview with: Dr. José L. Górriz (2015). Vascular Calcification Can Predict Mortality in Predialysis Chronic Kidney Disease