Kidney Week

Abstract: TH-PO130

Vascular Calcification Slows but Does Not Regress After Renal Transplantation

Session Information

• Transplantation: Cardiovascular and Metabolic Diseases
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Alappan, Harish Raj, Emory University - Undergraduate, Atlanta, Georgia, United States

Harish Raj Alappan,

• Vasanth, Payaswini, Emory University, Atlanta, Georgia, United States

Payaswini Vasanth,

• Manzoor, Shumila, Renal Division,Department Of Medicine ,Emory University, Atlanta, Georgia, United States

Shumila Manzoor,

• O'Neill, W. Charles, Emory University, Atlanta, Georgia, United States

W. Charles O'Neill,

Background

While prevention of uremic vascular calcification has been extensively studied, it is not clear whether this lesion is reversible. To address this, we measured the change in breast arterial calcification (BAC), a marker of generalized medial arterial calcification, after successful kidney transplantation (Tx) in women without other risk factors for medial arterial calcification.

Methods

Women with kidney transplantation between 2009 and 2016 who had BAC and at least 2 digital mammograms performed at this institution after Tx were included. Women with diabetes, warfarin use, or serum creatinine > 1.4 were excluded. Breast arterial calcification (BAC) was measured on serial mammograms and linear regression was performed on each patient. Comparison was made to randomly selected cohorts of women with ESRD or eGFR ≥ 60 ml/min/1.73 m².

Results

Characteristics of the final cohort of 16 patients (with ranges) were: mean age at Tx, 56 (39-67); mean pre-Tx ESRD duration, 7.0 years (0.3-14); mean serum creatinine at most recent mammogram, 1.05 mg/dl (0.60-1.40); median baseline BAC, 41 mm/breast (2-776); mean number of mammograms, 3.6 (2-6). The slopes of BAC vs. time showed a mean increase of 5.3 ± 2.6 mm/breast/y or 9.8 ± 5.2 %/y, which was significantly ≥0 (p<0.05). This was significantly less than the rate of 18.1 ± 5.6 mm/breast/y in 23 ESRD women (p=0.017) and similar to the rate of 4.3 ± 0.7 mm/breast/y in 43 women with eGFR ≥ 60 ml/min/1.73 m². The rate decreased in all 3 patients in whom it could also be measured pre-Tx. The post-Tx slope was negative in 7 patients but within the error of the measurement. In the 10 patients with >2 mammograms, none showed consistent decreases in BAC with each mammogram. There was no difference in age, pre-Tx ESRD duration, baseline BAC, or serum creatinine between patients with positive and negative slopes.

Conclusion

We conclude that medial arterial calcification significantly slows but does not regress after renal transplantation. This irreversibility emphasizes the importance of strategies to prevent vascular calcification during CKD and ESRD.

Funding

• Clinical Revenue Support