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Abstract: TH-PO222

Progression of Medial Arterial Calcification in CKD and ESRD

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • O'Neill, W. Charles, Renal Division,Department Of Medicine ,Emory University, ATLANTA, Georgia, United States
  • Manzoor, Shumila, Renal Division,Department Of Medicine ,Emory University, ATLANTA, Georgia, United States

Medial arterial calcification, as distinguished from atherosclerotic calcification, is common in chronic kidney disease (CKD) and portends poor clinical outcomes, but its progression relative to the severity of CKD and the role of other risk factors is unknown. Calcification of breast arteries detected by mammography, a marker of generalized medial calcification, was used to measure progression in women with CKD and end-stage renal disease (ESRD).


Women with and without CKD were identified from a computerized search of medical records. Subjects with current warfarin use, which is associated with medial arterial calcification, were excluded. Estimated glomerular filtration rate (eGFR) was determined by the four-variable MDRD formula and ESRD was defined as chronic outpatient hemodialysis. The lengths of calcified segments of breast arteries on digital mammograms were summed and expressed as millimeters per breast. Results are presented as medians and interquartile ranges with analysis by the Mann-Whitney U or Kruskall-Wallis test.


Progression of calcification was measured in 60 control subjects (estimated glomerular filtration rate (eGFR) > 90 ml/min/1.73 m2) and 137 subjects with CKD (eGFR <90 ml/min/1.73 m2) divided into tertiles by eGFR (Table). Progression in control subjects was linear over time and independent of age. An increased rate of progression was observed only in the lowest CKD tertile (eGFR <40 ml/min/1.73 m2), p=0.006. Progression accelerated markedly in ESRD (n=36), with a median of 20 mm/breast/y (7.4-51), p=0.006 vs CKD 3rd tertile. Diabetes significantly augmented progression in CKD (2-fold, p=0.029) and ESRD (4.4-fold, p=0.004) but not in the absence of CKD:4.0 (1.1-8.5) vs. 3.9 (0.7-7.8) mm/breast/y.


CKD is a risk factor for medial arterial calcification but only when advanced (eGFR < 40 ml/min/m2). This is consistent with hyperphosphatemia rather than earlier derangements in mineral metabolism as a contributing factor. Progression is markedly accelerated in ESRD patients, suggesting the possibility of dialysis-specific effects. Diabetes is a significant risk factor in the presence of CKD or ESRD.

eGFR (ml/min/1.73 m2)90-17053-9040-526-39
Age77.0 ± 1.074.4 ± 1.278.3 ± 1.073.4 ± 1.5
Diabetes (%)28332633
Δ BAC (mm/breast/y)3.9 (0.7-8.0)3.3 (0.3-6.2)4.2 (0.3-10)8.1 (2.4-23) *

* p = 0.006


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