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Kidney Week

Abstract: PO0390

Vascular Calcification and Progression of CKD

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Bou Slaiman, Salim, Emory University, Atlanta, Georgia, United States
  • Alappan, Harish Raj, Emory University, Atlanta, Georgia, United States
  • O'Neill, W. Charles, Emory University, Atlanta, Georgia, United States
Background

Vascular calcification, particularly the medial form, is common in advanced chronic kidney disease (CKD) and leads to poor outcomes. However, the extent to which medial calcification affects the kidneys and could exacerbate CKD is unknown. To this end, progression of CKD was compared in women with and without breast arterial calcification (BAC), a marker of systemic medial arterial calcification, and the prevalence of renal arterial calcification was assessed radiologically and histologically in patients undergoing nephrectomy.

Methods

Women with CKD (eGFR <60 ml/min/m2) were identified from previous studies of breast arterial calcification, and those with a subsequent measurement of serum creatinine at least 1 year later were included. Consecutive patients with CKD and nephrectomies were identified from a computerized search of medical records. Computed tomography (CT) scans were reviewed for aortic and renal artery calcification, and histology (hematoxylin and eosin staining) was reviewed for calcification of main renal arteries and parenchymal arteries. Current or past warfarin use was an exclusion in all cohorts.

Results

Women with (n=51) and without (n=67) breast arterial calcification had similar yearly eGFR declines (1.55 vs. 1.60 ml/min/1.73 m2) despite a greater age (75.4 ± 1.3 vs 70.4 ± 1.5) and lower baseline eGFR (33.8 ± 1.8 vs. 39.2 ± 1.6) in women with BAC. There was no correlation between the quantity of BAC and the decline in eGFR (r = 0.10). Of 246 patients with nephrectomies who were screened, 50 had an eGFR < 30. End-stage renal disease was present in 82% and 36% had diabetes.CT scans were available in 34 patients and showed aortic and renal artery calcification in 59% and 38%. Prevalences of histologic calcification of renal artery and intraparenchymal arteries were 16% and 15%. When present, calcification of parenchymal arteries was usually very mild, and was severe in only 3 cases and limited to large arteries. In patients with CT scans, only those with renal artery calcification had parenchymal artery calcification (4 of 11 vs. 0 of 17 without, p=0.016).

Conclusion

Vascular calcification does not contribute to the progression of CKD. This is explained by the surprisingly low prevalence and severity of calcification in intrarenal arteries. Patients without renal artery calcification on imaging are at low risk for parenchymal artery calcification.

Funding

  • Clinical Revenue Support