Background: Vascular calcifications (VCs) contribute to the massive mortality in hemodialysis (HD) patients. We aimed to identify prevalence and risk factors for arterial medial calcifications (AMCs) versus intimal calcifications (AICs) in a single-center HD population.
Methods: This cross-sectional study included 134 patients, mean age 56.9 ± 9.7 years, on HD for 8.2 ± 5.0 years. VCs were scored based on plain radiographs and ultrasonography of the common carotid arteries.
Results: Patients were categorized into groups I (13% without VC), II (10% with an AMC pattern), III (24% with an AIC pattern) and IV (53% with a mixed pattern). AIC and mixed patterns were associated with older age (p=0.006 and p=0.004, respectively), and mixed pattern with longer dialysis vintage (p=0.001). Pulse pressure was significantly higher in patients from group III than group IV, and intima-media thickness (IMT) was higher in both groups with AIC. By multivariate analysis, risk factors for any VC were high serum Ca, phosphate, Ca×P product, low total protein, high body mass index (BMI), systolic and diastolic blood pressure, IMT and history of smoking. Elevated calcium and/or phosphate predicted an AMC pattern, and high calcium, BMI and IMT an AIC pattern. Finally, high IMT, systolic blood pressure, BMI and older age were predictors of a mixed pattern.
Conclusion: We observed a very high prevalence of VC, mostly with a mixed AIC+AMC pattern. Apart from well-known risk factors, the data stress the importance of smoking, an under-recognized cause of AMC, and systolic blood pressure for AIC+AMC.