Association between vascular calcification, atherosclerosis and inflammatory markers in end-stage renal disease patient and simple method for detecting vascular calcification (direct radiography)

Abstract

Purpose: In our study, we planned to investigate the relationship of malnutrition with inflammation, atherosclerosis and calcification in dialysis patients. Materials and methods: 140 Chronic kidney disease (CKD) patients and 44 healthy controls were included in the study. Carotid artery intima-media thickness (CIMT) was measured by doppler ultrasonography. Valvular calcification was assessed by echocardiography and vascular calcification scores (VCS) were done based on the radiograms. Biochemical parameters were assessed using routine laboratory methods. Subjective global assessment (SGA) was used to evaluate malnutrition. Results: In the study, VCS showed no differences between hemodialysis (HD) and peritoneal dialysis (PD) patients (1.84±2.35 for HD, 1.77±1.64 for PD; p=0.83). CIMT, Osteopontin (OPN), interleukin-6 (IL-6) and homocysteine were significantly different in both dialysis groups compared to healthy controls. The Mean carotid intima-media thickness (m-CIMT) was higher in HD patients compared to PD group. CIMT, vascular calcification and SGA scores showed positive correlation with age, dialysis duration and valvular calcification grades, and negative correlation with albumin levels. A positive correlation between SGA scores and high-sensitive C-reactive protein (hs-CRP) levels was also noted. On multiple regression analysis, m-CIMT was independently associated with age, VCS and albumin levels. VCS was found to be independently associated with only albumin levels. Conclusion: Vascular and valvular calcification, an indicator of cardiovascular mortality and morbidity in dialysis patients, was found to be significantly associated with malnutrition. We found higher rates of valvular calcification in patients with vascular calcification. Malnutrition was more prominent in these patients.