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Hypertension. 2001;38:938-942
doi: 10.1161/hy1001.096358
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(Hypertension. 2001;38:938.)
© 2001 American Heart Association, Inc.


Fourth Workshop on Structure and Function of Large Arteries

Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal Disease

Jacques Blacher; Alain P. Guerin; Bruno Pannier; Sylvain J. Marchais; Gérard M. London

From Service de Médecine Interne, Hôpital Broussais, AP-HP (J.B.), Paris, France; and Service d’Hémodialyse, Hôpital F.H. Manhès (A.P.G., B.P., S.J.M., G.M.L.), Fleury-Mérogis, France.

Correspondence to Dr Jacques Blacher, Service de Médecine Interne, Hôpital Broussais, AP-HP, 96 Rue Didot, 75014 Paris, France. E-mail jacques.blacher{at}brs.ap-hop-paris.fr

Abstract

Abstract— To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53±21 months (mean±SD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval [CI], 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (P<0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (P<0.01 for both). The results of this study showed that the presence and extent of vascular calcifications were strong predictors of cardiovascular and all-cause mortality. Carotid incremental elastic modulus gave additional predictive value.


Key Words: renal disease • cardiovascular diseases • arteries • mortality • calcifications




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Nephrol. Dial. Transplant., July 1, 2006; 21(7): 1906 - 1914.
[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
J. R. Wu-Wong, W. Noonan, J. Ma, D. Dixon, M. Nakane, A. L. Bolin, K. A. Koch, S. Postl, S. J. Morgan, and G. A. Reinhart
Role of Phosphorus and Vitamin D Analogs in the Pathogenesis of Vascular Calcification
J. Pharmacol. Exp. Ther., July 1, 2006; 318(1): 90 - 98.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
M. Ketteler, G. Schlieper, and J. Floege
Calcification and Cardiovascular Health: New Insights Into an Old Phenomenon
Hypertension, June 1, 2006; 47(6): 1027 - 1034.
[Full Text] [PDF]


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ANGIOLOGYHome page
M. Boufi, P. Ghaffari, E. Allaire, H. Fessi, P. Ronco, and M. Vayssairat
Foot Gangrene in Patients with End-Stage Renal Disease: A Case Control Study
Angiology, May 1, 2006; 57(3): 355 - 361.
[Abstract] [PDF]


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CirculationHome page
H. M.H. Spronk
Vitamin K Epoxide Reductase Complex and Vascular Calcification: Is This the Important Link Between Vitamin K and the Arterial Vessel Wall?
Circulation, March 28, 2006; 113(12): 1550 - 1552.
[Full Text] [PDF]


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Nephrol Dial TransplantHome page
C. W. McIntyre
Is it practical to screen dialysis patients for vascular calcification?
Nephrol. Dial. Transplant., February 1, 2006; 21(2): 251 - 254.
[Full Text] [PDF]


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Nephrol Dial TransplantHome page
G. Jean, C. Chazot, and B. Charra
Hyperphosphataemia and related mortality
Nephrol. Dial. Transplant., February 1, 2006; 21(2): 273 - 280.
[Full Text] [PDF]


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Nephrol Dial TransplantHome page
H. Reichel
Current treatment options in secondary renal hyperparathyroidism
Nephrol. Dial. Transplant., January 1, 2006; 21(1): 23 - 28.
[Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
M. C. Matteucci, E. Wuhl, S. Picca, A. Mastrostefano, G. Rinelli, C. Romano, G. Rizzoni, O. Mehls, G. de Simone, F. Schaefer, et al.
Left Ventricular Geometry in Children with Mild to Moderate Chronic Renal Insufficiency
J. Am. Soc. Nephrol., January 1, 2006; 17(1): 218 - 226.
[Abstract] [Full Text] [PDF]


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Am J Health Syst PharmHome page
J. J. Schucker and K. E. Ward
Hyperphosphatemia and phosphate binders
Am. J. Health Syst. Pharm., November 15, 2005; 62(22): 2355 - 2361.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
E. Zitt and A. R. Rosenkranz
Vascular calcification and increased mortality in dialysis patients: is the baroreflex sensitivity the answer?
Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2580 - 2580.
[Full Text] [PDF]


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HeartHome page
A K Nightingale and J D Horowitz
Aortic sclerosis: not an innocent murmur but a marker of increased cardiovascular risk
Heart, November 1, 2005; 91(11): 1389 - 1393.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
M. W. Merx, C. Schafer, R. Westenfeld, V. Brandenburg, S. Hidajat, C. Weber, M. Ketteler, and W. Jahnen-Dechent
Myocardial Stiffness, Cardiac Remodeling, and Diastolic Dysfunction in Calcification-Prone Fetuin-A-Deficient Mice
J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3357 - 3364.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
C. R. Nolan
Strategies for Improving Long-Term Survival in Patients with ESRD
J. Am. Soc. Nephrol., November 1, 2005; 16(11_suppl_2): S120 - S127.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
J. L. Reynolds, J. N. Skepper, R. McNair, T. Kasama, K. Gupta, P. L. Weissberg, W. Jahnen-Dechent, and C. M. Shanahan
Multifunctional Roles for Serum Protein Fetuin-A in Inhibition of Human Vascular Smooth Muscle Cell Calcification
J. Am. Soc. Nephrol., October 1, 2005; 16(10): 2920 - 2930.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
K. A. Hruska, S. Mathew, and G. Saab
Bone Morphogenetic Proteins in Vascular Calcification
Circ. Res., July 22, 2005; 97(2): 105 - 114.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
M. F. O'Rourke and M. E. Safar
Relationship Between Aortic Stiffening and Microvascular Disease in Brain and Kidney: Cause and Logic of Therapy
Hypertension, July 1, 2005; 46(1): 200 - 204.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
L. J. Chesterton, M. K. Sigrist, T. Bennett, M. W. Taal, and C. W. McIntyre
Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness
Nephrol. Dial. Transplant., June 1, 2005; 20(6): 1140 - 1147.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
C. A. Peralta, L. S. Hicks, G. M. Chertow, J. Z. Ayanian, E. Vittinghoff, F. Lin, and M. G. Shlipak
Control of Hypertension in Adults With Chronic Kidney Disease in the United States
Hypertension, June 1, 2005; 45(6): 1119 - 1124.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
M. Litwin, E. Wuhl, C. Jourdan, J. Trelewicz, A. Niemirska, K. Fahr, K. Jobs, R. Grenda, Z. T. Wawer, P. Rajszys, et al.
Altered Morphologic Properties of Large Arteries in Children with Chronic Renal Failure and after Renal Transplantation
J. Am. Soc. Nephrol., May 1, 2005; 16(5): 1494 - 1500.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
T. Takenaka and H. Suzuki
New strategy to attenuate pulse wave velocity in haemodialysis patients
Nephrol. Dial. Transplant., April 1, 2005; 20(4): 811 - 816.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
G. M. Chertow and S. M. Moe
Calcification or Classification?
J. Am. Soc. Nephrol., February 1, 2005; 16(2): 293 - 295.
[Full Text] [PDF]


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Dentomaxillofac RadiolHome page
O Kansu, M Ozbek, N Avcu, G Genctoy, H Kansu, and C Turgan
The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease
Dentomaxillofac. Radiol., January 1, 2005; 34(1): 16 - 19.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
Z. A. Massy, O. Ivanovski, T. Nguyen-Khoa, J. Angulo, D. Szumilak, N. Mothu, O. Phan, M. Daudon, B. Lacour, T. B. Drueke, et al.
Uremia Accelerates both Atherosclerosis and Arterial Calcification in Apolipoprotein E Knockout Mice
J. Am. Soc. Nephrol., January 1, 2005; 16(1): 109 - 116.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
H. H. Jung, K. R. Ma, and H. Han
Elevated concentrations of cardiac troponins are associated with severe coronary artery calcification in asymptomatic haemodialysis patients
Nephrol. Dial. Transplant., December 1, 2004; 19(12): 3117 - 3123.
[Abstract] [Full Text] [PDF]