NEW YORK (Reuters Health), Aug 15 - In patients with end-stage renal disease (ESRD) who undergo kidney transplantation, coronary artery calcification (CAC) progresses in the early post-transplant period, but slows thereafter, research shows.
The research also suggests that smoking and the duration of dialysis before transplantation are the key driving forces behind early posttransplant calcification, while improvement in calcium-phosphate metabolism and uremia that comes with kidney transplantation are less important.
The research team, writing in the August American Journal of Kidney Diseases, notes that extensive CAC is common in patients with ESRD and is driven by uremia and increased serum calcium and phosphate levels. Therefore, improvement in abnormal mineral metabolism with renal transplantation might favorably influence CAC.
With this in mind, Dr. Martin Haas from University Hospital Vienna in Austria and colleagues investigated the course of CAC, with CT, after kidney transplantation in 31 patients with ESRD.
They report that mean total CAC Agatston scores increased significantly early after transplantation, from 716 at baseline to 916 at six months (p < 0.001), but remained unchanged at 12 months.
Also noteworthy, they say, is that progression of calcification was present only in patents with a baseline total CAC Agatston score higher than 10. In these patients, the CAC score increased from 964 at baseline to 1,234 at six months (p < 0.001) and remained stable thereafter.
The lack of progression in patients without calcification at baseline is "of particular interest," the authors say. For a variety of reasons, they say it "could be argued that patients without calcification will progress if they undergo dialysis for a longer period."
Independent predictors of post-transplantation CAC progression were duration of pre-transplant dialysis and smoking. Conversely, calcium-phosphate metabolism were not associated with progression of calcification.
Based on this study, which suggests that calcification slows in the long term after kidney transplantation, Dr. Haas and colleagues suggest that "early transplantation of patients with progressive CAC might be indicated, but accordant recommendations will need larger studies."
Last Updated: 2006-08-14 16:00:31 -0400 (Reuters Health)
Am J Kidney Dis 2006;48:307-313.
Related Reading
MDCT edges MRI in characterizing kidney lesions, June 20, 2006
Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
