vascular calcification

1. Moe, SM et al. ACKD: 3-12, 2007

2. Calcification of Coronary Arteries is Highly Prevalent Among
CKD Patient Populations
2
CKD = chronic kidney disease; RIND=Renagel in New Dialysis; TTG=treat-to-goal.
1. Russo D et al. Am J Nephrol. 2007;27:152-158.
2. Spiegel DM et al. Hemodial Int. 2004;8:265-272.
3. Chertow GM et al. Kidney Int. 2002;62:245-252.
Percentage of CKD Patients With Coronary
Artery Calcification Across 3 Studies in
Different CKD Populations
51
64
83
0
20
40
60
80
100
CKD Patients Not on
Dialysis
Incident Dialysis Prevalent Dialysis
Patients
(%)
(Russo1)
(Spiegel,
RIND2)
(Chertow,
TTG3)

3. Probability of all-cause survival according to calcification score.
Jacques Blacher et al. Hypertension. 2001;38:938-942
Copyright © American Heart Association, Inc. All rights reserved.

5. Diagnosis of CKD-MBD: Vascular Calcification
• In CKD stages 3-5D, the suggestionsa
indicate that:
• It is reasonable to use alternatives to computed
tomography-based imaging to detect the presence or
absence of vascular calcification, including:
• Lateral abdominal radiograph
• Echocardiogram
• Patients with known vascular/valvular calcification can
be considered at highest cardiovascular risk
KDIGO. Kid Int. 2009; 76 (Suppl 113):S1-S130

6. KDIGO2
KDOQI1
 Patients with known vascular/valvular
calcification (2A)
– Considered at highest cardiovascular risk
 It is reasonable to use this information
to guide the management of CKD-MBD
(not graded)
 Detecting presence/absence of valvular
calcification in CKD stages 3-5D (2C)
– Lateral abdominal X-ray to detect
presence/absence of vascular calcification
– Echocardiogram detect presence/ absence
of valvular calcification
Recommendations for Vascular Calcification
• Calcification screening
• No recommendation
• Dialysis patients with severe vascular
calcification and/or
other soft-tissue calcification
• Non-calcium-containing phosphate
binders are preferred
1. National Kidney Foundation (NKF). KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J
Kidney Dis. 2003;42(4 suppl 3):S1-S201.
2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline
for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) Kidney Int.
2009;76(suppl 113):S1-S130.

8. Arterial Calcification on Plain X-rays

10. Figure 1
Kidney International 2008 74, 1505-1507DOI: (10.1038/ki.2008.503)
Copyright © 2008 International Society of Nephrology Terms and Conditions
Kidney International (2008) 74, 1505–1507.
Cardiovascular risk in dialysis patients: an X-ray
vision on vascular calcifications
Teresa Adragão1 and João M. Frazão2

11. Prevalence of Abdominal Aorta Calcification (AAC) in Thai CKD patients
Lumlertgul, Dusit, et al. "Prevalence of and Predictive Factor for Abdominal Aortic
Calcification in Thai Chronic Kidney Disease Patients." Therapeutic Apheresis
● In this study done in
Thailand, the overall
prevalence of the presence
of Abdominal Aorta
Calcification (AAC), as
defined by a score of ≥1,
was 70.7%.
● By treatment status, AAC
was prevalent at 70.6% and
at 70.8% for patients not on
dialysis and patients
undergoing dialysis,
respectively.