CIN '2007 - 4º CONGRESO DE NEFROLOGIA EN INTERNET
Simple vascular calcification score, cardiovascular risk and bone disorders in hemodialysis patients
Dra Teresa Adragao
Nephrology Department, Santa Cruz Hospital, Carnaxide -
Abstract
Hemodialysis patients have a very high cardiovascular risk that is not explained by traditional risk factors [1] Vascular calcification is one of the factors associated with cardiovascular mortality in these patients [2]. It has been demonstrated that vascular calcification in dialysis and non-dialysis patients is an active cellular process, similar to bone formation [3-5]. Vascular smooth muscle cells can differentiate into osteoblasts due to different stimuli, which, in dialysis patients, may be hyperphosphatemia and hypercalcemia [6]. Reduction of calcification inhibitors, such as fetuin-A or matrix-Gla protein, may be another factor associated with the development of calcification [7]. KDIGO has recommended a new classification for chronic kidney disease mineral and bone disorder (CKD MBD) that includes for the first time the evaluation of vascular calcifications [8]. In hemodialysis patients vascular calcifications may be evaluated by different techniques: electron beam computed tomography (EBCT) [9], multislice computed tomography (MSCT) [10], ultrassonography [2] or plain X-Ray [11]. EBCT and MSCT allow a quantitative measurement and are considered to be the gold standard for evaluating vascular calcification but are very expensive. The utilization of plain X-ray for screening vascular calcifications has been suggested by KDOQI [12] and KDIGO [8]. We have developed a vascular calcification score evaluated in plain X-ray of hands and pelvis which was a predictor of cardiovascular death in dialysis patients [13]. This simple vascular calcification score has been also correlated with valvular calcifications and with arterial stiffness. There is a growing evidence of the existence of a link between bone disease and vascular disease in dialysis patients and this simple vascular calcification score has been used in different studies to analyse this relationship.Comentarios :