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High prevalence of middle cerebral artery calcification is associated with cardiovascular mortality in hemodialyzed patients: an overlooked part of arterial tree?

  • Nephrology - Original Paper
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Abstract

Purpose

We have analyzed markers of accelerated atherosclerosis like large artery stiffness, ankle-brachial index, carotid and vertebral duplex ultrasonography and their possible associations with the incidence of intracranial calcifications, clinical course of hemodialyzed patients, and cardiovascular mortality.

Methods

A computed tomographic scan of the head was performed for any neurological indication on 100 hemodialyzed patients. Eleven intracranial arteries were analyzed for calcification score, while internal carotid arteries and vertebral arteries were excluded in cerebral artery calcification score. As a control group for assessing intracranial calcifications, we have analyzed computed tomographic scans from diabetic patients who had an acute stroke.

Results

Deceased patients had significantly higher values of augmentation index and pulse wave velocity, lower ankle-brachial index, and higher internal carotid arteries peak systolic value than survived patients. Deceased patients had significantly higher number of calcified middle cerebral arteries as well as significantly higher intracranial artery calcification score and cerebral artery calcification score. Hemodialyzed patients had significantly higher both intracranial and cerebral artery calcification scores than diabetic control group. Age and calcified middle cerebral arteries had increased HR of 1.08 and 1.36 for cardiovascular mortality.

Conclusion

This study showed that large artery stiffness and not the presence of peripheral arterial disease or carotid artery stenosis have the prognostic role of middle cerebral arteries’ calcifications and cardiovascular mortality in hemodialyzed patients. The presence of middle cerebral arteries’ calcifications diagnosed by a non-invasive method should be considered a marker of middle-sized conduit arteries atherosclerosis, subclinical brain damage, and future fatal cardiovascular events.

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References

  1. Cozzolino M, Mangano M, Stucchi A, Ciceri P, Conte F, Galassi A (2018) Cardiovascular disease in dialysis patients. Nephrol Dial Transplant 33(3):28–34. https://doi.org/10.1093/ndt/gfy174

    Article  CAS  Google Scholar 

  2. Cozzolino M, Galassi A, Pivari F, Ciceri P, Conte F (2017) The cardiovascular burden in end-stage renal disease. Contrib Nephrol 191:44–57

    Article  Google Scholar 

  3. Sozio SM, Armstrong PA, Coresh J et al (2009) Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the choices for healthy outcomes in caring for ESRD (CHOICE) study. Am J Kidney Dis 54:468–477

    Article  Google Scholar 

  4. Guerin AP, London GM, Marchais SJ, Metivier F (2000) Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 15:1014–1021

    Article  CAS  Google Scholar 

  5. London GM (2003) Cardiovascular calcifications in uremic patients: clinical impact on cardiovascular function. J Am Soc Nephrol 14:S305–S309

    Article  Google Scholar 

  6. Goodman WG, Goldin J, Kuizon BD et al (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478

    Article  CAS  Google Scholar 

  7. Bugnicourt JM, Chillon JM, Massy ZA et al (2009) High prevalence of intracranial artery calcification in stroke patients with CKD: a retrospective study. Clin J Am Soc Nephrol 4:284–290

    Article  Google Scholar 

  8. Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W (2003) Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC study. Kidney Int 64:610–615

    Article  Google Scholar 

  9. Chen XY, Lam WW, Ng HK et al (2007) Intracranial artery calcification: a newly identified risk factor of ischemic stroke. J Neuroimaging 17(4):300–303

    Article  Google Scholar 

  10. Chen XY, Lam WW, Ng HK et al (2006) The frequency and determinants of calcification in intracranial arteries in Chinese patients who underwent computed tomography examinations. Cerebrovasc Dis 21(1–2):91–97

    Article  Google Scholar 

  11. Toyoda K, Fujii K, Fujimi S et al (2005) Stroke in patients on maintenance hemodialysis: a 22-year single-center study. Am J Kidney Dis 45(6):1058–1066

    Article  Google Scholar 

  12. Power A, Chan K, Haydar A, Hamady M, Cairns T, Taube D, Duncan N (2011) Intracranial arterial calcification is highly prevalent in hemodialysis patients but does not associate with acute ischemic stroke. Hemodial Int 15(2):256–263. https://doi.org/10.1111/j.1542-4758.2011.00543.x

    Article  PubMed  Google Scholar 

  13. Iwasa Y, Otsubo S, Yajima A, Kimata N, Akiba T, Nitta K (2011) Intracranial artery calcification in hemodialysis patients. Int Urol Nephrol 43(2):585–588. https://doi.org/10.1007/s11255-009-9664-4

    Article  CAS  PubMed  Google Scholar 

  14. London GM, Guerin AP, Marchais SJ et al (1996) Cardiac and arterial interactions in end-stage renal disease. Kidney Int 50:600–608. https://doi.org/10.1038/ki.1996.355

    Article  CAS  PubMed  Google Scholar 

  15. Briet M, Boutouyrie P, Laurent S, London GM (2012) Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int 82:388–400. https://doi.org/10.1038/ki.2012.131

    Article  PubMed  Google Scholar 

  16. Safar ME, Plante GE, Mimran A (2015) Arterial stiffness, pulse pressure, and the kidney. Am J Hypertens 28:561–569. https://doi.org/10.1093/ajh/hpu206

    Article  PubMed  Google Scholar 

  17. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM (1999) Impact of aortic stiffness on survival in end-stage renal disease. Circulation 99:2434–2439. https://doi.org/10.1161/01.CIR.99.18.2434

    Article  CAS  PubMed  Google Scholar 

  18. Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM (2001) Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation 103:987–992. https://doi.org/10.1161/01.CIR.103.7.987

    Article  CAS  PubMed  Google Scholar 

  19. Cano-Megías M, Guisado-Vasco P, Bouarich H et al (2019) Coronary calcification as a predictor of cardiovascular mortality in advanced chronic kidney disease: a prospective long-term follow-up study. BMC Nephrol 20:188. https://doi.org/10.1186/s12882-019-1367-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wang XR, Zhang JJ, Xu XX, Wu YG (2019) Prevalence of coronary artery calcification and its association with mortality, cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail 41(1):244–256. https://doi.org/10.1080/0886022X.2019.1595646

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kato A, Takita T, Maruyama Y, Maruyama Y, Kumagai H, Hishida A (2003) Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients. Kidney Int 64(4):1472–1479

    Article  Google Scholar 

  22. New SE, Aikawa E (2011) Cardiovascular calcification: an inflammatory disease. Circ J 75(6):1305–1313

    Article  CAS  Google Scholar 

  23. Wu XH, Chen XY, Wang LJ, Wong KS (2016) Intracranial artery calcification and Its clinical significance. J Clin Neurol 12(3):253–261

    Article  Google Scholar 

  24. Kao HW, Liou M, Chung HW et al (2015) Middle cerebral artery calcification: association with ischemic stroke. Medicine (Baltimore) 94(50):e2311. https://doi.org/10.1097/MD.0000000000002311

    Article  CAS  Google Scholar 

  25. Stefanidis I, Bach R, Mertens PR et al (2005) Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery. Clin Nephrol 64(2):129–137

    Article  CAS  Google Scholar 

  26. Mitchell GF (2008) Effects of central artery aging on the structure and function of the peripheral vasculature: implication for end-organ damage. J Appl Physiol 105:1652–1660

    Article  Google Scholar 

  27. Cipolla MJ (2009) The cerebral circulation. Morgan & Claypool Life Sciences, San Rafael

    Book  Google Scholar 

  28. Dodge JT Jr, Brown BG, Bolson EL, Dodge HT (1992) Lumen diameter of normal human coronary arteries influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation 86(1):232–246

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine, University Hospital Center Zagreb, 10000, Zagreb, Croatia

    Vedran Premužić & Bojan Jelaković

  2. Department of Radiology, School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia

    Danilo Gardijan, Tomislav Herega & Dražen Perkov

Authors
  1. Vedran Premužić
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  2. Danilo Gardijan
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  3. Tomislav Herega
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  4. Dražen Perkov
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  5. Bojan Jelaković
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by VP, DG, TH, and DP. The first draft of the manuscript was written by VP and BJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vedran Premužić.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Appendix 1

Appendix 1

See Appendix Tables 5, 6.

Table 5 Demographic, clinical, laboratory data, and hemodynamic and arterial stiffness data between survived and deceased patients
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Table 6 Intracranial artery calcifications between survived and deceased patients
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Premužić, V., Gardijan, D., Herega, T. et al. High prevalence of middle cerebral artery calcification is associated with cardiovascular mortality in hemodialyzed patients: an overlooked part of arterial tree?. Int Urol Nephrol 54, 1995–2004 (2022). https://doi.org/10.1007/s11255-021-03092-2

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  • DOI: https://doi.org/10.1007/s11255-021-03092-2

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