Hypercalcemia Is a Risk Factor for the Progression of Aortic Calcification in Kidney Transplant Recipients

• Published in: Kidney & blood pressure research Vol. 44; no. 4; pp. 823 - 834
• Main Authors: Naganuma, Toshihide, Takemoto, Yoshiaki, Uchida, Junji, Nakatani, Tatsuya, Kabata, Daijiro, Shintani, Ayumi
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-08-2019; Karger Publishers
• Subjects: Adult; Agatston score; Aorta; Aorta - metabolism; Aorta - pathology; Body mass index; Calcification; Calcification (ectopic); Calcium; Calcium (blood); Computed tomography; Correlation analysis; Disease Progression; Female; Health risk assessment; Humans; Hypercalcemia; Hypercalcemia - complications; Infrarenal abdominal aorta; Kidney diseases; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Linearity; Longitudinal Studies; Male; Middle Aged; Mortality; Multi-slice computed tomography; Nonlinear analysis; Nonlinearity; Prospective Studies; Regression analysis; Research Article; Risk analysis; Risk factor; Risk Factors; Vascular calcification; Vascular Calcification - etiology; Vascular Stiffness; Veins & arteries; Vascular calcification; Infrarenal abdominal aorta; Agatston score; Risk factor; Kidney transplantation; Multi-slice computed tomography
• ISSN: 1420-4096; 1423-0143
• DOI: 10.1159/000501740

Background/Aims: Vascular calcification is common and progressive in chronic kidney disease, including kidney transplant recipients (KTRs). However, the risk factors associated with the progression of aortic calcification (AoC) in KTRs have not been fully elucidated. In the present study, we evaluated AoC and examined the factors associated with its advancement in KTRs. Materials: This was a prospective longitudinal study that included 98 KTRs. We quantitatively investigated infrarenal abdominal AoC using the Agatston score, as measured by multi-slice computed tomography. After the baseline investigation, a follow-up scan was performed after 3 years, and the Agatston scores were obtained again. The changes in laboratory data affecting the 2nd Agatston scores were examined by multivariable analysis using non-linear regression after adjustment for several confounders. Results: The 2nd Agatston scores were significantly greater than the baseline Agatston scores (p < 0.001). After adjustment for the confounders, the change in corrected serum calcium exhibited a significant non-linear correlation with the 2nd Agatston scores (p = 0.022 for non-linearity/p = 0.031 for the effect of corrected serum calcium). Moreover, an interaction was present from the baseline AoC in the effect of corrected serum calcium on the progression of AoC, and the effect of hypercalcemia was greater in patients with higher baseline Agatston scores (p = 0.049). Conclusion: The present study revealed that hypercalcemia is a risk factor for the development of infrarenal abdominal AoC in KTRs. Furthermore, the effect of hypercalcemia was greater in patients with more severe vascular calcification.