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Chronic kidney disease (CKD) is a public health problem, increased hospitalization rates, cardiovascular disease, mortality and therefore costs to health systems. CKD has a prevalence of 9.5% worldwide. As CKD progresses, vascular calcification (VC) occurs, characterized by the accumulation of calcium and phosphate deposits on arterial walls, an extra-skeletal calcium deposit. Cardiovascular disease (CVD) is the principal cause of death in CKD patients, in consequence to classic cardiovascular risk factors, including male sex, smoking, hypertension, dyslipidemia, obesity, diabetes, as well as non-classic cardiovascular risk factors such as uremia, proteinuria, inflammation, and alteration in bone mineral metabolism, secondary hyperparathyroidism, hyperphosphatemia, increased fibroblast growth factor 23 (FGF23) and vascular calcification (VC), unique to patients with CKD.
The estimated prevalence of VC is as high as 80%.
A descriptive cross-sectional study is carried out in patients with chronic kidney disease on hemodialysis at the Dr Valentín Gómez Farías regional hospital of the ISSSTE, who underwent a tomographic study with Agatston score between November 2022 and October 2023. have the record and result of an Agatston tomographic score.
The tomographic study is performed without contrast, administration of beta blocker is considered if necessary to have a heart rate between 60 -65 beats per minute, which allows improving the quality of the images. Image acquisition is performed using a 128-channel Simens Somaton Definition Edge, Erlangen, Germany tomographic equipment, for which image acquisition is typically performed during sustained apnea with the use of cardiac synchronization to minimize artifact by motion. An area of interest is selected in the area of coronary arteries with calcium density (>130 IU Hounsfield), in which the lesion score was calculated by multiplying the lesion area by a density factor. The total CAC score was calculated by summing the scores for all lesions. A score of 0 was defined as no risk of cardiovascular events or mortality, 1–10 minimal risk, 11-100 low risk, 101–400 intermediate risk, and > 400 high risk.
- The majority of patients with chronic kidney disease presented a severe calcification score of 47%, with 26.3% and 26.3% for mild and moderate ranges. In the study there was a predominance of the male gender (73%) and within the Associated characteristics were time greater than one year in treatment with hemodialysis was present in 45% of those who presented severe calcification, smoking in severe calcification was present in 54%.
Patients with chronic kidney disease on hemodialysis have a high prevalence of vascular calcifications, with a predominance of severity which potentiates cardiovascular risk, with a predominance of the male gender and with a history of smoking. The problem of vascular calcification is a progressive process with a complex pathophysiology, however it is a territory of opportunity for new targets of treatment.