Predictors of coronary calcification in Indian hemodialysis patients

Abstract

Several biomolecules potentially serve as promoters or inhibitors of calcification in dialysis patients which include fetuin A, matrix gla protein, osteopontin, osteoprotegerin, etc. The primary aim was to compare the biomarkers of coronary artery calcification (CAC) and to study its role as predictors of CAC in hemodialysis (HD) patients. Of 126 patients undergoing chronic HD, 100 patients completed the study. Blood samples were drawn for serum creatinine, electrolytes, calcium, phosphorus, Vitamin D3, parathyroid hormone (PTH), lipid profile, high sensitivity C-reactive protein, ferritin, fetuin A, and fibroblast growth factor-23 (FGF-23). Non-contrast Computed Tomography scan of the coronary arteries was conducted on all participants. Participants who were positive for CAC (P group) were compared with those negative for CAC (N group) using two sample t-test. Multiple logistic regression analysis was conducted to determine the predictors of CAC. The prevalence of vascular calcification (VC) was 60% with higher prevalence seen in males (71%), older age group, patients with dialysis vintage >5 years (27%), and diabetic population (62%). Mean serum phosphorus was significantly higher (P <0.001) and fetuin A (P <0.001) was significantly lower in the P group. Age (OR: 1.2, P = 0.004), serum phosphorus (OR: 1.8, P = 0.024), and fetuin A (OR: 0.0006, P = 0.001) were found as predictors of CAC. CAC was more prevalent in males, patients with higher age group and in those with longer dialysis vintage and diabetic population. Participants with CAC exhibited significantly high phosphorus and low fetuin A levels. Age, phosphorus level, and fetuin A were found to be predictors of CAC in dialysis patients. FGF-23 could not predict CAC.