Rajesh Krishnamurthy MD, Presenter: Research Consultant, Eisai Co, Ltd Research support, Koninklijke Philips Electronics NV

Stuart Goldstein, Abstract Co-Author: Nothing to Disclose

Poyyapakkam R Srivaths MD, Abstract Co-Author: Nothing to Disclose

Coronary calcification (CC) is associated with increased mortality in adult chronic hemodialysis (HD) patients (pts). The prevalence, and risk factors associated with CC are not known in pediatric HD pts. The aim is to determine prevalence, risk factors, and causes of progression of CC in pediatric HD pts.

One year prospective longitudinal study of 16 pts (6F, 10M; median age 18.2 yrs; range 10.1-22.2 yrs) receiving chronic HD. CC was assessed annually by breath-held MDCT performed with prospective EKG triggering, and quantified by Agatston score for each coronary vessel, and a total score (TS) representing the cumulative calcium burden in all coronary locations. TS Δ = TS at one year minus TS at entry. Monthly serum Ca, P, total PTH, Albumin, cholesterol, Calcitriol/Calcium dose and quarterly IL-6, IL-8, CRP and FGF-23 levels were time averaged.

5/16 pts (all male) had CC. Pts with CC were older, had longer dialysis vintage, higher serum P and higher Ca x P product. Serum Ca, tPTH, elemental Ca intake and calcitriol doses were not different for CC pts. Median cytokine/CRP levels did not differ between pts with or without CC (Kruskal Wallis). Serum FGF 23 levels were significantly higher in pts with CC, and positively correlated with Agatston calcification score. Using multivariate analysis, serum FGF 23 and serum P were the most significant factors associated with Agatston score. 14/16 pts continued on HD and underwent a repeat CT at the end of one year. All pts with initial CC who completed CT at one year (3/5) progressed; one patient had new CC and no patient had resolved CC. Mean TS Δ was 42.28. TS Δ independently correlated with P (β 0.54, r2=0.81) and IL-6 concentration (β 0.58, r2=0.81) by multiple regression analysis.

This study confirms occurrence of CC in pediatric HD pts and shows a significant association between CC and prolonged dialysis vintage, CaxP > 80, and elevated serum FGF 23. CC progresses in majority of pediatric HD pts. High IL-6 and P are associated with CC progression. This data supports early renal transplantation in pediatric HD pts.

Confirms occurrence of progressive coronary calcification in children with prolonged dialysis vintage and abnormal CaxP product, and supports early transplantation in pediatric hemodialysis pts.

Krishnamurthy, R, Goldstein, S, Srivaths, P, Coronary Calcification Detected by Prospectively-gated MDCT in Pediatric Patients Undergoing Chronic Hemodialysis: Analysis of Risk Factors and Progression.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11016631.html