A Low Intact PTH Is Associated with Simple Vascular Calcifications in Hemodialysis Patients

Abstract

Purpose: Cardiovascular diseases are a common cause of mortality in patients with end stage renal disease and are associated with vascular calcification (VC) and arterial stiffness. In addition to high turnover bone disease, there is substantial evidence that low levels of serum intact PTH (iPTH) are associated with vascular calcium deposition. The objective was to evaluate the association of iPTH levels with VC, arterial stiffness, and to identify risk factors contributing to VCs and arterial stiffness. Methods: One hundred five hemodialysis (HD) patients were divided into three groups according to iPTH levels: A, <150 pg/mL; B, 150≤and≤400 pg/mL; and C, >400 pg/mL. The simple vascular calcification score (SVCS) was obtained by X-ray; the brachial ankle-pulse wave velocity (ba-PWV) and the serum fetuin-A level was mesured. Results: Patients in group A were older and had a higher SVCS, a prevalence of diabetes, and an increased arterial stiffness. Severe VCs (SVCS≥3) were associated with the low iPTH group (iPTH<150) /a higher CRP/a lower diastolic blood pressure (DBP)/diabetes/ increased arterial stiffness/older age and a lower serum fetuin-A level. The log [ba-PWV] had a positive correlation with age, systolic blood pressure (SBP)/DBP/PP/CRP/presence of diabetes and low iPTH and a negative correlation with serum albumin. Based on multivariate analysis, the low iPTH group and diabetes were identified as independent risk factors of severe VC and age/SBP/CRP and diabetes were risk factors for arterial stiffness. Conclusion: Low iPTH levels and/or diabetes had a greater risk of developing VCs and age/SBP/CRP/ diabetes were associated with increased arterial stiffness in HD patients.