Vascular calcifications and fractures are major complications of chronic kidney disease. Hemodialysis patients have a high prevalence of atrial fibrillation and an increased risk of thromboembolism, which should be prevented with Warfarin ( Coumadin ), a drug potentially causing increased risk of vascular calcifications and fractures.
A study has evaluated in hemodialysis patients with and without atrial fibrillation, the prevalence of vascular calcifications and fractures, as well as identifying the associated risk factors.
A total of 314 hemodialysis patients were recruited, 101 with documented atrial fibrillation and 213 without atrial fibrillation.
Comorbidities, chronic kidney disease mineral and bone disorder blood tests and therapies were collected.
Vertebral quantitative morphometry was carried out centrally for the detection of fractures, defined as vertebral body reduction by greater than or equal to 20 %.
In the same radiograph, the length of aortic calcification was also measured.
In the population vascular calcifications were very common ( more than 85 % ).
Severe vascular calcifications ( more than 10 cm ) were more common in patients with atrial fibrillation ( 76% ) than in patients without ( 33% ).
Vertebral fractures were present in 54% of patients.
Multivariable analysis showed that atrial fibrillation ( odds ratio, OR=5.41, 95 % CI 2.30–12.73 ) and 25(OH)Vitamin D less than 20 ng/mL ( OR=2.05, 95 % CI 1.10–3.83 ) were independent predictors of vascular calcifications.
Age ( OR=1.04/year, 95 % CI 1.01–1.07 ) and male gender ( OR=1.76, 95 % CI 1.07–2.90 ) predicted vertebral fractures.
In conclusion, hemodialysis patients had an elevated prevalence of severe vascular calcifications, especially when affected by atrial fibrillation.
Low vitamin D levels were strongly associated with severe vascular calcifications.
Prevalence of vertebral fractures was also remarkably high and associated with older age and male gender. ( Xagena )
Fusaro M et al, J Nephrol 2015; First online