Warfarin is Associated with the Risk of Vascular Calcification in Abdominal Aorta in Hemodialysis Patients: a Multicenter Case-control Study

Overview

Journal Turk J Med Sci

Specialty General Medicine

Date 2021 Jul 22

PMID 34289653

Citations 1

Authors

Rezzan Eren Sadioglu

Evren Ustuner

Ihsan Ergun

Suleyman Tevfik Ecder

Gokhan Nergizoglu

Kenan Keven

Affiliations

Soon will be listed here.

Abstract

Background: Vascular calcifications (VCs), recognized risk factor for increased mortality, are highly prevalent in hemodialysis (HD) patients. We aimed to investigate the relation between VC and warfarin use with plain radiography.

Methods: VCs were assessed using Adragao (radial and digital) and Kauppila (aortic) scores in 76 HD patients from six centers. Out of a total 711 HD patients, there were 32 (4.5%) who had been treated with warfarin for at least 1 year, and we included 44 control patients.

Results: Of the patients, 47% were females, the mean age was 66 ± 9 years, 23% were diabetics, the mean dialysis vintage was 68 ± 38 months. In warfarin group, median Kauppila score was higher than in control group [11 vs 6.5, (25%-75% percentile, 5 vs. 15), p = 0.032] and the percentage of the patients with a Kauppila score of >6 was higher, as well (76.6% vs. 50%; p = 0.029). Median Adragao score was not significantly different between the two groups [7 vs. 6, (%25,%75 percentile 6 vs. 8), p = 0.17]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppila scores of >6 (OR 3.60, 95% CI 1.18-10.9, p = 0.024).

Discussion: In this study, we found that warfarin is associated to vascular calcifications, especially in aorta of HD patients.

Citing Articles

Vitamin K antagonists and cardiovascular calcification: A systematic review and meta-analysis.

Kosciuszek N, Kalta D, Singh M, Savinova O Front Cardiovasc Med. 2022; 9:938567.

PMID: 36061545 PMC: 9437425. DOI: 10.3389/fcvm.2022.938567.

References

Kwon H, Lee O, Kim M, Joo W, Lee S, Kim M . The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients. Kidney Res Clin Pract. 2016; 33(2):95-102. PMC: 4714181. DOI: 10.1016/j.krcp.2014.04.003. View

Schurgers L, Joosen I, Laufer E, Chatrou M, Herfs M, Winkens M . Vitamin K-antagonists accelerate atherosclerotic calcification and induce a vulnerable plaque phenotype. PLoS One. 2012; 7(8):e43229. PMC: 3430691. DOI: 10.1371/journal.pone.0043229. View

Tsai C, Marcus L, Patel P, Battistella M . Warfarin Use in Hemodialysis Patients With Atrial Fibrillation: A Systematic Review of Stroke and Bleeding Outcomes. Can J Kidney Health Dis. 2017; 4:2054358117735532. PMC: 5652660. DOI: 10.1177/2054358117735532. View

Rennenberg R, van Varik B, Schurgers L, Hamulyak K, Ten Cate H, Leiner T . Chronic coumarin treatment is associated with increased extracoronary arterial calcification in humans. Blood. 2010; 115(24):5121-3. DOI: 10.1182/blood-2010-01-264598. View

Bellasi A, Ferramosca E, Muntner P, Ratti C, Wildman R, Block G . Correlation of simple imaging tests and coronary artery calcium measured by computed tomography in hemodialysis patients. Kidney Int. 2006; 70(9):1623-8. DOI: 10.1038/sj.ki.5001820. View

Goodman W, Goldin J, Kuizon B, Yoon C, Gales B, Sider D . Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000; 342(20):1478-83. DOI: 10.1056/NEJM200005183422003. View

Reynolds J, Joannides A, Skepper J, McNair R, Schurgers L, Proudfoot D . Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. J Am Soc Nephrol. 2004; 15(11):2857-67. DOI: 10.1097/01.ASN.0000141960.01035.28. View

Chatrou M, Winckers K, Hackeng T, Reutelingsperger C, Schurgers L . Vascular calcification: the price to pay for anticoagulation therapy with vitamin K-antagonists. Blood Rev. 2012; 26(4):155-66. DOI: 10.1016/j.blre.2012.03.002. View

Fusaro M, Tripepi G, Noale M, Plebani M, Zaninotto M, Piccoli A . Prevalence of vertebral fractures, vascular calcifications, and mortality in warfarin treated hemodialysis patients. Curr Vasc Pharmacol. 2013; 13(2):248-58. DOI: 10.2174/15701611113119990146. View

10.

Blacher J, Guerin A, Pannier B, Marchais S, London G . Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001; 38(4):938-42. DOI: 10.1161/hy1001.096358. View

11.

Shroff R, Long D, Shanahan C . Mechanistic insights into vascular calcification in CKD. J Am Soc Nephrol. 2012; 24(2):179-89. DOI: 10.1681/ASN.2011121191. View

12.

Cozzolino M, Missaglia E, Ortiz A, Bellasi A, Adragao T, Apostolous T . [Vascular calcification in chronic kidney disease]. Recenti Prog Med. 2011; 101(11):442-52. View

13.

Westenfeld R, Krueger T, Schlieper G, Cranenburg E, Magdeleyns E, Heidenreich S . Effect of vitamin K2 supplementation on functional vitamin K deficiency in hemodialysis patients: a randomized trial. Am J Kidney Dis. 2011; 59(2):186-95. DOI: 10.1053/j.ajkd.2011.10.041. View

14.

Cranenburg E, Schurgers L, Uiterwijk H, Beulens J, Dalmeijer G, Westerhuis R . Vitamin K intake and status are low in hemodialysis patients. Kidney Int. 2012; 82(5):605-10. DOI: 10.1038/ki.2012.191. View

15.

Lilien M, Groothoff J . Cardiovascular disease in children with CKD or ESRD. Nat Rev Nephrol. 2009; 5(4):229-35. DOI: 10.1038/nrneph.2009.10. View

16.

Adragao T, Pires A, Birne R, Dias Curto J, Lucas C, Goncalves M . A plain X-ray vascular calcification score is associated with arterial stiffness and mortality in dialysis patients. Nephrol Dial Transplant. 2008; 24(3):997-1002. DOI: 10.1093/ndt/gfn584. View

17.

Tsai M, Chen Y, Chang W, Li S . Warfarin accelerated vascular calcification and worsened cardiac dysfunction in remnant kidney mice. J Chin Med Assoc. 2018; 81(4):324-330. DOI: 10.1016/j.jcma.2017.08.021. View

18.

. Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder.... Kidney Int Suppl (2011). 2019; 7(3):e1. PMC: 6341011. DOI: 10.1016/j.kisu.2017.10.001. View

19.

Becker C, Jakobs T, Aydemir S, Becker A, Knez A, Schoepf U . Helical and single-slice conventional CT versus electron beam CT for the quantification of coronary artery calcification. AJR Am J Roentgenol. 2000; 174(2):543-7. DOI: 10.2214/ajr.174.2.1740543. View

20.

Floege J, Kubo Y, Floege A, Chertow G, Parfrey P . The Effect of Cinacalcet on Calcific Uremic Arteriolopathy Events in Patients Receiving Hemodialysis: The EVOLVE Trial. Clin J Am Soc Nephrol. 2015; 10(5):800-7. PMC: 4422249. DOI: 10.2215/CJN.10221014. View