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Progression of Coronary Artery Calcification in Renal Transplantation and the Role of Secondary Hyperparathyroidism and Inflammation

Sandro Mazzaferro^*, Marzia Pasquali^*, Franco Taggi, Matteo Baldinelli^*, Carmina Conte^*, Maria Luisa Muci^*, Nicola Pirozzi^*, Iacopo Carbone, Marco Francone, and Francesco Pugliese^*

^* Department of Clinical Science and Department of Radiological Science, University of Rome "La Sapienza"; Department of Environment and Primary Prevention of the Istituto Superiore di Sanità

Correspondence: Dr. Sandro Mazzaferro, Department of Clinical Science, University of Rome "La Sapienza," Viale del Policlinico 155, 00161 Rome, Italy. Phone: +39 06 49972666 or +39 335 8417818 (cell); Fax: +39 06 49970524; E-mail: sandro.mazzaferro{at}uniroma1.it

Background and objectives: Transplantation should favorably affect coronary calcification (CAC) progression in dialysis; however, changes in CAC score in the individual patient are not reliably evaluated.

Design, setting, participants & measurements: The authors used special tables of reproducibility limits for each score level to study, by multislice computed tomography and biochemistries, the 2-year changes in CAC in 41 transplant patients (age 48 ± 13 yr, 25 men, dialysis vintage 4.8 ± 4.3 yr, underwent transplant 6.2 ± 5.5 yr prior). Thirty balanced dialysis patients served as controls.

Results: In the study group, Agatston score was stable, and C-reactive protein decreased, whereas fetuin and osteoprotegerin increased. In the control group, Agatston score increased, parathyroid hormone and phosphate decreased, and inflammation markers were persistently twice as high as in the study group. With regard to individual changes, 12.2% transplant patients worsened, compared with 56.6% of patients in dialysis (P < 0.0001). Patients without calcification at entry showed slower progression in transplantation (8.3%) than in dialysis (44.4%; P < 0.034), and the difference was similar to that observed in cases with CAC (17.6% versus 61.9%; P < 0.007). Discriminant analysis indicated parathyroid hormone, the modality of therapy (dialysis or transplantation), and erythrocyte sedimentation rate as the variables most associated with worsening.

Conclusions: Renal transplantation lowers but does not halt CAC progression. Inflammation and hyperparathyroidism are associated with progression in the populations studied.