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Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development

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Abstract

Background

Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk.

Methods

Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52–105).

Results

Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23–1181) and for AVC was 0 (IQR 0–25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR −10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival.

Conclusion

EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.

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Acknowledgments

Data were presented in part as an abstract at the ASN Renal Week congress 2014 in Philadelphia. The work performed by Xoana Barros at University Hospital of the RWTH Aachen was possible thanks to the Long-Term ERA-EDTA Fellowship Exchange Programme.

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    Authors and Affiliations

    1. Department of Nephrology, University Hospital of the RWTH Aachen, Aachen, Germany

      Xoana Barros, Nadine Kaesler, Rafael Kramann & Jürgen Floege

    2. Department of Radiology, University Hospital of the RWTH Aachen, Aachen, Germany

      Timm Dirrichs & Sebastian Reinartz

    3. Department of Cardiology, Städtische Kliniken Mönchengladbach GmbH, Elisabeth-Krankenhaus Rheydt, Rheydt, Germany

      Ralf Koos

    4. Dialysis Center, Kuratorium für Heimdialyse (KfH), Würselen, Germany

      Ulrich Gladziwa

    5. Department of Nephrology, Klinikum Coburg, Coburg, Germany

      Markus Ketteler

    6. Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany

      Nikolaus Marx & Vincent M. Brandenburg

    7. Department of Nephrology, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain

      Xoana Barros & José V. Torregrosa

    8. Department of Medical Informatics, University Hospital of the RWTH Aachen, Aachen, Germany

      András Keszei

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    1. Xoana Barros
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    Correspondence to Xoana Barros.

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    The authors declare they have no competing interests.

    Ethical approval

    The study was approved by the ethical committee of the RWTH Aachen University Hospital.

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    Patients were included after written and informed consent.

    Additional information

    X. Barros and T. Dirrichs contributed equally to the manuscript.

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    Barros, X., Dirrichs, T., Koos, R. et al. Epicardial adipose tissue in long-term hemodialysis patients: its association with vascular calcification and long-term development. J Nephrol 29, 241–250 (2016). https://doi.org/10.1007/s40620-015-0221-1

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    • DOI: https://doi.org/10.1007/s40620-015-0221-1

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