HDCN Abstract:  ASN Annual Meeting -- Philadelphia  

Pilkey RM, Garland JS, Hopman W, Zimmerman D, et al

Lifetime warfarin exposure is associated with aortic valve (AV) calcification in hemodialysis (HD) patients.

ASN Annual Meeting -- Philadelphia
J Am Soc Nephrol (Nov) 16:729A 2005

Vitamin K dependent matrix Gla protein inhibits calcification. The primary objective of this case-control study was to determine the association between long-term exposure to the vitamin K antagonist warfarin (> 18 months)and severity of AV calcification in HD patients. The secondary objective was to determine the association between months of warfarin exposure and AV calcification in the subgroup taking warfarin for at least 6 months.

AV calcification was determined by echocardiography (absent, mild, moderate, severe). Clinical data was abstracted for up to 2 years prior to the echocardiogram. For the primary objective, there were 108 HD patients with dialysis vintage of > 6 months. There were 18 cases and 90 controls.

In bivariate analysis, there was no difference between groups with respect to age, dialysis vintage, diabetes, cardiac disease, serum phosphorus, calcium-phosphate product, PTH, daily dose of elemental calcium, and daily dose of calcitriol. Case subjects had greater severity of AV calcification (p=0.04). Multiple linear regression was performed. Predictors of AV category (r2=.19, =0.05, p=.003) were age (p=.012), daily dose of elemental calcium (p=.016), and greater than 18 months of warfarin (p=.043). For the secondary objective, 39 subjects were taking warfarin for at least 6 months. Severity of AV calcification was: absent (n=9), mild (n=20), moderate (n=5) and severe (n=5). AV calcification correlated with dialysis vintage (p=0.06) and lifetime months of warfarin (p=.004). The interaction term between dialysis vintage and lifetime months of warfarin was negative. Multiple linear regression was performed. Predictors of AV calcification (r2=0.43, =0.05, p=.013) included lifetime months of warfarin (p=.012), daily dose of calcitriol (p=.017), and daily dose of elemental calcium (p=.031).

In addition to known risk factors for calcification, there appears to be an association between warfarin exposure and severity of AV calcification in HD patients.

© Copyright 2005-2006, American Society of Nephrology. Reproduced with permission.
Until September of 2006, all ASN abstracts from the 2005 Annual Meeting are available at this link.

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