Qunibi W, Moustafa M, Kessler P, et al.
Effect of Atorvastatin on Progression of Heart Valve Calcification in
Hemodialysis Patients Treated with Calcium Acetate or Sevelamer.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol
(Nov) 18:707A 2007

Heart valve calcification (HVC) is common in hemodialysis patients (HDP), may
contribute to serious consequences.
In the CARE-2 study, we compared
progression rate of HVC in HDP treated with calcium acetate (CA) or sevelamer
(SV) when LDL was lowered to < 70 mg/dL. HDP with phosphorus (P) > 5.5
mg/dL, LDL > 80, and EBCT CAC scores 30 to 7000 were randomized to either
CA or SV for 1 year. Atorvastatin added to achieve above LDL goal in both
groups. Primary endpoint: % change in CACS at 1 year analyzed by t-tests on
Geometric Means (GM). Secondary endpoints: change in aorta, mitral, and
aortic valve EBCT calcium scores, serum P, Ca, Ca X P, PTH, HCO3,
LDL. 203 patients randomized; 103 CA, 100 SV. Achieved LDL levels: 68 and 62
mg/dl in CA and SV respectively. At baseline, calcification of mitral and
aortic valves present in 54.7%, and 39.9%, respectively, 27% with both. For
mitral and aortic valves, table shows GM percent change from screening values
to Day 360. P and Ca X P were similar. Adjusted Ca was higher in CA patients.
Results unchanged including or excluding 0 scores at baseline or Day
360.
HVC is common in HDP. Its progression did not differ in CA and SV
-treated HDP following equivalent lipid control. Calcium load from use of
calcium acetate does not contribute to progression of HVC in HDP. Uremia-
related factors may contribute to progression of HVC.
Table. Comparisons of screening to Day 360
percent change in calcification scores | Using log(Score)-transformation | Using log(Score+1)-transformation |
|---|
| Calcium
Acetate | Sevelamer | P-value | Calcium
Acetate | Sevelamer | P-value |
| Aortic
Valve | 61% (8, 140) | 43% (-4, 114) | 0.67 | 34% (-
14, 109) | 36% (-6, 95) | 0.97 |
| Mitral
Valve | 51% (9, 110) | 77% (31, 140) | 0.47 | 83%
(19, 182) | 89% (32,
169) | 0.92 |
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