HDCN Abstract:  ASN Annual Meeting -- San Francisco  

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)-transformationUsing log(Score+1)-transformation
Calcium AcetateSevelamerP-valueCalcium AcetateSevelamerP-value
Aortic Valve61% (8, 140)43% (-4, 114)0.6734% (- 14, 109)36% (-6, 95)0.97
Mitral Valve51% (9, 110)77% (31, 140)0.4783% (19, 182)89% (32, 169)0.92


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