Abdominal Aortic Calcification and Its Determinants in People Living with Maintenance Haemodialysis in 2 Selected Public Hospitals from Myanmar

Introduction: People living with maintenance haemodialysis have high mortality due to cardiovascular events which are related with vascular calcification. Vascular calcification is influenced by clinical and laboratory parameters. Some of them have controversial issues and are not studied in people living with maintenance haemodialysis in Myanmar. This study aimed to find out the prevalence of abdominal aortic calcification and its determinants in people living with maintenance haemodialysis attending in 2 selected public hospitals from Myanmar.

Methods: After getting informed consent, clinical assessment, hemoglobin, serum albumin, serum lipids, calcium, phosphate, CRP and serum fetuin-A level were done. And lateral lumber spine Xray was taken and abdominal aortic calcification score (AAC) was calculated.

Results: A total of 96 people living with maintenance haemodialysis were enrolled. The mean AAC score was 3.64 ± 4.86 and 61.5% (60/96) of paticipants had positive AAC score. A quarter 24.7% (24/96) had significant AAC score (score ³ 5) and 37.5% (36/96) had AAC score ‘Zero’. Mean age was 51 years and mean BMI was 21.6 ± 2.0 kg/m². Dialysis vintage ranged from 5 months to 8 years. All participants had hypertension whereas a quarter (24/96) had diabetes mellitus. All participants were clinically pale with mean hemoglobin 9.2 gm%. Mean serum albumin was 43.2 ± 9.9 g/L. Mean serum corrected calcium was low normal (8.8 ± 0.79 mg/dL) and mean serum phosphate was high normal (5.0 ± 1.6 mg/dL). Mean fasting total cholesterol was 195.13 ± 31.43 mg/dL. Mean HDL cholesterol was low (48.49 ± 15.62 mg/dL). Mean LDL cholesterol was high (130.0 ± 104.3 mg/dL). Mean serum triglyceride was high (152.44 ± 24.75 mg/dL). Mean CRP was 4.7 ± 1.9 mg/dL.

Mean Fetuin-A level was 412.3 μg/ml ± 170.5 μg/ml. And mean Fetuin-A level for those with AAC score ‘Zero’ was high (545.6 μg/ml ± 84.4 μg/ml) whereas it was low (181.2 μg/ml ± 90.0 μg/ml) in those with significant AAC score (AAC score ³ 5). Those with non-significant AAC score (AAC score ³ 5) had high Fetuin-A level (433.7 μg/ml ± 96.1 μg/ml).

There was a statistically significant positive association between AAC score and age (rho = 0.296, p= 0.003); AAC score and fasting LDL cholesterol  (rho = 0.226, p = 0.027); AAC score and fasting triglyceride (rho = 0.246, p = 0.016) and AAC score and CRP (rho =  0.404, p < 0.001). There was a statistically significant negative association between AAC score and fasting HDL cholesterol (rho =  - 0.315, p < 0.001); and, AAC score and serum fetuin-A levels (rho = - 0.854, p < 0.001). AAC score was not associated with history of diabetes mellitus, hypertension, BMI, dialysis vintage, anemia, serum albumin, serum corrected calcium, serum phosphate.

Conclusion: In people living with maintenance haemodialysis, a significant positive association was found between abdominal aortic calcification and age, triglyceride, LDL cholesterol and CRP. Significant negative association was seen with HDL cholesterol and serum Fetuin-A level.