Pulmonary calcification in hemodialysis patients: correlation with pulmonary artery pressure values.

BACKGROUND End-stage renal disease (ESRD) patients receiving chronic hemodialysis (HD) via an arteriovenous (A-V) access often develop unexplained pulmonary hypertension (PHT). This study evaluated the role of pulmonary calcification (PC) in this phenomenon. METHODS The clinical manifestations, systolic pulmonary artery pressure (PAP) values measured by Doppler echocardiography and the presence and the extent of PC expressed by lung uptake of 99mTc-MDP bone scintigraphy, were studied in 49 patients with ESRD receiving chronic HD therapy via A-V access. The correlation between PC and PHT was investigated. RESULTS There were 36 men and 13 women with a mean age of 61.7 +/- 13.2 years receiving HD therapy for 38.2 +/- 43.7 months. Twenty (40.8%) patients had PC expressed by increased lung uptake of 99mTc- MDP and 28 (57.1%) patients had PHT with a mean systolic PAP of 46 +/- 11 mm Hg. No correlation was found between PC and PHT. CONCLUSION The data suggest that PC expressed by lung uptake of 99mTc-MDP has no role in the pathogenesis of PHT among ESRD patients undergoing HD therapy via A-V access.

[1]  M. Yigla,et al.  The pathogenesis of pulmonary hypertension in haemodialysis patients via arterio-venous access. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[2]  K. Nitta,et al.  The progression of vascular calcification and serum osteoprotegerin levels in patients on long-term hemodialysis. , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[3]  M. Yigla,et al.  Pulmonary hypertension in patients with end-stage renal disease. , 2003, Chest.

[4]  D. Case,et al.  The use of bone scintigraphy to evaluate metastatic calcification caused by end-stage renal disease and secondary hyperparathyroidism. , 2003, Clinical nuclear medicine.

[5]  W. Qunibi,et al.  Cardiovascular calcification in patients with end-stage renal disease: a century-old phenomenon. , 2002, Kidney international. Supplement.

[6]  E. Chan,et al.  Calcium deposition with or without bone formation in the lung. , 2002, American Journal of Respiratory and Critical Care Medicine.

[7]  K. Hruska,et al.  Pathophysiological mechanisms of vascular calcification in end-stage renal disease. , 2001, Kidney international.

[8]  R. Elashoff,et al.  Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. , 2000, The New England journal of medicine.

[9]  M. Kramer,et al.  Pulmonary calcifications: a review. , 2000, Respiratory medicine.

[10]  S. Achenbach,et al.  Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary-artery stenoses and occlusions. , 1998, The New England journal of medicine.

[11]  D. Kerr,et al.  Hypercalcemia and metastatic calcification. , 1997, Cardiovascular research.

[12]  D. Aberle,et al.  Intrathoracic calcifications: radiographic features and differential diagnoses. , 1994, Radiographics : a review publication of the Radiological Society of North America, Inc.

[13]  J. Ikezoe,et al.  Metastatic pulmonary calcification: early detection by high-resolution CT. , 1993, Journal of computer assisted tomography.

[14]  D. Mendelson,et al.  Computer tomography demonstration of pulmonary artery calcification in Eisenmenger's syndrome. , 1985, The Journal of computed tomography.

[15]  J. Porush,et al.  Pulmonary calcification in hemodialyzed patients detected by technetium-99m diphosphonate scanning. , 1980, Kidney international.

[16]  Wang Ns,et al.  Pulmonary calcification: scanning electron microscopic and X-ray energy-dispersive analysis. , 1979 .

[17]  E. Pauwels,et al.  Bone scintigraphy in uremic pulmonary calcification. , 1979, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[18]  J. Conger,et al.  Soft tissue calcification in chronic dialysis patients. , 1977, The American journal of pathology.

[19]  J. Conger,et al.  Pulmonary calcification in chronic dialysis patients. Clinical and pathologic studies. , 1975, Annals of internal medicine.

[20]  I. Steinberg.  Calcification of the pulmonary artery and enlargement of the right ventricle: a sign of congenital heart disease. Eisenmenger syndrome--pulmonary hypertension, increased pulmonary resistance, and reversal of blood flow. , 1966, The American journal of roentgenology, radium therapy, and nuclear medicine.

[21]  R. Lingam,et al.  Case report. Metastatic pulmonary calcification in renal failure: a new HRCT pattern. , 2002, The British journal of radiology.

[22]  S. Matsuyama,et al.  MR appearance of pulmonary metastatic calcification. , 1996, Journal of computer assisted tomography.

[23]  S. Massry,et al.  Excess PTH in CRF induces pulmonary calcification, pulmonary hypertension and right ventricular hypertrophy. , 1995, Kidney international.