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WARFARIN USE IS ASSOCIATED WITH HIGHER PREVALENCE VERTEBRAL FRACTURES, VASCULAR CALCIFICATIONS AND INCREASED MORTALITY IN CHRONIC KIDNEY DISEASE

Questo Abstract è stato accettato come Comunicazione.

Abstract

INTRODUCTION AND AIMS. In addition to bleeding, other risks have been associated with the use of Warfarin (W), including an increase to vascular calcifications and fractures caused by a reduction in the levels of vitamin K dependent protein, Matrix Gla Protein (MGP) and Bone Gla Protein (BGP).The Aim was to evaluate prevalence Vertebral Fractures (VF), Vascular Calcifications (VC) and Mortality in relation to W. use.

METHODS. Cross-sectional study in hemodialysis patients, 18 dialysis centers. We included 387 hemodialysis patients (11.9% on W treatment). We evaluated VF with a computerized analysis, of scanned L-L vertebral X-rays. Reduction of > 20% of vertebral body height was considered a VF, while reductions between 15% and 20% were considered borderline F (BF). VC were quantified by measuring the length of calcific deposits along wall of the aorta and iliac arteries. Follow up 2.7±0.5 years.

RESULTS. Bone markers were: Ca 9.15±0.68 mg/dl, P 4.8± 1.28 mg/dl, median ALP 83 U/L, median PTH 244, median 25(OH)D 28.9 nmol/L, median BGP 175 mcg/L, median ucBGP 10.95 mcg/L, median MGP 19.36 nmol/L, median PCR 1.6 mg/L. We found that 55% of patients had VF and 30.9% of patients had BF. Prevalence of VC was 80.6% in the aorta and 55,1% in the iliac arteries.

We found VF were significantly associated W. use in Male (6.1% vs 14.4%, p=0.044) but not in female; Severe Aortic calcifications appeared to be significantly related to age, male gender, hypertriglyceridemia, W. treatment, the latter with an odd ratio of 3.04 (95% CI 1.52-6.07, p=0.0016). Also Severe Iliac calcifications were significantly related to Age, PTH and W., the latter with an odd ratio of 3.30 (95% CI 1.59-6.85, p=0.0013). Further during follow-up (2.7±0.5 years) mortality was of the 19.9% (on 387 total patients) with a significative increase in patients users W. (Log rank test p=0.0009).

CONCLUSIONS. Hemodialysis patients in treatment with W. are associated with higher Prevalence VF in men, VC and increased Mortality.

M. Fusaro(1), M. Noale(1), G. Tripepi(2), A. D'Angelo(3), R. Cristofaro(3), D. Miozzo(3), M. Gallieni(4)
((1)Consiglio Nazionale delle Ricerche (CNR) - Institute of Neuroscience, Aging Section Padova , (2)Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR - Istituto di Biometeorologia Reggio Calabria , (3)Nephrology Unit, University of Padua , (4)Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo Milano )
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Realizzazione: Tesi S.p.A.

Per assistenza contattare: Claudia Ingrassia, Tesi S.p.A.
0172 476301 — claudia.ingrassia@gruppotesi.com