Abstract 17376: Incremental Effects of Diabetes Mellitus and Chronic Kidney Disease in Medial Calcification: Synergistic Pathways for Peripheral Vascular Disease Progression
Background: Diabetes mellitus (DM) complicated by chronic kidney disease (CKD) is the strongest risk factor for gangrene and amputation in patients with peripheral vascular disease (PVD), increasing mortality up to 38% in the first year after diagnosis. Advanced, obstructive PVD is characterized by intimal calcification. However, the role of medial calcification and ossification in DM-CKD patients with PVD has not been characterized.
Hypothesis: We hypothesize that DM associated CKD will have incremental effects in medial calcification in patients with symptomatic PVD.
Methods: Fifty symptomatic patients with superficial femoral artery stenosis undergoing directional atherectomy were evaluated. Plaque specimens were grouped by no CKD/no DM (n=14), DM alone (n=12), CKD alone (n= 10), and with DM+CKD (n=14). Using H&E stain, percent of medial calcification was quantified. Calcification density by microscopic planimetry was also performed.
Results: Percentage of plaques with medial calcification are shown in Figure 1. This percentage was lowest in patients with no CKD/no DM, intermediate in DM alone and CKD alone, and greatest among patients with DM+CKD (p=0.017). Calcium densities followed the same pattern. (No-DM: 0.04±01; DM: 0.07±02; CKD: 0.05±01; DM+CKD: 0.1±02; (p<0.02). We observed a single focus of microscopic ossification in a plaque from DM+CKD peripheral atheroma.
Conclusions: Symptomatic PVD when associated with DM alone or DM+CKD have incremental effects in medial calcification, suggesting accelerated progression of peripheral atheroma. Careful screening, early detection, and intense therapy for PVD may reduce the impact of medial calcification and improve prognosis in DM patients when complicated by CKD.
- © 2012 by American Heart Association, Inc.