OBJECTIVES: Abnormal bone turnover and mineralization is the characteristic of the end-stage renal disease (ESRD) patients receiving dialysis treatment. Reduced bone mineral density (BMD) has been reported in ESRD patients in many recent studies. Recent study has demonstrated hypoxia increases the loss of bone mass whereas the use of erythropoietin (EPO) increases bone marrow mesenchymal stem cell in vitro, which is the commonly found in ESRD patients. The objective of the present study is to analyze the relationship between erythropoiesis and calcium, phosphorus, parathyroid hormone (PTH) status in ESRD patients. METHODS: This study was a cross-sectional analysis of 183 ESRD patients (78 males, 105 females) on dialysis with mean age of 52 +/- 13 years and mean dialysis duration of 3.4 +/- 3.0 years. Duration and dose of EPO administration, hemoglobin, serum ferritin, and iron were checked in all subjects. BMD was evaluated by DXA. RESULTS: Age was negatively, and body weight and c-calcium positively associated with spine and femur neck and total hip BMD. Hemoglobin was positively correlated with femur neck and total hip BMD. Total dose of EPO, iPTH, and alkaline phosphatase had no significant association with BMD. However, according to tertile of serum PTH concentration, BMD were worst in third tertile group. In multivariate linear regression analysis, age, weight, and serum PTH affect BMD. CONCLUSIONS: BMD was independently related with age and weight. Hemoglobin correlated positively with femur neck and total hip BMD. However, treatment with EPO had no association with BMD. Increased PTH was related with reduced BMD.
Alkaline Phosphatase ; Anoxia ; Body Weight ; Bone Density ; Bone Marrow ; Calcium ; Cross-Sectional Studies ; Dialysis ; Erythropoiesis ; Erythropoietin ; Femur Neck ; Ferritins ; Hemoglobins ; Hip ; Humans ; Iron ; Kidney Failure, Chronic ; Linear Models ; Male ; Mesenchymal Stromal Cells ; Parathyroid Hormone ; Phosphorus ; Spine

Objective: To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT). Materials and Methods: This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen’s kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods. Results: For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496–0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636–0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen’s kappa, 0.565 [95% CI: 0.511–0.619 for visual assessment vs. 0.695 [95% CI: 0.638–0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001). Conclusion The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.