INTRODUCTION Patients with chronic renal disease in predialytic and dialytic stage are at high risk of developing cardiovascular disease, especially regarding ischemic cardiopathy and sudden death (1). These cardiopathies have been at least in part attributed to hyperphosphatemia with increased CaxP product, favoring extraskeletal calcium deposits in myocardium, cardiac valves, and coronary arteries (2-5). Hyperphosphatemia is a frequent occurrence in patients with advanced chronic renal failure due to excessive absorption of intestinal dietary phosphate and a relative inability of the dialysis procedure to get rid of the absorbed element, due to the relatively poor dialyzability of phosphate. The use of calcium carbonate as a phosphate chelating agent, even in case of a satisfactory chelation of phosphate, entails a calcium overload to the organism, with increased CaxP product and deposition of calcium phosphate salts in extraskeletal tissues (6). The extensive use of vitamin D for suppression of increased PTH levels can only worsen the situation, due to the increased intestinal absorption of calcium and phosphate with consequent hypercalcemia and hyperphosphatemia, and enhanced positive calcium and phosphate balances. Recent radiological techniques can localize and quantify the deposited calcium salts in the heart, with special reference to the coronary arteries. Electron Beam Artificial Kidney and Dialysis / Hemodialysis The International Journal of Artificial Organs / Vol. 27 / no. 9, 2004 / pp. 759-765 Cardiac calcium evaluation in hemodialysis patients with multisection spiral computed tomography G. SPLENDIANI 1 , M. MOROSETTI 2 , M. MANNI 3 , L. JANKOVIC 2 , A. NATICCHIA 1 , A. STURNIOLO 1 , T. TULLIO 1 , A. BALDUCCI 3 , G. COEN 1 1 Department of Nephrology and Dialysis Service, University Hospital “Tor Vergata” Rome - Italy 2 Department of Nephrology and Dialysis Service, Hospital “G.B. Grassi” Ostia - Italy 3 Department of Nephrology and Dialysis Service, Hospital “San Giovanni Addolorata” Rome - Italy © Wichtig Editore, 2004 0391-3988/759-07 $15.00/0 ABSTRACT: Aim: The aim of this study is cardiac calcium content evaluation in hemodialysis patients by a new technique, based on ultrafast multisection CT (MTC). Methods: The study was carried out on 30 HD patients, 14F and 16 M, average age 57.7±13.9 years, average HD age 57.3±47.4 months. The intact PTH levels were 625.4±571 pg/mL. Serum calcium, phosphate and CaxP product were 9.75±0.84 mg/mL, 6.21±1.01 mg/dL and 60.2±10.7 mg 2 /dL 2 , respectively. Results: The values obtained with the MTC technique were reported in terms of Agatson scores. Score values frankly in the pathologic range (>100) were found in 24 patients (80%). Correlation analysis has shown positive and significant correlation coefficients of the score with patients’ age (p=0.003), serum calcium (p=0.012), CaxP (p=0.015), iPTH (=0.049), and borderline, to HD age (p=0.06). Conclusion: Risk factors for cardiac calcification are mainly age, degree of hyperparathyroidism, increased CaxP and serum calcium levels. A control of calcium phosphate parameters in hemodialysis patients seems to be mandatory to avoid increased severity of coronary artery disease. (Int J Artif Organs 2004; 27: 759-65) KEY WORDS: Coronary artery calcifications, Hemodialysis, Multisection spiral computerized tomography