CONCLUSIONS RESULTS INTRODUCTION and AIMS METHODS REFERENCES: CHRONIC PROTON PUMP INHIBITOR TREATMENT IS ASSOCIATED WITH AN INCREASED RISK OF VASCULAR CALCIFICATIONS IN CHRONIC KIDNEY DISEASE Maria Fusaro 1, M.D., Ph.D., Marianna Noale 1, M.S.C., Giovanni Tripepi2, M.S.C., Amgela D’Angelo3, M.D., Davide Miozzo3,M.D., Maurizio Gallieni4, M.D., for the VC (Vascular Calcification) Study Group 1CNR Aging Section, Institute of Neuroscience, Padua, Italy;2CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases Hypertension of Reggio Calabria,Reggio Calabria , Italy; 3 Nephrology Unit, University of Padua, Italy; 4Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy INTRODUCTION and AIMS METHODS Proton pump inhibitors (PPIs) are extensively used for the chronic treatment of common gastrointestinal disorders. Chronic PPI use is associated with increased risk of fractures. The primary endpoint was the extent of aortic and iliac calcifications, in relation to PPI use. Multicenter, cross-sectional study in hemodialysis patients, 18 hospital based dialysis centers in Northern Italy. We included 387 hemodialysis patients (76.2% on chronic PPI treatment). Vascular (aortic and/or iliac) Calcification (CV) assessments were centralized. Witteman’s method (1) was used for blinded assessments in duplicate. VC were quantified by measuring the length of calcific deposits along the anterior and posterior wall of the aorta (mild 0.1-5 cm, moderate 5.1-10 cm and severe > 10 cm) (2). They also evaluated the presence or absence of calcifications of the iliac arteries in the same radiograph (mild 0.1-3 cm, moderate 3.1-5 cm and severe > 5 cm). Any differences were resolved by consensus 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 pg/mL, mediana 25(OH)D 28.9 nmol/L, median BGP 175 cmg/L, median ucBGP 10.95 mcg/L, median MGP 19.36 nmol/L, median PCR 1.6 mg/L. Prevalence of VC was 80.6% (mild 20.1%, moderate 30.8%, severe 29.7%) in the aorta and 55.1% in the iliac arteries (Fig 1). We found Arterial calcifications were significantly more common in the PPI group: 57,0% vs 41,3% (p=0.0086). Also the rates of aortic and ilizc calcifications considered separately were higher (+12.2% p=0.0254 and +13.6% p=0.0211, respectively). The proportions of patients suffering from angina and atrial fibrillation were significantly higher in the PPI group (+ 11.7% p=0.0083 and +8.8% p=0.0306, respectively). Severe aortic calcifications, as well as moderate and severe iliac calcifications, appeared to be significantly related to age, male gender, hypertriglyceridemia, warfarin treatment and also to PPI treatment, the latter with an odd ratio of 2.15-2.66 depending on calcification site. Fig 1. Vertebral fractures in dialysis patients (Legend: VF=vertebral fractures; BF=borderline fractures; VC=Vascular Calcification) p=0.0086 Fig 2. PPI treatment and vascular calcifications CONCLUSIONS In hemodialysis patients chronic treatment with PPIs is associated with vascular calcification, a known risk factor for cardiovascular events and mortality in hemodialysis patients, amd for cariovascular events on non renal elderly subjects. Additional studies are warranted to explore the association among chronic PPI treatment, vascular calcifications and cardiovascular events. Participating centers: Adria (Dott. Stoppa F; Dott.ssa Bernardi AM); Bassano del Grappa (Dott.ssa Pellanda V; Dott. Dell’Aquila R); Belluno (Dott. Tarroni G; Dott. De Paoli Vitali); Bolzano (Dott. Corradini R; Dott. Avolio M; Dott.Giacon B); Castelfranco V.to (Dott. Ferraro A; Dott. De Luca M); Dolo (Dott. Lucatello S; Dott.ssa Meneghel G); Feltre (Dott. Vianello A; Dott. Antonucci F); Firenze (Dott.ssa Grimaldi C; Dott. Mannarino A); Lodi (Dott. Barbisoni F; Dott. Elli A); Mestre (Dott. Morachiello P; Dott. Feriani M); Padova (Dott.ssa Rebeshini M; Dott. Naso A); Piove di Sacco-Chioggia (Dott.ssa Spinello M; Dott. Urso M); Rovigo (Dott.ssa Pati T; Dott. Gemelli A; Dott.ssa Bernardi AM); Schio (Dott.ssa Magonara FM; Dott. Axia M); Sesto SG (Dott. Ciurlino D; Dott. Bertoli S); Trento (Dott. Pica A; Dott.ssa Venturelli C; Dott. Brunori G); Treviso (Dott.ssa Puggia R; Dott.ssa Caberlotto A; Dott.ssa Mastrosimone S; Dott. Cascone C); Voghera (Dott.ssa Foschi A; Dott Milanesi F) REFERENCES: 1.Genant HK, Wu CY, Van Kuijk C et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137–1148 2. Witterman JC, Grobbee DE, Valkenburg HA et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet 343: 504-507, 1994. Corresponding Author Maria Fusaro, M.D., Ph.D. CNR Aging Section, Institute of Neuroscience, Padua, Italy Via Giustiniani, 2, 35128 Padova, Italy. Telephone: +390498212173 FAX: +390498212151 E-mail: dante.lucia@libero.it