Should CT coronary calcium score be avoided in dialysis patients in light of presumed high prevalence of CAC in this population?

The incidence of coronary calcifications in patients on dialysis exceeds 80% and is between 50-80% in patients with CKD. In addition, dialysis and ESRD cause two types of vascular calcification - in the medial and intimal layers, the latter being the one that correlates best with atherosclerotic plaque. In patients without ESRD, coronary calcification adds prognostic information if present, whereas altho increasing coronary calcification was seen in cardiac mortality/morbidity in ESRD, when correcting for other risk factors for CAD, the calcium score was not significantly predictive. Unfortunately, CT calcium scores are unable to differentiate between these two types of calcified plaques. Add to this the fact of calcium/phosphate metabolism...

Short answer, CT coronary calcium is likely beneficial only in select situations in dialysis patients. There are a couple of things to consider in answering this question:

1. Do they have an alternative indication for preventive therapy (statin +/- ASA)?; and
2. Independent of dialysis, what is the risk of atherosclerotic vascular disease?

Prevalence of CAD is high in CKD patients in general, and dialysis patients specifically likely in part due to a high prevalence of co-morbidities, but also accelerated vascular calcification and atherosclerosis. If patients have an indication for preventive therapy (known ASCVD, DM, >7.5% risk at 10 years), then I would just treat them with preventive therapy (mostly statin, but a whole other set of discussi...

In select group of patients, CTA coronaries is my practice.