Is progression of arteriosclerosis in ESRD patients inhibited by nocturnal hemodialysis of renal transplantation?

Cardiovascular disease is the leading cause of mortality in patients with
end-stage renal disease (ESRD). The vascular abnormalities in ESRD are
especially characterized by arterial wall calcifications, whereas intimal
hyperplasia seen with *classic atherosclerosis* is less pronounced. These
calcifications are strongly associated with increased mortality. The exact
mechanism by which calcification develops is unknown, but there is a direct
relationship with increased serum calcium and serum phosphorus. With long and
frequent hemodialysis, such as nocturnal hemodialysis, and with renal
transplantation, calcium and phosphate values can be normalized. It is unknown
whether these treatments inhibit the progression of arterial calcification or
bring about regression of calcification. The hypothesis of this study is that
with nocturnal hemodialysis the progression of arterial calcification is less
than with conventional hemo- or peritoneal dialysis, and approximates the
progression rate seen with a renal transplant.

1. To assess whether nocturnal hemodialysis and renal transplantation give less
progression of arterial calcification, compared with conventional hemodialysis
and peritoneal dialysis;
2. To identify the risk factors for arterial calcification in dialysis and
transplant patients.

Prospective observational cohort study, comparing 4 cohorts with a follow-up of
3 years; each cohort exists of 40 patients to account for a 25%
lost-to-follow-up-rate (e.g. by renal transplantation in the 3 dialysis groups,
or by mortality).

- The study is an observational study, not an intervention-study.
- Participation does not influence or change the nature of the treatment, i.c.
the modality of renal replacement therapy;
- Participation is associated with limited physical examination, questionnaires
and blood sampling;
- Blood sampling is performed in combination with regular blood sampling, and
requires a maximum of 10 cc blood per visit extra, twice a year;
- Multislice-CT-scan is performed at inclusion, and after 1, 2 and 3 years;
this scan takes < 1 minute of time and radiation exposure is less than with
conventional abdominal CT-scan;
- Yearly measurements of pulse-wave velocity are done with ultrasound
(non-invasive), which takes 30 minutes of time.