Association Between Angiotensin-Converting Enzyme 2 and Coronary Artery Calcification in Patients on Maintenance Hemodialysis Therapy.

While all mechanisms that contribute to the pathogenesis of coronary artery calcification (CAC) are unknown, angiotensin-converting enzyme 2 (ACE2) may be involved in this process in maintenance hemodialysis (MHD) patients. The aim of this study was to investigate the association between ACE2 and CAC in patients on MHD therapy. Ninety patients on MHD therapy were involved in this prospective study. CAC was quantified by CAC score (CACs) using the Agatston method and a multi-slice CT scanner. Univariate and multivariate logistic regression were used to analyze the association between ACE2 and CACs. In the univariate analysis, CACs positively correlated with ACE2 (r = 0.666, P < 0.001). After adjusting for age, sex, smoking, hypertension, body mass index, diabetes mellitus, and hyperlipidemia, ACE2 levels continued to significantly and independently predict the presence of CAC. ROC curve analysis showed that the serum ACE2 level can predict the extent of CAC. These findings indicate that elevated serum ACE2 may be involved in vascular calcification in patients receiving MHD therapy.