Background Coronary artery calcification (CAC) is highly prevalent in patients with chronic kidney disease (CKD) and is strongly associated with adverse cardiovascular outcomes. Pentoxifylline (PTX), a methylxanthine derivative with anti-inflammatory and hemorheologic properties, may have a potential role in attenuating vascular calcification and slowing CKD progression. Patients and methods This prospective, open-label, randomized controlled trial included 80 CKD patients were randomized to receive either PTX 400 mg twice daily plus conventional therapy ( n =40) or conventional therapy alone ( n =40) for 6 months. Baseline and follow-up assessments included clinical evaluation, laboratory investigations, and coronary artery calcium scoring using multislice computed tomography with the Agatston method. The primary outcome was progression of CAC, while secondary outcomes included CKD progression and changes in renal and biochemical parameters. Results Baseline demographic, clinical, and laboratory characteristics were comparable. After 6 months, estimated glomerular filtration rate declined significantly in the control group but remained stable in the PTX group. CKD progression was less frequent in PTX group (12.5 vs. 32.5%, P =0.032). The Agatston score increased significantly in the control group but decreased in the PTX group, with a significantly lower score observed in the intervention arm ( P =0.036). Regression of coronary calcification occurred more frequently with PTX (27.5 vs. 5%, P =0.023). Multivariate analysis identified group allocation as the sole independent predictor of CAC progression. Conclusion PTX therapy significantly attenuated CAC progression and was associated with reduced CKD progression in patients with moderate to advanced CKD.
Gaber et al. (2026) studied this question.