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      Aortic arch calcification predicts cardiovascular and all-cause mortality in maintenance hemodialysis patients.

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          Abstract

          Vascular calcification is associated with cardiovascular risk in maintenance hemodialysis (MHD) patients. Previous reports have shown that simple assessment of aortic arch calcification (AoAC) using plain radiography is associated with cardiovascular mortality in the general population. We conducted a prospective study to investigate factors associated with the presence at baseline and progression of AoAC in MHD patients and examined its prognostic value in a short-term outcome.

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          Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients.

          K Kitatani, Masaaki Inaba, Eiji Ishimura … (2007)
          Although abdominal aortic calcification (AAC) is reported as a predictor for cardiovascular mortality in the general population, it is unknown whether this is also true in hemodialysis patients in whom vascular calcification and cardiovascular diseases are highly prevalent. Cohort study. 515 patients on maintenance hemodialysis therapy at a single center. AAC evaluated in a plain roentgenograph of the lateral abdomen at baseline. All-cause and cardiovascular death. Mean age was 60 +/- 12 (SD) years. AAC was present in 291 patients (56.5%). During a mean follow-up period of 51 +/- 17 months, there were 103 all-cause deaths, of which 41 were from cardiovascular diseases. Of patients with and without AAC, 27.8% and 9.8% died, respectively (11.6% and 3.1% of cardiovascular diseases, respectively). Kaplan-Meier analysis showed that all-cause mortality was significantly greater in patients with AAC compared to those without (P < 0.0001, log-rank test). Similarly, cardiovascular mortality was significantly greater in the former than in the latter group (P = 0.0001, log-rank test). Multivariate Cox proportional hazards analysis found that the presence of AAC was significantly associated with increased all-cause mortality (hazard ratio, 2.07; 95% confidence interval, 1.21 to 3.56; P < 0.01) and increased cardiovascular mortality (hazard ratio, 2.39; 95% confidence interval, 1.01 to 5.66; P < 0.05) after adjustment for age, hemodialysis duration, presence of diabetes, serum albumin level, and C-reactive protein level. Nonquantitative assessment of AAC and the lack of information for medication and history of cardiovascular diseases. The presence of AAC is significantly associated with both all-cause and cardiovascular mortality in hemodialysis patients, suggesting that careful attention should be given to the presence of AAC in a simple radiograph of the lateral abdomen as a prognostic indicator.
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            Correlation of simple imaging tests and coronary artery calcium measured by computed tomography in hemodialysis patients.

            Rachel Wildman, P. Raggi, E Ferramosca … (2006)
            Vascular calcification is associated with an adverse prognosis in end-stage renal disease. It can be accurately quantitated with computed tomography but simple in-office techniques may provide equally useful information. Accordingly we compared the results obtained with simple non-invasive techniques with those obtained using electron beam tomography (EBT) for coronary artery calcium scoring (CACS) in 140 prevalent hemodialysis patients. All patients underwent EBT imaging, a lateral X-ray of the lumbar abdominal aorta, an echocardiogram, and measurement of pulse pressure (PP). Calcification of the abdominal aorta was semiquantitatively estimated with a score (Xr-score) of 0-24 divided into tertiles, echocardiograms were graded as 0-2 for absence or presence of calcification of the mitral and aortic valve and PP was divided in quartiles. The CACS was elevated (mean 910+/-1657, median 220). The sensitivity and specificity for CACS > or = 100 was 53 and 70%, for calcification of either valve and 67 and 91%, respectively, for Xr-score > or = 7. The area under the curve for CACS > or = 100 associated with valve calcification and Xr-score was 0.62 and 0.78, respectively. The likelihood ratio (95% confidence interval) of CACS > or = 100 was 1.79 (1.09, 2.96) for calcification of either valve and 7.50 (2.89, 19.5) for participants with an Xr-score > or = 7. In contrast, no association was present between PP and CACS. In conclusion, simple measures of cardiovascular calcification showed a very good correlation with more sophisticated measurements obtained with EBT. These methodologies may prove very useful for in-office imaging to guide further therapeutic choices in hemodialysis patients.
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              Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients.

              Marlies Noordzij, Ellen Cranenburg, Lyda F Engelsman … (2011)
              Previous studies have shown that simple imaging methods may be useful for detection of vascular calcifications in dialysis patients. Based on annual, plain chest X-rays during follow-up on dialysis, we studied the associations of mineral metabolism with the presence and progression of aortic calcification. In addition, we assessed the impact of aortic calcification on mortality. Three hundred and eighty-four patients who started haemodialysis or peritoneal dialysis between 1997 and 2007 were included (age 61 ± 15 years, 64% male, 61% haemodialysis). Annual chest X-rays were screened for calcification in the aortic arch, and patients were categorized as having no, moderate or severe calcification. Progression was defined as an increase in calcification category during follow-up on dialysis. At baseline, 96 (25%) patients had severe, 205 (53%) patients had moderate and 83 (22%) patients had no aortic calcification. For 237 of the 288 patients with no or moderate calcifications at baseline, X-rays were available for follow-up. During follow-up (mean 2.3 years), aortic calcification progressed in 71 patients (30%). We found that baseline plasma calcium > 9.5 mg/dL and iPTH > 300 pg/mL were associated with progression [odds ratios of 3.1, 95% confidence interval (1.2-8.2) and 4.4 (1.4-14.1), respectively]. Progression of aortic calcification was significantly associated with increased risk of all-cause mortality (hazard ratio: 1.9; 95% CI: 1.2-3.1) and cardiovascular mortality (hazard ratio: 2.7; 95% CI: 1.3-5.6). Aortic calcification progressed in almost a third of the patients during dialysis. Hypercalcaemia and hyperparathyroidism were associated with an increased risk of progression. Progression of aortic calcification was significantly related to an increased mortality risk.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Kidney Blood Press. Res.
                Title: Kidney & blood pressure research
                ISSN (Electronic): 1423-0143
                ISSN (Print): 1420-4096
                Publication date (Electronic): 2014
                Volume: 39
                Issue: 6
                Affiliations
                [1 ] Department of Nephrology, Jyoban Hospital, Iwaki-city, Fukushima, Japan.
                Article
                Publisher Item ID: 000368476
                DOI: 10.1159/000368476
                PubMed ID: 25571879
                SO-VID: ccc036cd-d7ef-47b8-a94f-bf54b1078404
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