Assessment and significance of abdominal aortic calcification in chronic kidney disease

Hanada, Shigeru; Ando, Ryoichi; Naito, Seiji; Kobayashi, Naho; Wakabayashi, Mai; Hata, Toshihiko; Sasaki, Sei

doi:10.1093/ndt/gfp728

Cited by 55 publications

(48 citation statements)

References 38 publications

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“…Hong et al (29) postulated that the high prevalence of aortic calcification and its association with age may limit its prognostic value for the survival of patients on dialysis. The same reasoning could be applied to patients with nondialysis CKD, in whom the presence of aortic calcification is age related and very prevalent, which was reported in this study and others (1)(2)(3)(4)(5)(6)(7)(8)(9). This discovery of the independent prognostic value that a plain radiograph of hands may have in detecting VC constitutes the most original finding of this study.…”

Section: Discussionsupporting

confidence: 61%

“…Several studies have reported on the high prevalence of vascular calcification (VC) in patients with nondialysis CKD (1)(2)(3)(4)(5)(6)(7)(8)(9). It has been postulated that the early diagnosis of VC and the treatment of the factors that promote it could reduce the high rate of cardiovascular mortality observed in patients with CKD (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

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Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Górriz¹,

Molina²,

Cerverón³

et al. 2015

Clinical Journal of the American Society of Nephrology

156

131

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Background and objectives Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed.Design, setting, participants, & measurements The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop .30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models.Results VC was present in 79% of patients and prominent in 47% (AS$3 or KS.6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P,0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P,0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS$3. After a median followup of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS$3 but not KS.6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P,0.001). VC did not predict renal progression.Conclusions VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Górriz¹,

Molina²,

Cerverón³

et al. 2015

Clinical Journal of the American Society of Nephrology

156

131

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“…59,60 In brief, ten CT slices were obtained at 1-cm intervals above the bifurcation of the common iliac vessels, the cross-section of the abdominal aorta on each slice was divided into 12 sectors, and the number of calcified sectors was counted. Then, the ACI was obtained with the following formula: ACI (%) = (number of sectors with calcification)/120 (number of sectors evaluated) 3100.…”

Section: Imaging Studiesmentioning

confidence: 99%

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

Suwabe

Ubara

Mise

et al. 2015

JASN

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In patients with autosomal dominant polycystic kidney disease (ADPKD), massive renal enlargement is a serious problem. Renal transcatheter arterial embolization (TAE) can reduce renal volume (RV), but effectiveness varies widely, and the reasons remain unclear. We investigated factors affecting renal volume reduction rate (RVRR) after renal TAE in all 449 patients with ADPKD who received renal TAE at Toranomon Hospital from January of 2006 to July of 2013, including 228 men and 221 women (mean age =57.069.1 years old). One year after renal TAE, the RVRR ranged from 3.9% to 84.8%, and the least squares mean RVRR calculated using a linear mixed model was 45.5% (95% confidence interval [95% CI], 44.2% to 46.8%). Multivariate analysis using the linear mixed model revealed that RVRR was affected by the presence of large cysts with wall thickening (regression coefficient [RC], 26.10; 95% CI, 29.04 to 23.16; P,0.001), age (RC, 20.82; 95% CI, 21.03 to 20.60; P,0.001), dialysis duration (RC, 20.10; 95% CI, 20.18 to 20.03; P,0.01), systolic BP (RC, 0.39; 95% CI, 0.19 to 0.59; P,0.001), and the number of microcoils used for renal TAE (RC, 1.35; 95% CI, 0.83 to 1.86; P,0.001). Significantly more microcoils were needed to achieve renal TAE in patients with younger age and shorter dialysis duration. In conclusion, cyst wall thickening had an important effect on cyst volume reduction. Renal TAE was more effective in patients who were younger, had shorter dialysis duration, or had hypertension, parameters that might associate with cyst wall stiffness and renal artery blood flow.

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“…Vascular calcification has been shown to be a marker of atherosclerotic plaque burden and a contributor to arterial stiffness [5]. The presence of abdominal aortic calcification (AAC) has been associated with adverse cardiovascular events, chronic kidney disease, and end-stage renal disease [6]. However, the impact of donor AAC on living kidney transplantation has not yet been explored.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

Wu¹,

Wojciechowski

Chandran

et al. 2015

Transpl Int

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SummaryWe assessed the prevalence of abdominal aortic calcification (AAC) in older living kidney donors and its effect on recipient eGFR and graft histology. A total of 292 consecutive living pairs with donor age ≥50 from 2003 to 2013 were identified (mean age 56; range 50-78; F/M: 1.8). Donor AAC was determined by prenephrectomy unenhanced CT. Recipient eGFR and spot urine protein: creatinine ratios (UPCRs) were recorded. A total of 180 recipients had 6-month protocol biopsies. AAC was present in 40.7% of donors, and they were older (58.6 versus 54.7 years old, P < 0.0001) and more likely to be male (77.6% vs. 37.3%, P = 0.004). There was no significant difference in eGFR or spot UPCR up to 36 months in recipients of allografts from donors with versus without AAC. At 6-month biopsy, there was a higher percentage of allografts with vascular fibrous intimal thickening and arteriolar hyaline thickening from donors with versus without AAC (vascular fibrous intimal thickening: 38.8% vs. 7.1% and arteriolar hyaline thickening: 35.8% vs. 7.1%; P < 0.001 for both). The presence of donor AAC predicts the presence of vascular disease [vascular fibrous intimal thickening (OR: 7.2; CI:2.9-17.9) and arteriolar hyaline thickening (OR:5.7; CI:2.3-14.1)] in allografts at 6 months. Donor AAC is predictive of renal vascular disease and may help to improve the screening of potential donors and inform post-transplant management.

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Assessment and significance of abdominal aortic calcification in chronic kidney disease

Cited by 55 publications

References 38 publications

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

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