Progression of Aortic Arch Calcification Is Associated with Overall and Cardiovascular Mortality in Hemodialysis

Abstract

Background. Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). Nevertheless, little is known whether the progression of vascular calcification outweighs the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients. Methods. This study included 140 maintenance HD patients. Vascular calcification was assessed using the aortic arch calcification (AoAC) score measured from chest radiographs at the baseline and the second year of follow-up. Progression of vascular calcification (ΔAoAC) was defined as the difference between the two measurements of AoAC. The association of ΔAoAC with overall and CV mortality was evaluated using multivariate Cox regression analysis. Results. During the mean follow-up period of 5.8 years, there were 49 (35%) overall mortality and 27 (19.3%) CV mortality. High brachial-ankle pulse wave velocity was positively correlated with ΔAoAC, whereas old age was negatively correlated with ΔAoAC. In multivariate adjusted Cox analysis, increased ΔAoAC (per 1 unit), but not baseline AoAC, was significantly associated with overall mortality (HR, 1.183; 95% CI, 1.056–1.327; p=0.004) and CV mortality (HR, 1.194; 95% CI, 1.019–1.398; p=0.028). Conclusion. Progression of AoAC outperformed the baseline AoAC in association with increased risk of overall and CV mortality in HD patients. A regular follow-up of chest radiograph and AoAC score assessments are simple and cost-effective to identify the high-risk individuals of unfavorable outcomes in maintenance HD patients.

Aortic Arch Calcification and Cardiomegaly Are Associated with Overall and Cardiovascular Mortality in Hemodialysis Patients

“…The AoAC score can be calculated from chest X-rays, which represents the extent of VC in the aorta. Many studies have shown that the presence and progression of AoAC are strong risk factors for cardiovascular morbidity and mortality [ 28 , 29 , 30 ]. The etiology of VC is multifactorial in patients with ESRD, and it has been reported to involve aging, diabetes, smoking, oxidative stress, inflammation, hyperfibrinogenemia, dysregulation of fibroblast growth factor 23, intact parathyroid hormone, calcium and phosphorus, protein-energy wasting, loss of osteopontin and fetuin-A, the osteoprotegerin/receptor activator of NF-kB/receptor activator of the NF-kB ligand system, as well as an increase in sclerostin [ 31 , 32 , 33 ].…”

Predictors of Vascular Calcification in Hemodialysis Patients

“…Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). Nevertheless, little is known whether the progression of vascular calcification outweighs the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients [8]. [11] and with that Carotid intima media thickness has significantly positive correlation with traditional atherosclerotic risk factors like age, body mass index in CKD patients [12] and that age, BMI, phosphate, dialysis adequacy were associated with CAC progression [13] and the results of multivariate analysis indicated that only age and serum phosphate level were independent risk factors.…”

Arterial Calcifications and Osteoprotegerin in Chronic Hemodialysis Patients – Impact on 6 Years Survival

“…The presence and extension of vascular calci cations, detected on coronary arteries and abdominal aorta, predicted risk of all-cause death in patients starting hemodialysis 10 . The aortic arch calci cation was measured on chest radiographs and its progression was associated with mortality in HD patients 11 . Ultrasound, as one of the most valuable and, also available tool, can easily detect morphological abnormalities of the vascular walls.…”