Abstract
BackgroundAbdominal aortic calcification (AAC) has a pretty high incidence in dialysis patients and may be associated with their prognosis. AAC can be assessed by abdominal CT or X-ray. We determined to investigate whether the occurrence of AAC is associated with all-cause mortality and cardiovascular (CV) events in dialysis patients through this meta-analysis and systematic review.MethodsA comprehensive literature search was conducted using the PubMed, Cochrane library, Embase, Medline databases to collect cohort studies investigating whether AAC is associated with all-cause mortality and CV events of patients, and we also searched gray articles and conferences abstracts. Meta-analysis was performed by STATA software. Pooled results were expressed as hazard ratio (HR) with corresponding 95% confidence intervals (CI). Fixed-effect models were used to pool the HR of each trial.Results10 studies (2,724 dialysis patients) were identified. The presence of AAC was associated with increased risk for all-cause mortality among dialysis patients (HR, 2.84; 95% CI, 2.03–3.98; I2 = 9.8%; P = 0.354). Meanwhile, there was an association between AAC and increased risk for all CV events (fatal and non-fatal) in patients (HR, 2.04; 95% CI, 1.51–2.76, I2 = 44.6%; P = 0.125). 3 studies presented their endpoint as CV mortality, and the pooled HR was 2.46 (95%CI 1.38–4.40; I2 = 0.0%; P = 0.952).There were also 2 studies that reported their primary endpoint as all-cause mortality and CV events, and the pooled HR was 5.72 (95% CI 3.24–10.10; I2 = 0.0%; P = 0.453).ConclusionsAmong patients treated with dialysis, AAC is associated with adverse outcomes, including all-cause mortality and CV events (fatal and non-fatal). The abdominal X-ray or CT scan can be used as a useful added method to evaluate the patient’s calcification. This may provide reasonable data for estimating the risk of adverse events in dialysis patients, which is helpful in guiding clinical treatment and improving the prognosis of dialysis patients.
Highlights
The risk of cardiovascular (CV) disease in patients with end stage renal disease(ESRD) is far greater than that in general population patients, and CV mortality in dialysis patients is 10–20 times that of general people [1, 2]
The presence of aortic calcification (AAC) was associated with increased risk for all-cause mortality among dialysis patients (HR, 2.84; 95% confidence intervals (CI), 2.03–3.98; I2 = 9.8%; P = 0.354)
There was an association between AAC and increased risk for all CV events in patients (HR, 2.04; 95% CI, 1.51– 2.76, I2 = 44.6%; P = 0.125). 3 studies presented their endpoint as CV mortality, and the pooled hazard ratio (HR) was 2.46 (95%CI 1.38–4.40; I2 = 0.0%; P = 0.952)
Summary
The risk of cardiovascular (CV) disease in patients with end stage renal disease(ESRD) is far greater than that in general population patients, and CV mortality in dialysis patients is 10–20 times that of general people [1, 2]. Coronary artery calcification has been considered as an important predictor of CV events and all-cause mortality in patients with ESRD [5, 6]. Abdominal aortic calcification (AAC) has been rarely used as a marker to diagnose atherosclerosis or a tool to assessment the risk of CV events [9]. AAC has been shown to be an independent risk factor for all-cause mortality or CV events in the general population [4, 10, 11]. Studies published to date have not reached consistent conclusions regarding the presence or extent of AAC and CV or all-cause mortality in maintenance dialysis patients. We determined to investigate whether the occurrence of AAC is associated with all-cause mortality and cardiovascular (CV) events in dialysis patients through this meta-analysis and systematic review
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