Abstract
BackgroundAbdominal aortic calcification (AAC) has been known to be associated with cardiovascular mortality in hemodialysis. However, the association between AAC and future coronary artery disease (CAD) occurrence is not clear. We aimed to clarify the association of AAC severity and the occurrence of future CAD events in hemodialysis patients.MethodsHemodialysis (HD) patients were recruited in this prospective cohort study. AAC severity was quantified by AAC score, which was measured by lateral lumbar radiography. We used receiver operation curve (ROC) analysis to find the cutoff AAC value for CAD prediction. CAD-free survival was analyzed by Kaplan-Meier study.ResultsThere were 303 patients recruited for study with a median (interquartile range) follow-up of 95 (65–146) months. The AAC score in patients with occurrence of new CAD [9 (3–15.25), n = 114] was higher than in patients without new CAD occurrence [5 (1–9) n = 189], p < 0.001. Multivariate hazard ratio of AAC score for CAD was 1.039 (p = 0.016). ROC study showed that an AAC score of 5.5 had a sensitivity of 0.658 and a specificity of 0.587 in the prediction of new CAD occurrence. Patients with AAC score above 5.5 had significantly higher cumulative incidence of CAD than patients with AAC score below 5.5. Age, diabetes, prior history of CAD, and longer dialysis vintage were major factors associated with higher AAC score.ConclusionsAAC score can predict the occurrence of future CAD events in HD patients. The best cut-off value of AAC score is 5.5. AAC score greater than 5.5 is a reliable abdominal aortic calcification marker, and can predict future CAD in ESRD patients. Major contributive factors for higher AAC score were age, presence of diabetes, prior history of CAD, and longer dialysis vintage.
Highlights
Abdominal aortic calcification (AAC) has been known to be associated with cardiovascular mortality in hemodialysis
We conducted a 5-year prospective cohort study in chronic HD patients to analyze the relationship between AAC score and future coronary artery disease (CAD) events
The major finding of our study is that higher AAC score can predict future CAD events in chronic HD patients
Summary
Abdominal aortic calcification (AAC) has been known to be associated with cardiovascular mortality in hemodialysis. The association between AAC and future coronary artery disease (CAD) occurrence is not clear. We aimed to clarify the association of AAC severity and the occurrence of future CAD events in hemodialysis patients. Vascular calcification is commonly seen in chronic kidney disease (CKD) patients [1, 2]. The prevalence of vascular calcification in end stage renal disease patients can be as high as 81% in a cross-sectional study [3]. AAC to predict coronary artery disease (CAD) in chronic HD patients has not yet been investigated. We conducted a 5-year prospective cohort study in chronic HD patients to analyze the relationship between AAC score and future CAD events
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