Abstract
Background: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). Methods: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. Results: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36; interquartile range: 8–36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p < 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p < 0.001) beyond traditional cardiovascular risk factors. Conclusions: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HD patient management improves survival.
Highlights
Vascular calcification (VC) is a useful marker of cardiovascular disease and several methods are available for the assessment of their presence and extension [1,2,3,4,5]. the pathogenesis of VC is not well established, several studies suggest that the prevalence of VC increases as renal function declines, likely due to the many metabolic abnormalities that characterize chronic kidney disease (CKD) [3,5,6]
The pathogenesis of VC is not well established, several studies suggest that the prevalence of VC increases as renal function declines, likely due to the many metabolic abnormalities that characterize chronic kidney disease (CKD) [3,5,6]
Which VC measures best predicts long-term survival and whether a measure of vascular calcification adds to the predictive value of traditional Framingham risk stratification in incident to hemodialysis (HD) patients, has not been determined through a concurrent comparison of these measures in a single prospective cohort [5]
Summary
Vascular calcification (VC) is a useful marker of cardiovascular disease and several methods are available for the assessment of their presence and extension [1,2,3,4,5]. the pathogenesis of VC is not well established, several studies suggest that the prevalence of VC increases as renal function declines, likely due to the many metabolic abnormalities that characterize chronic kidney disease (CKD) [3,5,6]. Coronary artery calcification (CAC) has been traditionally used to detected presence and extension of vascular calcification, several other less expensive and widely available tools are available to assess VC in different arterial sites as well as vascular risk [2,5] In these regards, the Kauppila score (KS) using lateral-lateral plain X-ray of the lumbar spine has been proposed to evaluate VC in the abdominal aorta. Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts It is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). Results: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting
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