Abstract
Backgrounds and AimsThe presence and progression of vascular calcification have been demonstrated as important risk factors for mortality in dialysis patients. However, since the majority of subjects included in most previous studies were hemodialysis patients, limited information was available in peritoneal dialysis (PD) patients. Therefore, the aim of this study was to investigate the prevalence of aortic arch calcification (AoAC) and prognostic value of AoAC progression in PD patients.MethodsWe prospectively determined AoAC by chest X-ray at PD start and after 12 months, and evaluated the impact of AoAC progression on mortality in 415 incident PD patients.ResultsOf 415 patients, 169 patients (40.7%) had AoAC at baseline with a mean of 18.1±11.2%. The presence of baseline AoAC was an independent predictor of all-cause [Hazard ratio (HR): 2.181, 95% confidence interval (CI): 1.336–3.561, P = 0.002] and cardiovascular mortality (HR: 3.582, 95% CI: 1.577–8.132, P = 0.002). Among 363 patients with follow-up chest X-rays at 12 months after PD start, the proportion of patients with AoAC progression was significantly higher in patients with baseline AoAC (64.2 vs. 5.3%, P<0.001). Moreover, all-cause and cardiovascular death rates were significantly higher in the progression groups than in the non-progression group (P<0.001). Multivariate Cox analysis revealed that AoAC progression was an independent predictor for all-cause (HR: 2.625, 95% CI: 1.150–5.991, P = 0.022) and cardiovascular mortality (HR: 4.008, 95% CI: 1.079–14.890, P = 0.038) in patients with AoAC at baseline.ConclusionsThe presence and progression of AoAC assessed by chest X-ray were independently associated with unfavorable outcomes in incident PD patients. Regular follow-up by chest X-ray could be a simple and useful method to stratify mortality risk in these patients.
Highlights
Cardiovascular disease is the most common cause of morbidity and mortality in patients with end-stage renal disease (ESRD) [1]
Blood was drawn after a 12-hour overnight fasting, and the following laboratory data were measured from blood samples: hemoglobin, blood urea nitrogen, creatinine, calcium, phosphorus, albumin, total cholesterol, triglyceride, low density lipoprotein (LDL)-cholesterol, high density lipoprotein (HDL)-cholesterol, and intact parathyroid hormone concentrations
Compared to patients without baseline aortic arch calcification (AoAC), total cholesterol, intact parathyroid hormone (iPTH), and albumin concentrations were significantly lower, while high sensitivity Creactive protein (hs-CRP) levels were significantly higher in the baseline AoAC present group
Summary
Cardiovascular disease is the most common cause of morbidity and mortality in patients with end-stage renal disease (ESRD) [1]. Previous studies have revealed vascular calcification is independently associated with all-cause and cardiovascular mortality in both general population and ESRD [3,8,9,10,11]. Since vascular calcification progresses rapidly in dialysis patients, ESRD patients with the progression of vascular calcification are demonstrated to have an unfavorable outcome [12]. The identification of vascular calcification and risk stratification of patients by the changes in vascular calcification may be important for clinicians to manage dialysis patients
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