Abdominal aorta calcification predicts cardiovascular but not non-cardiovascular outcome in patients receiving peritoneal dialysis

Abstract

Abdominal aorta calcification (AAC) is associated with worse clinical outcomes in dialysis patients. However, the long-term prognostic values of AAC to cardiovascular (CV) and non-CV mortality in patients starting peritoneal dialysis (PD) remain unknown. This study is aimed to the analyze the predictive power of AAC to CV and non-CV mortality in PD patients. We prospectively enrolled 123 patients undergoing PD. All patients received quantitative analysis of AAC via abdominal computer tomography at enrollment. The AAC ratio was measured by the area of the whole aorta affected by aortic calcification above the iliac bifurcation. The CV mortality and non-CV mortality during the follow-up period were investigated using the Cox proportional hazard model and time-dependent receiver operating characteristic (ROC) analysis. After median 6.8 (interquartile range, 3.6–9.2) years of follow-up, there were 18 CV mortality, 24 non-CV mortality and 42 total mortality. The age and AAC ratio were significantly higher in CV mortality group compared with others without CV mortality. In time-dependent ROC analysis, AAC had excellent predictive power of CV mortality (AUC:0.787) but not non-CV mortality (AUC:0.537). The best cutoff value of AAC ratio to predict CV mortality was 39%. In addition, AAC was not associated with non-CV mortality but remained to be a significantly predictor of CV mortality after adjusted with clinical covariates in different Cox proportional hazard models. AAC has excellent prognostic value of CV mortality but is unable to predict non-CV morality in patients undergoing PD.

Elevated serum fatty acid-binding protein 4 level predicts all-cause and cardiovascular mortality in peritoneal dialysis patients: a five-year study

“…Vascular calcification is another important risk factor for cardiovascular mortality in patients on PD [ 33 ]. In patients with chronic kidney disease, vascular calcification is characterized by medial arterial calcification [ 34 ].…”

Objective Methods to Assess Aorto-Iliac Calcifications: A Systematic Review

“…The results from the 11 selected studies (Table 1) revealed a diverse landscape of measurement methods for calcifications in the aorto-iliac arteries. Seven studies adopted manual measurement techniques [10,11,[14][15][16]18,19], while the remaining studies explored automatic methods leveraging advanced technologies [12,13,17,20].…”

“…The calcification index was calculated as the mean value of the percentage for the 10 slices. A similar method was applied in the study of Tsai et al [11], where the calcified index was measured by the standard 64-multiple detector CT (MDCT) scan (LightSpeed VCT, GE Healthcare, Milwaukee, WI). The calcified area was calculated based on an attenuation range of >150 Hounsfield Units (HU) using image analysis software.…”

Contribution of Gut Microbiota-Derived Uremic Toxins to the Cardiovascular System Mineralization

“…Adeney et al demonstrated that even in patients with moderately advanced CKD (eGFR < 60 mL/min per 1.73 m 2 , mean 50.6 mL/min per 1.73 m 2 ) Shanahan without symptomatic cardiovascular disease (CVD), but with high serum phosphate level the prevalence and advancement of coronary artery calcification (CAC), calcification of descending aorta and mitral valve were significantly more pronounced as compared to subjects with normal kidney function [ 7 ]. Several studies reported the association between the risk of CV events and CV death and the degree of VC identified in several locations (coronary arteries, aortic arch and abdominal aorta) in different CKD patient groups (peritoneal dialysis, hemodialysis and pre-dialysis) [ 8 , 9 , 10 ]. The risk of cardiovascular and cerebrovascular events attributed to VC is largely independent from “traditional” risk factors for development of atherosclerosis, such as smoking, obesity or serum LDL-cholesterol [ 11 , 12 , 13 , 14 ].…”