Aortic Arch Calcification Predicts Patency Loss of Arteriovenous Fistula in End-Stage Renal Disease Patients

Abstract

Aortic arch calcification (AAC) is recognized as an important cardiovascular risk factor in patients with end-stage renal disease (ESRD). The aim of the study was to evaluate the impact of AAC grade on patency rates of arteriovenous fistula (AVF) in this specific population. The data of 286 ESRD patients who had an initial AVF placed were reviewed. The extent of AAC identified on chest radiography was divided into four grades (0–3). The association between AAC grade, other clinical factors, and primary patency of AVF was then analyzed by Cox proportional hazard analysis. The multivariate analysis demonstrated that the presence of AAC grade 2 (hazard ratio (95% confidence interval): 1.80 (1.15–2.84); p = 0.011) and grade 3 (3.03 (1.88–4.91); p < 0.001), and higher level of intact-parathyroid hormone (p = 0.047) were associated with primary patency loss of AVF. In subgroup analysis, which included AVF created by a surgeon assisted with preoperative vascular mapping, only AAC grade 3 (2.41 (1.45–4.00); p = 0.001), and higher intact-parathyroid hormone (p = 0.025) level were correlated with AVF patency loss. In conclusion, higher AAC grade and intact-parathyroid hormone level predicted primary patency loss of AVF in an ESRD population.

Aortic Arch Calcification as a Predictor of Repeated Arteriovenous Fistula Failure within 1-Year in Hemodialysis Patients

“…A previous report demonstrated that higher AAC grade predicted primary patency loss of AVF in ESRD patients [12]. The present study extends the previous finding that higher AAC grade is also a predictor of repeated AVF failure among hemodialysis populations.…”

Emerging Role of Vitamins D and K in Modulating Uremic Vascular Calcification: The Aspect of Passive Calcification

“…Calcification of arterioles within the endothelial and medial layers induces arterial stiffness and occlusion, which may cause coronary artery disease and calciphylaxis in peripheral vessels [2,3,4]. Therefore, vascular calcification is predictive of poor prognoses and clinical outcomes in CKD patients, such as overall mortality and even poor arteriovenous graft maturation [5,6]. Etiologies of vascular calcification include the traditional (e.g., hypertension, diabetes mellitus (DM), old age, smoking, and dyslipidemia [7]) and nontraditional risk factors (e.g., hyperhomocysteinemia, and higher high sensitive C-reactive protein (hsCRP) for cardiovascular disease [8].…”

Comparison of Solute Clearance, Hospitalization Rate, and Aortic Arch Calcification between Online Hemodiafiltration and High-Flux Hemodialysis: A 6-Year Observational Study

“…AAC is very common in ESRD [10], especially in patients on HD [30]. This circumstance is consequent to stiffness in vascular wall and reduce vascular compliance, which have been found to be predictive of cardiovascular mortality [27].…”

“…The CONvective TRAnsport STudy (CONTRAST) and French Convective versus Hemodialysis in Elderly (FRENCHIE) studies showed the effect of pre-dialysis serum phosphate reduction by HDF therapy [6, 7]. Other studies also demonstrated that HDF therapy is superior compared to standard HD in reducing inflammation [8, 9], preventing protein-energy wasting [10], and reducing episodes of intradialytic hypotension [11]. In addition, several studies showed beneficial effects on patient survival.…”