Impact of arterial microcalcification of the vascular access on cardiovascular mortality in hemodialysis patients

Abstract

Gross vascular calcification seen on imaging studies is common in hemodialysis (HD) patients, and is a significant predictor for cardiovascular mortality in HD patients. We have reported that arterial microcalcification (AMiC) of the vascular access is associated with increased aortic stiffness. This study investigated the impact of vascular access AMiC on cardiovascular mortality in HD patients. The study included 149 HD patients (mean age: 59.1 ± 13.9 years, 86 men and 63 women, 65.8% diabetic) who underwent vascular access surgery. Radial or brachial artery specimens were obtained intraoperatively, and pathologic examination was performed using von Kossa stain to identify AMiC. We compared all-cause and cardiovascular mortality between patients with and without AMiC. The mean follow-up was 37.8 ± 34.5 months, and AMiC was present in 38.8% (n = 57) of patients. The presence of diabetes (odds ratio: 16.49, 95% confidence interval: 1.81-150.36, P = 0.013) was the only independent risk factor for vascular access AMiC. During the observational period, there were 27 cardiovascular deaths. Kaplan-Meier analysis showed an increased cardiovascular mortality risk (log rank = 4.83, P = 0.028) in AMiC patients, and Cox regression analysis confirmed that AMiC was an independent predictor for cardiovascular mortality (hazard ratio: 2.35, 95% confidence interval: 1.09-5.09, P = 0.030). In conclusion, vascular access AMiC is a strong risk factor for cardiovascular mortality in HD patients.

New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes

“…Another study reported that arterial microcalcification was associated with 1-year primary unassisted patency in a retrospective cohort of 114 patients (51). The same group showed that microcalcification also predicts cardiovascular mortality in patients on hemodialysis (52). In conclusion, the available data are inconsistent with respect to the effect of vascular calcification on AVF outcomes, indicating that larger and multicenter studies are needed to finally answer this question.…”

Upper limb vascular calcification score as a predictor of mortality in diabetic hemodialysis patients

“…[12][13][14]19 In this study, a mean diabetic duration >10 years yielded a survival detriment for subgroups I and II vs a similar subcontrol group, suggesting the pivotal role of long standing diabetes as a cofactor for increased mortality in patients with upper extremity Vc.…”

“…Notably, diabetic patients had a 3.43-fold risk of arteriovenous access Vc compared with nondiabetic patients. Similarly, Yun et al 19 showed that upper arm arterial microcalcification evident in spot vascular access specimens (radial or brachial artery) obtained intraoperatively in hemodialysis patients (65.8% diabetic patients) increased cardiovascular mortality by 2.35-fold. Apart from upper extremity vascular access level, all-cause mortality rates were increased 16-fold in patients with AMC of pelvic or femoral arteries (7% diabetic patients) compared with patients with no Vc (3% diabetic patients).…”

“…11,18,19 Another recent study showed that patients with an arterial arteriovenous access VcS >10% (refers to percentage of calcification in arterial specimens obtained at the time of arteriovenous graft surgery) had peripheral vascular disease and congestive heart failure more frequently than those with a VcS of <10% (28% vs 4% and 33% vs 8%, respectively). 20 Schlieper et al 11 reported lower mean cumulative survival rates in patients with arteriovenous access Vc compared with those without arteriovenous access Vc (946 vs 1089 days).…”

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

“…Therefore, elderly patients, especially those with multiple comorbidities, may not survive long enough to obtain the benefits of AVF placement. In other words, AVG can be considered to be the first choice of VA for elderly patients with multiple comorbidities and limited life expectancy although, in the general population, AVG is considered to be a secondary choice due to its lower patency and association with increased patient morbidity and mortality, or as an alternative option in cases with unsuitable, damaged, or sometimes exhausted veins inappropriate for AVF access creation [18][19][20] . The association between increased age and greater risk of maturation failure may be due to the absence of adequate vessels, which are essential components for successful AVF creation, as vessels naturally deteriorate with age and are also damaged by concurrent comorbidities.…”