Is progression of coronary artery calcification influenced by modality of renal replacement therapy? A systematic review

Jansz, Thijs T.; Verhaar, Marianne C.; London, Gérard M.; Jaarsveld, Brigit C. van

doi:10.1093/ckj/sfx124

Cited by 19 publications

(12 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We reported an abdominal artery calcification prevalence of 57.2% in our PD patients, in correspondence with published meta results in Asia population [4]. There were a few cross-sectional studies suggesting that abdominal artery calcification might be less common in PD patients compared to HD patients [14], while other studies reported no advantage of one modality over the other [4,17].…”

Section: Discussionsupporting

confidence: 88%

Abdominal Aortic Calcification Score as a Predictor of Clinical Outcome in Peritoneal Dialysis Patients: A Prospective Cohort Study

Yan

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Abdominal aortic calcification assessed by X-ray is recommended to evaluate vascular calcification in dialysis patients. It has been shown that abdominal aortic calcification score (AACS) is a predictor of adverse outcomes in hemodialysis patients, but evidence regarding its prognostic value in peritoneal dialysis (PD) patients is still insufficient. We aimed to examine the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE) and mortality in PD patients.Methods Eligible patients undergoing PD between July 2011 and July 2014 were recruited. AACS was quantified using lateral lumbar radiography at recruitment. Patients were prospectively followed up until death, PD cessation, or to the end of the study (August 31, 2018). Both subdistribution hazards and cause-specific hazards models were used to evaluate the association between AACS and MACCE as well as mortality.Results 292 patients were enrolled, including 160 males (54.8%) with mean age 57.1±15.2 years and median PD duration 28.4 (IQR 12.0, 57.8) months. Among them, 75 (25.7%) patients were comorbid with diabetes, and 94 (32.2%) patients had cardiovascular disease (CVD). The average AACS was 2.0 (0.0, 6.0). Patients were categorized on the tertiles of AACS (Low AACS group, AACS=0, n=125; Medium AACS group, AACS 1-4, n=72; and High AACS group, AACS>4, n=95). AACS was associated with age (OR=1.081, P < 0.001), PD duration (OR=1.012, P=0.003), CVD (OR =1.919, P=0.020) and diabetes (OR=2.554, P=0.002). During the follow-up period of 43.6 (24.6, 50.7) months, there were 65 MACCEs and 84 deaths. Significantly higher cumulative incidences of all-cause mortality (Log-rank = 35.992, P＜0.001; Gray=38.662, P < 0.001) and MACCE (Log-rank=26.146, P＜0.001; Gray=27.810, P < 0.001) were observed in the upper AACS tertile. AACS was an independent predictor of all-cause mortality (HR=2.438, 95% CI 1.246-4.772, P = 0.009; SHR=2.323, 95%CI 1.229-4.389, P=0.009) and MACCE (HR = 3.455, 95% CI 1.734-6.884, P <0.001; SHR=3.063, 95%CI 1.460-6.430, P=0.003) in this study.Conclusions AACS was associated with age, PD duration, CVD and diabetes in PD patients. AACS could predict MACCE and all-cause mortality in this population. It thus might be a safe and feasible method to identify PD patients with adverse outcomes.

show abstract

Section: Discussionsupporting

confidence: 88%

Abdominal Aortic Calcification Score as a Predictor of Clinical Outcome in Peritoneal Dialysis Patients: A Prospective Cohort Study

Yan

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 88%

Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a prospective cohort study

Yan

Yang

et al. 2020

BMC Nephrol

View full text Add to dashboard Cite

Background: Abdominal aortic calcification assessed by X-ray is recommended to evaluate vascular calcification in dialysis patients. It has been shown that abdominal aortic calcification score (AACS) is a predictor of adverse outcomes in hemodialysis patients, but evidence regarding its prognostic value in peritoneal dialysis (PD) patients is still insufficient. We aimed to examine the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE) and mortality in PD patients. Methods: Eligible patients undergoing PD between July 2011 and July 2014 were recruited. AACS was quantified using lateral lumbar radiography at recruitment. Patients were prospectively followed up until death, PD cessation, or to the end of the study (August 31, 2018). Both subdistribution hazards and cause-specific hazards models were used to evaluate the association between AACS and MACCE as well as mortality. Results: 292 patients were enrolled, including 160 males (54.8%) with mean age 57.1 ± 15.2 years and median PD duration 28.4 (IQR 12.0, 57.8) months. Among them, 75 (25.7%) patients were comorbid with diabetes, and 94 (32.2%) patients had cardiovascular disease (CVD). The average AACS was 2.0 (0.0, 6.0). Patients were categorized on the tertiles of AACS (Low AACS group, AACS = 0, n = 125; Medium AACS group, AACS 1-4, n = 72; and High AACS group, AACS> 4, n = 95). AACS was associated with age (OR = 1.081, P < 0.001), PD duration (OR = 1.012, P = 0.003), CVD (OR = 1.919, P = 0.020) and diabetes (OR = 2.554, P = 0.002). During the follow-up period of 43.6 (24.6, 50.7) months, there were 65 MACCEs and 84 deaths. Significantly higher cumulative incidences of all-cause mortality (Log-rank = 35.992, P<0.001; Gray = 38.662, P < 0.001) and MACCE (Log-rank = 26.146, P<0.001; Gray = 27.810, P < 0.001) were observed in the upper AACS tertile. AACS was an independent predictor of all-cause mortality (HR = 2.438, 95% CI 1.246-4.772, P = 0.009; SHR = 2.323, 95%CI 1.229-4.389, P = 0.009) and MACCE (HR = 3.455, 95% CI 1.734-6.884, P < 0.001; SHR = 3.063, 95%CI 1.460-6.430, P = 0.003) in this study. Conclusions: AACS was associated with age, PD duration, CVD and diabetes in PD patients. AACS could predict MACCE and all-cause mortality in this population. It thus might be a safe and feasible method to identify PD patients with adverse outcomes.

show abstract

“…However, all of these studies had imbalances in age, dialysis vintage, or comorbidities between groups, which were not adjusted for statistically. In addition, the longitudinal study analyzed CAC progression as percentage change, which yields biased results because of the skewed distribution of CAC scores with excessive zeros [5]. The problematic distribution of CAC scores precludes many strategies commonly used to analyze changes.…”

Section: Discussionmentioning

confidence: 99%

“…This high cardiovascular mortality is strongly associated with vascular calcification [3,4], which occurs frequently [2] and progresses almost universally in end-stage renal disease [5]. Vascular calcification can be measured at various sites, such as the coronary arteries, and is promoted by phosphate, which is frequently elevated in end-stage renal disease [6,7].…”

Section: Introductionmentioning

confidence: 99%

Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

et al. 2018

Self Cite

View full text Add to dashboard Cite

Background: Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in peritoneal dialysis than in hemodialysis is currently unknown. Therefore, we compared coronary artery calcification (CAC), its progression, and calcification biomarkers between patients on hemodialysis and peritoneal dialysis. Methods: We measured CAC in 134 patients who had been treated exclusively with hemodialysis (n = 94) or peritoneal dialysis (n = 40) and were transplantation candidates. In 57 of them (34 on hemodialysis and 23 on peritoneal dialysis), we also measured CAC progression annually up to 3 years and the inactive species of desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, osteoprotegerin. We compared CAC cross-sectionally with Tobit regression. CAC progression was compared in 2 ways: with linear mixed models as the difference in square root transformed volume score per year (ΔCAC SQRV) and with Tobit mixed models. We adjusted for potential confounders. Results: In the cross-sectional cohort, CAC volume scores were 92 mm³ in hemodialysis and 492 mm³ in peritoneal dialysis (adjusted difference 436 mm³; 95% CI –47 to 919; p = 0.08). In the longitudinal cohort, peritoneal dialysis was associated with significantly more CAC progression defined as ΔCAC SQRV (adjusted difference 1.20; 95% CI 0.09 to 2.31; p = 0.03), but not with Tobit mixed models (adjusted difference in CAC score increase per year 106 mm³; 95% CI –140 to 352; p = 0.40). Peritoneal dialysis was associated with higher osteoprotegerin (adjusted p = 0.02) but not with dp-ucMGP or fetuin-A. Conclusions: Peritoneal dialysis is not associated with less CAC or CAC progression than hemodialysis, and perhaps with even more progression. This indicates that vascular calcification does not develop less in peritoneal dialysis than in hemodialysis.

show abstract

Is progression of coronary artery calcification influenced by modality of renal replacement therapy? A systematic review

Cited by 19 publications

References 51 publications

Abdominal Aortic Calcification Score as a Predictor of Clinical Outcome in Peritoneal Dialysis Patients: A Prospective Cohort Study

Abdominal Aortic Calcification Score as a Predictor of Clinical Outcome in Peritoneal Dialysis Patients: A Prospective Cohort Study

Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a prospective cohort study

Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis

Contact Info

Product

Resources

About