Prognostic Value of Aortic Stiffness and Calcification for Cardiovascular Events and Mortality in Dialysis Patients

Abstract

SummaryBackground and objectives Radiographic calcification and arterial stiffness each individually are predictive of outcome in dialysis patients. However, it is unknown whether combined assessment of these intermediate endpoints also provides additional predictive value.Design, setting, participants, & measurements Scoring of abdominal aortic calcification (AAC) using plain lateral abdominal x-ray and measurement of carotid-femoral pulse wave velocity (PWV) were performed in a cohort of 1084 prevalent dialysis patients recruited from 47 European dialysis centers.Results During a follow-up of 2 years, 234 deaths and 91 nonfatal cardiovascular (CV) events occurred. Compared with the lowest tertile of AAC, the risk of an event was increased by a factor 3.7 in patients with a score of 5 to 15 (middle tertile), and by a factor 8.6 in patients with scores of 16 to 24. Additionally, each 1-m/s increase in PWV was associated with a 15% higher risk. At higher AAC (scores Ն5), the effect of PWV was attenuated because of a negative PWV ϫ AAC interaction (hazard ratio [HR]: 0.895 and 0.865 for middle and upper AAC tertiles). After accounting for age, diabetes, and serum albumin, AAC and PWV remained independent predictors of outcome.Conclusions AAC and central arterial stiffness are independent predictors of mortality and nonfatal CV events in dialysis patients. The risk associated with an increased PWV is less pronounced at higher levels of calcification. Assessment of AAC and PWV is feasible in a clinical setting and both may be used for an accurate CV risk estimation in this heterogeneous population.

Aortic Stiffness and Central Wave Reflections Predict Outcome in Renal Transplant Recipients

“…15,16 The present study provides the first direct evidence in RTRs that not only aortic stiffness but also central wave reflection are predictors for fatal and nonfatal CV events, extending the available evidence from the dialysis population to patients with a kidney transplant. It is also the first study to confirm in nondialyzed patients that stiffness and wave reflection both contribute independently to adverse central hemodynamic effects as has been shown in hemodialysis patients.…”

Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatment

“…In these reports, cardiovascular events were also significantly correlated with high CACS. Aortic calcification also significantly correlated with cardiovascular and all-cause mortality and was an independent predictor of cardiovascular and all-cause mortality [14][15][16][17][18][19]. These associations between vascular calcification and clinical outcomes were independent even after adjusting traditional risk factors such as age, hemodialysis duration, hypertension, diabetes, smoking, and dyslipidemia.…”

“…Vascular calcification affects on the future cardiovascular events and/or mortality in dialysis patients [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Several clinical trials to aim to improve cardiovascular events and/or mortality in dialysis patients have been planned or reported.…”

Vasculoprotective Effects of Dietary Cocoa Flavanols in Patients on Hemodialysis

“…Atherosclerosis is characterized by atheromatous plaques with blood flow restrictions and tissue ischemia and leads to altered vascular compliance because of distorted conduit function and increased arterial stiffness (4,5). Macrovascular prognostic implications include endothelial dysfunction, which is an important and early step in the development of atherosclerosis (6).…”