Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease

Disthabanchong, Sinee; Boongird, Sarinya

doi:10.5527/wjn.v6.i3.100

Cited by 32 publications

(22 citation statements)

References 107 publications

(98 reference statements)

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“…Few studies have analyzed the effects of the progression of AAC assessed by lateral lumbar radiography among HD patients. Although a CT scan is the most sensitive and accurate technique for evaluating VC [40], we assumed that this semi-quantitative method also offers acceptable sensitivity and specificity as a useful alternative to a CT scan [18]. AAC in patients on chronic HD reflects the severity of atherosclerosis and correlate with calcification at other sites [41].…”

Section: Discussionmentioning

confidence: 99%

Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

et al. 2019

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Background and aims Malnutrition and inflammation are closely linked to vascular calcification (VC), the severity of which correlate with adverse outcome. However, there were few studies on the interplay between malnutrition, inflammation and VC progression, rather than VC presence per se. We aimed to determine the relationship of malnutrition, inflammation, abdominal aortic calcification (AAC) progression with survival in hemodialysis (HD) patients. Methods Malnutrition and inflammation were defined as low serum albumin (< 40 g/L) and high hs-CRP (≥ 28.57 nmol/L), respectively. We defined AAC progression as an increase in AAC score using lateral lumbar radiography at both baseline and one year later. Patients were followed up to investigate the impact of AAC progression on all-cause and cardiovascular mortality. Results AAC progressed in 54.6% of 97 patients (mean age 58.2±11.7 years, 41.2% men) at 1-year follow-up. Hypoalbuminemia (Odds ratio 3.296; 95% confidence interval 1.178–9.222), hs-CRP (1.561; 1.038–2.348), low LDL-cholesterol (0.976; 0.955–0.996), and the presence of baseline AAC (10.136; 3.173–32.386) were significant risk factors for AAC progression. During the mean follow-up period of 5.9 years, 38(39.2%) patients died and 27(71.0%) of them died of cardiovascular disease. Multivariate Cox regression analysis adjusted for old age, diabetes, cardiovascular history, and hypoalbuminemia determined that AAC progression was an independent predictor of all-cause mortality (2.294; 1.054–4.994). Conclusions Malnutrition and inflammation were significantly associated with AAC progression. AAC progression is more informative than AAC presence at a given time-point as a predictor of all-cause mortality in patients on maintenance HD.

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Section: Discussionmentioning

confidence: 99%

Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

et al. 2019

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“…The optimum diagnostic technique for vascular calcification remains unsettled. CT based imaging is outstanding in accuracy and reproducibility, yet plain radiography is a convenient and inexpensive alternative, and it delivers substantially lower radiation [28]. The predictive value of AACS based on lateral lumbar X-ray film for CVD and mortality has been validated in the general population [29,30].…”

Section: Discussionmentioning

confidence: 99%

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

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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.

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“…Ultrasonography is a cost-effective and sensitive method for the detection of VC in the peripheral arteries, such as the carotid artery or radial artery. 16 Abbreviation: ABI, ankle brachial index. * The ABI was evaluated preoperatively; the results showed that the more pathologic the ABI, the more challenging the anastomosis (grade from 1 [very straightforward] through 5 [very difficult]; P < .001; likelihood ratio, 36.978).…”

Section: Discussionmentioning

confidence: 99%

Ankle Brachial Index Predicts for Difficulties in Performing Microvascular Anastomosis

Bartella

Luderich

Kamal

et al. 2020

Journal of Oral and Maxillofacial Surgery

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In reconstructive microsurgery, severe arteriosclerosis is a known predictor for free flap failure because of problems with the vascular anastomosis. We investigated whether the ankle brachial index (ABI) could be a suitable preoperative measurement for the prediction of compromise regarding vascular anastomosis in patients undergoing microsurgical reconstruction. Material and Methods: We conducted a prospective cohort study of patients who had undergone reconstructive microvascular surgery in a tertiary care center from 2015 to 2017. The ABI was preoperatively assessed by dividing the systolic blood pressure measured at the ankle by the brachial systolic blood pressure. Results from 0.9 to 1.3 are within the physiologic range. Values less than 0.9 indicate moderate to severe arteriosclerosis, and those greater than 1.3 indicate the major form of arteriosclerosis with complete calcification of the tunica media. The ABI value correlated with the ease of the anastomosis (rated from 1 [very straightforward] through 5 [very difficult]), gross examination findings (intraluminal plaque [yes vs no]), and the necessity of plaque removal before anastomosis (yes vs no). In addition, cross-sectional specimens were obtained from the arteries and veins of the donor and recipient sites intraoperatively. The specimens were rated histologically for the arteries and veins using an ordinal scale. Histologic evaluation was performed to confirm and objectify the results from the ABI. Statistical analysis was performed using SPSS software, version 24.0 (IBM Corp, Armonk, NY) and t tests, analysis of variance, and c 2 tests. Results: The sample included 41 patients with a mean age of 56.7 years; 59% were men. The mean ABI was 1.06. The mean ease of anastomosis was 1.8. The mean ABI was associated with the ease of anastomosis. A pathologic ABI was significantly related to problems with the arterial anastomosis (P = .004) and increased arteriosclerosis in the arteries from the donor (P = .047) and recipient (P = .036) sites. Conclusions: A pathologic ABI was associated with increased difficulty with the microvascular anastomosis.

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Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease

Cited by 32 publications

References 107 publications

Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

Malnutrition, inflammation, progression of vascular calcification and survival: Inter-relationships in hemodialysis patients

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

Ankle Brachial Index Predicts for Difficulties in Performing Microvascular Anastomosis

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