The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients

Abstract

BackgroundThe composite summary score (range, 0–24) of abdominal aortic calcification (AAC) devised by Kauppila et al is a simple method of assessing AAC severity. However, few studies have been conducted to determine an optimal AAC cutoff score for the prediction of mortality or to investigate the relation between mineral metabolism and AAC progression using the scoring system.MethodsThe medical records of 112 patients on hemodialysis who had undergone simple lateral lumbar radiography every 6 months from August 2009 were reviewed. Patients were followed until November 2012, and the relationship between the degree of AAC at baseline and mortality was evaluated. In addition, the relationship between the progression of AAC and serum concentrations of calcium and phosphate was evaluated in the 75 patients who were successfully followed until November 2012.ResultsThe mean AAC score at baseline was 5.5±4.8, and the cutoff calcification score for the prediction of mortality was 7.75 (sensitivity=61%, specificity=81%). Patients were allocated to Group A (baseline total calcification score ≤8.0, n=85) or Group B (baseline total calcification score>8.0, n=27), and multivariate analysis showed that Group B was an independent risk factor of all-cause mortality and cardiovascular events. Of the 75 patients successfully followed, 51 showed AAC progression (Group 1) and 24 showed no change or improvement (Group 2). Group 1 was found to have significantly higher mean serum corrected calcium levels during the 2nd year and 3rd year of follow-up than Group 2. Furthermore, repeated-measures analysis of variance showed higher monthly corrected calcium concentrations (P=0.099) and mean corrected calcium levels during the 1st year, 2nd year, and 3rd year of follow-up (P=0.062) in Group 1, but without statistical significance. The cutoff values of mean corrected calcium of the 2nd year and 3rd year for the prediction of AAC progression during follow-up years were 8.96 mg/dL and 9.45 mg/dL, respectively. Serum phosphate levels and corrected calcium×phosphate values were similar in Groups 1 and 2.ConclusionPatients with an AAC score of>8 at baseline seem to be at higher risk of mortality during follow-up. Of the serum variables examined, such as corrected calcium, phosphate, and corrected calcium×phosphate, corrected calcium was found to be marginally associated with AAC progression. However, a larger-scale prospective study is required to confirm our findings.

Relationship of Serum Soluble Klotho Levels and Echocardiographic Parameters in Patients on Maintenance Hemodialysis

“…Routine blood tests were performed immediately including hemoglobin, creatinine, albumin, hypersensitive C reactive protein (hs-CRP), calcium (corrected), phosphate, and intact parathyroid hormone values. Corrected calcium levels were calculated using the following formula [11]: corrected calcium = calcium + 0.8 × (4 – serum albumin). Blood samples for s-Klotho measurement were centrifuged, aliquoted in vials, and stored at –80°C until assay.…”

Vascular Calcification on Plain Radiographs Is Related with the Severity of Lesions Detected by Coronary Angiography in Dialysis Patients

“…Arrows indicate calcification on the anterior and posterior wall of the abdominal aorta adjacent to vertebrae L1-L4. Ogawa et al 2009;Nitta and Ogawa 2011;An and Son 2013;Kwon et al 2014). Two nephrologists individually determined VC scores on plain radiographs without information about patients.…”

“…Previous studies illustrated that high or meaningful VC scores of artery or aorta on plain radiographs are associated with CAD events in dialysis patients. (Blacher et al 2001;Adragao et al 2004;An et al 2009An et al , 2010Ogawa et al 2009;Nitta and Ogawa 2011;An and Son 2013;Kwon et al 2014).…”

Abdominal aortic calcification score predicts the occurrence of coronary artery disease in middle‐aged peritoneal dialysis patients

“…Studies showed presence of abdominal aortic calcification was associated with all-cause mortality and cardiovascular mortality in haemodialysis dialysis (HD) patients. 8,9 Severity of abdominal aortic calcification is also significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal cardiovascular events in HD patients. 1 However, the association between acute CAD and AAC in peritoneal dialysis (PD) patients is unclear.…”

“…Abdominal aortic calcification has also frequently been used for the prediction of CAD in dialysis patients. Studies showed presence of abdominal aortic calcification was associated with all‐cause mortality and cardiovascular mortality in haemodialysis dialysis (HD) patients . Severity of abdominal aortic calcification is also significantly associated with diastolic dysfunction and predicts all‐cause mortality and nonfatal cardiovascular events in HD patients .…”