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

Nephrology ◽  
2019 ◽  
Vol 24 (3) ◽  
pp. 336-340 ◽  
Author(s):  
Hung-Chih Chen ◽  
Che-Yi Chou ◽  
Hsuan-Jen Lin ◽  
Chiu-Ching Huang ◽  
Chiz-Tzung Chang
Keyword(s):  
Coronary Artery Disease ◽  
Peritoneal Dialysis ◽  
Coronary Artery ◽  
Aortic Calcification ◽  
Dialysis Patients ◽  
Middle Aged ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
Calcification Score ◽  
Artery Disease

Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease

2020 ◽  
Vol 51 (9) ◽  
pp. 726-735
Author(s):  
Roosa Lankinen ◽  
Markus Hakamäki ◽  
Kaj Metsärinne ◽  
Niina S. Koivuviita ◽  
Jussi P. Pärkkä ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Aortic Calcification ◽  
Abdominal Aortic Calcification ◽  
Advanced Chronic Kidney Disease ◽  
Abdominal Aortic ◽  
Calcification Score ◽  
Stage 4 ◽  
Ckd Stage ◽  
Artery Disease

Background: Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study. Methods: One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients. Results: The duration of follow-up was 42 ± 17 months (range 134–2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11–15) mL/min/1.73 m2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e′ ratio, and albumin. Conclusion: Stress ergometry performance, abdominal aortic calcification score, E/e′ of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.

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

2020 ◽  
Author(s):  
dahua ma ◽  
Hao Yan ◽  
Xiaoxiao Yang ◽  
Zanzhe Yu ◽  
Zhaohui Ni ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Outcomes ◽  
Aortic Calcification ◽  
Dialysis Patients ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
Cerebrovascular Events ◽  
Calcification Score ◽  
All Cause Mortality ◽  
Predictive Role

Abstract 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.

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

2020 ◽  
Author(s):  
dahua ma ◽  
Hao Yan ◽  
Xiaoxiao Yang ◽  
Zanzhe Yu ◽  
Zhaohui Ni ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Outcomes ◽  
Aortic Calcification ◽  
Dialysis Patients ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
Cerebrovascular Events ◽  
Calcification Score ◽  
All Cause Mortality ◽  
Predictive Role

Abstract Background : Abbominal 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. 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 ). 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 might be a safe and feasible method to identify PD patients with adverse outcomes.

scholarly journals P0747STRESS ERGOMETRY PERFORMANCE AND ABDOMINAL AORTIC CALCIFICATION PREDICT PATIENT OUTCOMES IN CKD STAGE 4-5

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Roosa Lankinen ◽  
Markus Hakamäki ◽  
Kaj Peter Metsarinne ◽  
Jussi Pärkkä ◽  
Tapio Hellman ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Work Load ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
Stage 4 ◽  
Ckd Stage ◽  
Maximal Stress ◽  
Artery Disease

Abstract Background and Aims Patients with chronic kidney disease (CKD) stage 4-5 have an increased risk of cardiovascular morbidity and mortality. Method We recruited 174 consecutive patients with CKD stage 4-5 between 2013 and 2017 into a prospective follow-up study assessing arterial disease, quality of life, mortality and their predictors. Together with baseline medical data, standard maximal bicycle ergometry stress testing, abdominal aortic calcification score (AAC) and echocardiography was collected. Patients were followed up for mean 42 months. Results Mean age at recruitment was 61 years, 54 (31%) were women and estimated glomerular filtration rate (eGFR) was 12.9 ml/min. Altogether, 36 (21%) patients died during follow-up with a mean time to death of 835 days. At baseline, all but one patient were hypertensive, 75 patients had diabetes and 21 patients had coronary artery disease. Mean AAC was 6.27±5.68 and work load of the last 4 minutes of maximal stress (WMAX) was 83.7±36.5W, respectively. In the multivariate proportional hazard models pro-BNP [1.98 (95% CI 1.36 – 2.90), p=0.0004], WMAX [HR 0.45 (95% CI 0.27 – 0.77), p=0.0033], AAC [HR 2.51 (95% CI 1.37 – 4.61), p=0.0030], E/e’ –ratio [HR 1.66 (95% CI 1.08 – 2.56), p=0.0221] and albumin [HR 0.59 (95% CI 0.39 – 0.90), p=0.0134] were significant predictors for mortality when adjusted with age, sex, diabetes and previous coronary artery disease. Patients who perished, especially those who died in less than 2 years, within follow-up had significantly higher AAC and lower WMAX compared to those surviving to the end of the study (Figure 1). Conclusion Maximal stress ergometry test work load and AAC are associated with patient survival in severe CKD.

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