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 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.

scholarly journals The impact of vascular calcification among dialysis dependent south African CKD patients: A five year follow up study.Cardiovascular mortality and morbidity, ethnic variation and hemodynamic correlates

2019 ◽  
Author(s):  
Kudakwashe SIMBA ◽  
Megan BORKUM ◽  
Nalene STRAUSS ◽  
Wisdom BASERA ◽  
Charles SWANEPOEL ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Ethnic Differences ◽  
Pulse Wave ◽  
Aortic Calcification ◽  
Sub Saharan Africa ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
Calcification Score ◽  
The Impact

Abstract BACKGROUND Vascular calcification is a risk factor for cardiovascular morbidity and mortality in patients with end stage renal disease (ESRD). In Western countries, Blacks with ESRD appear to have lesser degrees of vascular calcification compared to non-Blacks. However, there is no published data on the association of ethnic differences in vascular calcification and survival in ESRD from Sub-Saharan Africa. METHODS This study assessed 5-year changes in vascular calcification and mortality in a previously published cohort of patients with ESRD. Vascular calcification was assessed by abdominal aortic calcification score and vascular stiffness by pulse wave velocity. RESULTS Sixty-six of the original 74 participants, studied at baseline, were identified. The median age was 46.6 years (37.6-59.2) and 57.6% were women. Abdominal aortic calcification showed no progression among Blacks [baseline range 0-5, follow up range 0-8 (p=1.00)], but a non-significant trend to progression among non-Blacks [baseline range 0-19, follow up range 0-22 (p=0.066)]. Black participants did not display a survival advantage (p=0.870). Overall, sepsis was the most common cause of mortality (64% of those with an identifiable cause of death). Non-Blacks had higher parathyroidectomy rates than Blacks with 9/30 cases compared to 2/36 (p=0.036). After adjustment for parathyroidectomy at follow up, the odds ratio of having abdominal vascular calcification score of ≥1 amongst non-Blacks was 8.6-fold greater compared to Blacks (p= 0.03). Central aortic systolic pressures (CASP) and pulse wave velocities (PWV) were higher in the study population than age matched normative values. At follow up, a positive correlation (r=0.5) was observed between PWV and abdominal aortic calcification (p=0.047). Elevated baseline coronary artery calcification score and FGF-23 level at baseline were not associated with a difference in mortality. CONCLUSION There was no significant progression in vascular calcification among Blacks. After adjusting for increased parathyroidectomy rates, there was a greater progression of vascular calcification amongst non-Blacks compared to Blacks highlighting possible ethnic differences in calcium phosphate metabolism in patients with ESRD. Lack of vascular calcification progression in Blacks was not associated with improved survival, but the sample size was small.

scholarly journals Impact of Abdominal Aortic Calcification on Central Haemodynamics and Decline of Glomerular Filtration Rate in Patients with Chronic Kidney Disease Stages 3 and 4

2019 ◽  
Vol 44 (5) ◽  
pp. 950-960 ◽  
Author(s):  
Hanna Jansson ◽  
Aso Saeed ◽  
Maria K. Svensson ◽  
Kristina Finnved ◽  
Mikael Hellström ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Independent Predictor ◽  
Aortic Calcification ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
Rate Of Decline

Background/Aim: Calcifications of large arteries are frequent in chronic kidney disease (CKD) and may contribute to the high cardiovascular risk in this population. The aim of this study was to examine whether abdominal aortic calcification volume (AACV) was a predictor of the rate of decline in glomerular filtration rate (GFR) in a cohort of patients with CKD stages 3 and 4. Methods: Eighty-four patients with CKD stages 3 and 4 were enrolled in this prospective observational study. At study entry, and annually, GFR was measured by plasma 51Cr-EDTA clearance. At baseline, haemodynamics was assessed and AACV was determined by computer tomography. Results: The mean follow-up time was 3.4 years and mean decline in GFR was –2.69 mL/min/1.73 m2 per year. At baseline, abdominal aortic calcification (AAC) was detected in 66 patients (79%). A binary logistic regression analysis revealed that age was the only statistically significant independent predictor of AAC. In patients with AAC, male gender (B = 0.413, p = 0.030), aortic diastolic blood pressure (B = –0.025, p = 0.001) and ankle-brachial index (B = –1.666, p = 0.002) were independently associated with AACV using a multiple linear regression analysis. Neither the presence nor the extent of AAC was significantly associated with the rate of change in GFR during follow-up. Conclusion: In this cohort of patients with CKD stages 3 and 4, only age was an independent predictor of the presence of AAC. AACV was not associated with the rate of decline in GFR.

scholarly journals A high abdominal aortic calcification score by dual X-ray absorptiometry is associated with cardiovascular events after kidney transplantation

2018 ◽  
Vol 33 (12) ◽  
pp. 2253-2259 ◽  
Author(s):  
Stan Benjamens ◽  
Robert A Pol ◽  
Andor W J M Glaudemans ◽  
Ivanka Wieringa ◽  
Stefan P Berger ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cardiovascular Events ◽  
Aortic Calcification ◽  
Abdominal Aortic Calcification ◽  
X Ray ◽  
Abdominal Aortic ◽  
Calcification Score

P0756THE RELATIONSHIP BETWEEN ABDOMINAL AORTIC CALCIFICATION AND PROGRESSION OF RENAL INSUFFICIENCY IN PATIENTS WITH CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
SO MI KIM ◽  
Jong Tae Cho ◽  
Ji Hyun Jeon ◽  
Yong-Moon Lee ◽  
Eun Kyoung Lee ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Early Stage ◽  
Aortic Calcification ◽  
Abdominal Aortic Calcification ◽  
Abdominal Aortic ◽  
The Impact ◽  
Annual Decline

Abstract Background and Aims Although abdominal aortic calcification (AAC) is known to be associated with cardiovascular mortality in patients with chronic kidney disease (CKD), there are little information about the impact of AAC on progression of CKD. Therefore, we investigated the relationship between the AAC and progression of renal insufficiency in CKD patients with early stage. Method A total of 183 patients with CKD, stage 3 was included. The degree of AAC was evaluated by computed tomography and the score was calculated as follows: abdominal calcification index (ACI)= (total score of calcification on all slices)/12 × 1/(number of slices) × 100%. Based on tertile of ACI, the patients were divided into three groups: low-, intermediate-, and high-groups. The annual decline of glomerular filtration rate (GFR) and time to dialysis were assessed. Results The AAC was found (ACI > 0) in 129 patients (70.4%), and the mean ACI was 21.3 %. The average duration of follow-up was 46.9 months. The high ACI group showed higher annual decline in GFR compared to other groups (27.8 vs 14.5 vs 11.3 mL/min, p=0.042). During the follow-up, 68.8% (42/61) of high ACI group received dialysis and the time to dialysis was significantly shorter than other groups (14.8 vs. 25.8 vs.29.1 months, p=0.038) Conclusion In this study, we showed the AAC was associated with rapid progression of CKD. Evaluation of the AAC in CKD with early stage provides useful information for predicting the progression of CKD.

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