Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients

BackgroundPeripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.MethodsWe enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.ResultsThe median AACS was 11 (range 0 – 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low (< 0.9) in 17%, and high (> 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS ≥ 7 ( p < 0.001). The adjusted hazard ratio for all-cause mortality was 4.85 (95% confidence interval [CI] 1.94 – 24.46) for aortic calcification (AACS ≥ 7), 2.14 for diabetes (yes/no), 0.93 for albumin (per 1 g/L), and 1.04 for age (per year). A low or high ABI were not independently associated with mortality.ConclusionsSevere aortic calcification was a strong predictor of all-cause mortality in PD patients. The evaluation of aortic calcifications by lateral X ray is a simple method that allows the identification of high-risk patients.

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The ankle brachial index independently predicted all-cause mortality in high-risk patients with peripheral arterial disease

Evidence-Based Medicine ◽

10.1136/ebm.12.6.187 ◽

2007 ◽

Vol 12 (6) ◽

pp. 187-187

Author(s):

D. G Hackam

Keyword(s):

High Risk ◽

Peripheral Arterial Disease ◽

Ankle Brachial Index ◽

Arterial Disease ◽

High Risk Patients ◽

All Cause Mortality ◽

Risk Patients ◽

Peripheral Arterial

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Peripheral Arterial Disease Predicts Overall and Cardiovascular Mortality in Peritoneal Dialysis Patients

Renal Failure ◽

10.3109/0886022x.2012.696470 ◽

2012 ◽

Vol 34 (8) ◽

pp. 1010-1014 ◽

Cited By ~ 5

Author(s):

Shun-Li Tian ◽

Xin-Kui Tian ◽

Qing-Feng Han ◽

Tao Wang

Keyword(s):

Peritoneal Dialysis ◽

Peripheral Arterial Disease ◽

Cardiovascular Mortality ◽

Arterial Disease ◽

Dialysis Patients ◽

Peripheral Arterial

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Association between inflammation markers and abdominal aortic calcification in patients with peripheral arterial disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2015.04.128 ◽

2015 ◽

Vol 241 (1) ◽

pp. e35 ◽

Cited By ~ 1

Author(s):

V. Zelinskiy ◽

A. Zhorina ◽

V. Andreev

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Aortic Calcification ◽

Inflammation Markers ◽

Abdominal Aortic Calcification ◽

Abdominal Aortic ◽

Peripheral Arterial

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

10.21203/rs.3.rs-20999/v2 ◽

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.

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Prognostic value of ankle-brachial index and dobutamine stress echocardiography for cardiovascular morbidity and all-cause mortality in patients with peripheral arterial disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.03.022 ◽

2007 ◽

Vol 46 (1) ◽

pp. 62-70 ◽

Cited By ~ 22

Author(s):

Mallik R. Thatipelli ◽

Patricia A. Pellikka ◽

Robert D. McBane ◽

Thom W. Rooke ◽

Gabriela A. Rosales ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Prognostic Value ◽

Stress Echocardiography ◽

Dobutamine Stress Echocardiography ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Dobutamine Stress ◽

Cardiovascular Morbidity ◽

All Cause Mortality ◽

Peripheral Arterial

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

10.21203/rs.3.rs-20999/v1 ◽

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.

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Hallucal thenar index: A new index to detect peripheral arterial disease using laser speckle flowgraphy

Vascular ◽

10.1177/1708538120938935 ◽

2020 ◽

pp. 170853812093893

Author(s):

Kazuhiro Tsunekawa ◽

Fumio Nagai ◽

Tamon Kato ◽

Ikkei Takashimizu ◽

Daisuke Yanagisawa ◽

...

Keyword(s):

Blood Flow ◽

Peripheral Arterial Disease ◽

Operating Characteristic ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Laser Speckle ◽

Laser Speckle Flowgraphy ◽

Skin Perfusion ◽

Peripheral Arterial ◽

Cutaneous Blood

Objectives Laser speckle flowgraphy is a technology using reflected scattered light for visualization of blood distribution, which can be used to measure relative velocity of blood flow easily without contact with the skin within a short time. It was hypothesized that laser speckle flowgraphy may be able to identify foot ischemia. This study was performed to determine whether laser speckle flowgraphy could distinguish between subjects with and without peripheral arterial disease. Materials and methods All subjects were classified based on clinical observations using the Rutherford classification: non-peripheral arterial disease, class 0; peripheral arterial disease group, class 2–5. Rutherford class 6 was one of the exclusion criteria. Laser speckle flowgraphy measured the beat strength of skin perfusion as an indicator of average dynamic cutaneous blood flow change synchronized with the heartbeat. The beat strength of skin perfusion indicates the strength of the heartbeat on the skin, and the heartbeat strength calculator in laser speckle flowgraphy uses the blood flow data to perform a Fourier transform to convert the temporal changes in blood flow to a power spectrum. A total of 33 subjects with peripheral arterial disease and 40 subjects without peripheral arterial disease at a single center were prospectively examined. Laser speckle flowgraphy was used to measure hallucal and thenar cutaneous blood flow, and the measurements were repeated three times. The hallucal and thenar index was defined as the ratio of beat strength of skin perfusion value on hallux/beat strength of skin perfusion value on ipsilateral thenar eminence. The Mann–Whitney U-test was used to compare the median values of hallucal and thenar index and ankle brachial index between the two groups. A receiver operating characteristic curve for hallucal and thenar index of beat strength of skin perfusion was plotted, and a cutoff point was set. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index was explored in all subjects, the hemodialysis group, and the non-hemodialysis (non-hemodialysis) group. Results The median value of the hallucal and thenar index of beat strength of skin perfusion was significantly different between subjects with and without peripheral arterial disease (0.27 vs. 0.87, respectively; P < 0.001). The median value of ankle brachial index was significantly different between subjects with and without peripheral arterial disease (0.8 vs. 1.1, respectively; P < 0.001). Based on the receiver operating characteristic of hallucal and thenar index, the cutoff was 0.4416 and the sensitivity, specificity, positive predictive value, and negative predictive value were 68.7%, 95%, 91.7%, and 77.6%, respectively. The correlation coefficients of all subjects, the hemodialysis group, and the non-hemodialysis group were 0.486, 0.102, and 0.743, respectively. Conclusions Laser speckle flowgraphy is a noninvasive, rapid, and widely applicable method. Laser speckle flowgraphy using hallucal and thenar index would be helpful to determine the differences between subjects with and without peripheral arterial disease. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index indicated that this index was especially useful in the non-hemodialysis group.

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