Prognostic value of cardiovascular calcifications in hemodialysis patients: a longitudinal study
- 87 Downloads
Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment.
We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6–160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q).
Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 ± 47 months (Q1), 87 ± 51 month (Q2), 66 ± 48 (Q3) and 54 ± 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles.
Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies.
KeywordsCardiovascular calcifications Hemodialysis Calcification inhibitors Calcification promoters Long-term survival
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 7.Yoon HE, Chung S, Whang HC, Shin YR et al (2012) Abdominal aortic calcification is associated with diastolic dysfunction, mortality, and nonfatal cardiovascular events in maintenance hemodialysis patients. J Korean Med Sci 27(8):870–875. https://doi.org/10.3346/jkms.2012.27.8.870 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Kwon HY, Lee OH, Kim MJ et al (2014) The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients. Kidney Res Clin Pract 33(2):95–102. https://doi.org/10.1016/j.krcp.2014.04.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Hong D, Wu S, Pu L et al (2013) Abdominal aortic calcification is not superior over other vascular calcification in predicting mortality in hemodialysis patients: a retrospective observational study. BMC Nephrol 14:120. https://doi.org/10.1186/1471-2369-14-120 CrossRefPubMedPubMedCentralGoogle Scholar