Skip to main content

Advertisement

SpringerLink
Log in

Vascular calcification estimated by aortic calcification area index is a significant predictive parameter of cardiovascular mortality in hemodialysis patients

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Vascular calcification is a feature of arteriosclerosis. In hemodialysis (HD) patients, vascular calcification progresses rapidly. This study used the aortic calcification area index (ACAI), an index of vascular calcification, to evaluate vascular calcification factors in HD patients, to investigate correlations between ACAI and long-term prognosis and to assess correlations between various factors and long-term prognosis.

Methods

Subjects comprised 137 patients on maintenance HD. ACAI was measured as an index of vascular calcification as measured by abdominal plain computed tomography. The patients were divided into a high ACAI (H) group and a low ACAI (L) group according to whether the ACAI was below or above the mean value (21.4%) of ACAI, and long-term all-cause death and cardiovascular death rates were compared between groups. Risk factors for all-cause death and cardiovascular death were examined by Cox hazard analysis.

Results

During follow-up (mean follow-up period 95.3 ± 50.3 months), 76 patients died, including 46 cardiovascular deaths. Deaths included 51 of 70 patients (67.1%) in Group H and 25 of 67 patients (37.3%) in Group L. Cardiovascular death rates were 51.4 and 14.9%, respectively. On Kaplan–Meier analysis, the number of all-cause deaths was significantly higher in Group H (P < 0.001, log-rank test). Similarly, the number of cardiovascular deaths was significantly higher in Group H. Multivariate Cox proportional hazards analysis showed that ACAI (%) was a significant prognostic indicator for cardiovascular death (hazard ratio 1.03; 95% confidence interval 1.00–1.06, P = 0.03).

Conclusion

High ACAI was clearly correlated with mortality rate in HD patients, particularly cardiovascular mortality rate. ACAI was a useful long-term prognostic indicator in HD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;18:1478–83.

    Article  Google Scholar 

  2. Nakai S, Masakane I, Akiba T, Iseki K, Watanabe Y, Itami N, et al. Overview of regular dialysis treatment in Japan ( as of 31 December 2005). Ther Apher Dial. 2007;11:411–41

    Article  PubMed  Google Scholar 

  3. Yukawa S, Sonobe M, Yukawa A, Mimura K, Mune M, Maeda H, et al. Prevention of aortic calcification in patients on hemodialysis by long-term administration of vitamin E. J Nutr Sci Vitam. 1992;38(Suppl):S187–90.

    Article  Google Scholar 

  4. Taniwaki H, Ishimura E, Tabata T, Tsujimoto Y, Shioi A, Shoji T, et al. Aortic calcification in haemodialysis patients with diabetes mellitus. Nephrol Dial Transpl. 2005;20(11):2472–8.

    Article  Google Scholar 

  5. Ohya M, Otani H, Kimura K, Saika Y, Yukawa S, Shigematsu T, et al. Improved assessment of aortic calcification in Japanese patients undergoing maintenance hemodialysis. Intern Med. 2010;49(19):2071–5.

    Article  PubMed  Google Scholar 

  6. Go AS, Chrtow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  PubMed  CAS  Google Scholar 

  7. Foley R, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(Suppl):S112–9.

    Article  PubMed  CAS  Google Scholar 

  8. Shigematsu T, Kono T, Satoh K, Yokoyama K, Yoshida T, Hosoya T, et al. Phosphate overload accelerates vascular calcium deposition in end-stage renal disease patients. Nephrol Dial Transpl. 2003;18(Suppl 3):iii86–9.

    CAS  Google Scholar 

  9. London GM, Guerin AP, Marhais SJ, Metivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transpl. 2003;18:1731–40.

    Article  Google Scholar 

  10. Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke SK, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002;39:695–701.

    Article  PubMed  Google Scholar 

  11. Yokoyama K, Nishioka M, Sakuma T, Yoshida S, Iida R, Yoshida H, et al. Most patients with coronary artery calcification have no coronary artery stenosis and hyperphosphatemia should be important in reevaluating the K/DOQI guideline. Ther Apher Dial. 2006;10:101.

    Article  PubMed  Google Scholar 

  12. Okuno S, Ishimura E, Kitatani K, Fujino Y, Kohno K, Maeno Y, et al. Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2007;49(3):417–25.

    Article  PubMed  Google Scholar 

  13. Ogawa T, Ishida H, Akamatsu M, Matsuda N, Fujiu A, Ito K, et al. Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients. Int Urol Nephrol. 2010;42(1):187–94.

    Article  PubMed  Google Scholar 

  14. K/DOQI Workgroup. Clinical practice guideline for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(3):S62–84.

    Google Scholar 

  15. Qunibi WY. Consequences of hyperphosphatemia in patients with end-stage renal disease (ESRD). Kidney Int Suppl. 2004;90:S8–12.

    Article  PubMed  CAS  Google Scholar 

  16. Tonelli M, Sacks F, Pfeffer M, et al. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation. 2005;112:2627–33.

    Article  PubMed  CAS  Google Scholar 

  17. Mathew S, Tustison KS, Sugatani T, et al. The mechanism of phosphorus as a cardiovascular risk factor in CKD. J Am Soc Nephrol. 2008;19:1092–105.

    Article  PubMed  CAS  Google Scholar 

  18. Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcification in end-stage renal disease. Nephrol Dial Transpl. 2000;15:1014–21.

    Article  CAS  Google Scholar 

  19. Mattace-Raso FU, van der Cammen JM, Hofman A, van Popele NM, Bos ML, Schalekamp MADH, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113:657–63.

    Article  PubMed  Google Scholar 

  20. London GM. Large arteries hemodynamics: conduit versus cushioning function. Blood Press Suppl. 1997;2:48–51.

    PubMed  CAS  Google Scholar 

  21. Westerhof N, O’Rourke MF. Haemodynamic basis for the development of left ventricular failure in systolic hypertension and for its logical therapy. J Hypertens. 1995;13:943–52.

    Article  PubMed  CAS  Google Scholar 

  22. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol. 1993;21:1497–506.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported in part by the Grant-in-Aid from the Japanese Society for the Promotion of Science (20590982, 23591222 to T.S.), and by the Public Welfare Science Research Funds (22141101 to T.S.).

Author information

Authors and Affiliations

  1. Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan

    Masaki Ohya & Takashi Shigematsu

  2. Kisen Kidney Disease Clinic, 358-1 Zenmyouji, Wakayama, Wakayama, 640-8471, Japan

    Haruhisa Otani

  3. Department of Internal Medicine, Sakura Clinic, 140-1 Nataka, Kainan, Wakayama, 642-0032, Japan

    Keigo Kimura

  4. Department of Internal Medicine, Ryosyukai Fujii Hospital, 3-1 Nishinouchicho, Kishiwada, Osaka, 596-0044, Japan

    Yasushi Saika & Ryoichi Fujii

  5. Department of Internal Medicine, Hakubunkai Kodama Hospital, 12 Esashicho, Wakayama, Wakayama, 640-8335, Japan

    Susumu Yukawa

Authors
  1. Masaki Ohya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haruhisa Otani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keigo Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasushi Saika
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryoichi Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susumu Yukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Shigematsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masaki Ohya.

About this article

Cite this article

Ohya, M., Otani, H., Kimura, K. et al. Vascular calcification estimated by aortic calcification area index is a significant predictive parameter of cardiovascular mortality in hemodialysis patients. Clin Exp Nephrol 15, 877–883 (2011). https://doi.org/10.1007/s10157-011-0517-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-011-0517-y

Keywords

Search

Navigation