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Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Objective

Although aortic arch calcification (AoAC) is reported as a predictor for cardiovascular mortality in the general population, it is unknown whether this is also true in hemodialysis (HD) patients in whom vascular calcification and cardiovascular diseases are highly prevalent.

Methods

The enrolled study subjects were 401 patients (270 men and 131 women) on chronic HD therapy. Calcification of the aortic arch was semiquantitatively estimated with a score (AoACS) on plain chest radiography. Survival curves were estimated by means of the Kaplan–Meier method and evaluated using the log-rank test.

Results

AoAC was present in 203 patients (50.6%). During a follow-up period of 4.0 years, there were 72 all-cause deaths, of which 41 were from cardiovascular diseases. Of patients with and without AoAC, 15.2 and 20.7% died, respectively (11.3 and 6.6% of cardiovascular diseases, respectively). Kaplan–Meier analysis showed that cardiovascular mortality was significantly greater in patients with AoAC compared to those without (P = 0.0396, log-rank test). Multivariate Cox proportional hazards analysis found that the presence of AoAC was significantly associated with increased cardiovascular mortality (hazard ratio, 2.556; 95% confidence interval, 1.006–6.490; P < 0.05) after adjustment for age, presence of diabetes, body mass index, diastolic blood pressure, and serum albumin level.

Conclusion

The presence of AoAC is significantly associated with cardiovascular mortality in HD patients, suggesting that careful attention should be given to the presence of AoAC in a plain chest radiograph as a prognostic indicator.

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References

  1. Foley RN, Murray AM, Li S et al (2005) Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998–1999. J Am Soc Nephrol 6:489–495

    Article  Google Scholar 

  2. Cannata-Andia JB, Rodriguez-Garcia M, Carrillo-Lopez N, Naves-Diaz M, Diaz-Lopez B (2006) Vascular calcifications: pathogenesis, management, and impact on clinical outcomes. J Am Soc Nephrol 17(12(Suppl. 3)):S267–S273. doi:10.1681/ASN.2006080925

    Article  PubMed  Google Scholar 

  3. Raggi P, Boulay A, Chasan-Taber S et al (2002) Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 39:695–701. doi:10.1016/S0735-1097(01)01781-8

    Article  PubMed  Google Scholar 

  4. Jono S, McKee MD, Murry CE et al (2000) Phosphate regulations of vascular smooth muscle cell calcification. Circ Res 87:E10–E17

    CAS  PubMed  Google Scholar 

  5. Gelev S, Spasovski G, Dzikova S et al (2008) Vascular calcification and atherosclerosis in hemodialysis patients: what can we learn from the routine clinical practice? Int Urol Nephrol 40:763–770. doi:10.1007/s11255-008-9379-y

    Article  CAS  PubMed  Google Scholar 

  6. Giachelli CM, Jono S, Shioi A, Nishizawa Y, Mori K, Morii H (2001) Vascular calcification and inorganic phosphate. Am J Kidney Dis 38(4(Suppl. 1)):S34–S37. doi:10.1053/ajkd.2001.27394

    Article  CAS  PubMed  Google Scholar 

  7. Guerin AP, London GM, Marchais SJ, Metivier F (2000) Arterial stiffening and vascular calcification in end-stage renal disease. Nephrol Dial Transplant 15:1014–1021. doi:10.1093/ndt/15.7.1014

    Article  CAS  PubMed  Google Scholar 

  8. Blacher J, Demuth K, Guerin AP, Safar ME, Moatti N, London GM (1998) Influence of biochemical alterations on arterial stiffness in patients with end-stage renal disease. Arterioscler Thromb Vasc Biol 18:535–541

    CAS  PubMed  Google Scholar 

  9. Goodman WG, Goldin J, Kuizon BD et al (2000) Coronary artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483. doi:10.1056/NEJM200005183422003

    Article  CAS  PubMed  Google Scholar 

  10. Matsuoka M, Iseki K, Tamashiro M et al (2004) Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis. Clin Exp Nephrol 8:54–58. doi:10.1007/s10157-003-0260-0

    Article  PubMed  Google Scholar 

  11. Moe SM, O’Neil KD, Fineberg N et al (2003) Assessment of vascular calcification in ESRD patients using spiral CT. Nephrol Dial Transplant 18:1152–1158. doi:10.1093/ndt/gfg093

    Article  CAS  PubMed  Google Scholar 

  12. Nitta K, Akiba T, Uchida K et al (2003) The progression of vascular calcification and serum osteoprotegerin levels in patients on long-term hemodialysis. Am J Kidney Dis 42:303–309. doi:10.1016/S0272-6386(03)00655-3

    Article  CAS  PubMed  Google Scholar 

  13. Taniwaki H, Ishimura E, Tabata T et al (2005) Aortic calcification in haemodialysis patients with diabetes mellitus. Nephrol Dial Transplant 20:2472–2478. doi:10.1093/ndt/gfi039

    Article  PubMed  Google Scholar 

  14. Iribarren C, Sidney S, Sternfeld B, Browner WS (2000) Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 283:2810–2815. doi:10.1001/jama.283.21.2810

    Article  CAS  PubMed  Google Scholar 

  15. Kojima F, Uchida K, Ogawa T, Tanaka Y, Nitta K (2008) Plasma levels of fibroblast growth factor-23 and mineral metabolism in diabetic and non-diabetic patients on chronic hemodialysis. Int Urol Nephrol 40:1067–1074. doi:10.1007/s11255-008-9462-4

    Article  CAS  PubMed  Google Scholar 

  16. Ogawa T, Ishida H, Matsuda N, Fujiu A, et al. (2009) Simple evaluation of aortic arch calcification by chest radiography in hemodialysis patients. Hemodial Int (in press)

  17. London GM, Guerin AP, Marchais SJ, Metivier F, Pannier B, Adda H (2003) Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 18:1731–1740. doi:10.1093/ndt/gfg414

    Article  PubMed  Google Scholar 

  18. Adragao T, Pires A, Lucas C et al (2004) A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant 19:1480–1488. doi:10.1093/ndt/gfh217

    Article  PubMed  Google Scholar 

  19. Witteman JC, Kannel WB, Wolf PA, Grobbee DE, Hofman A, D’Agostino RB, Cobb JC (1990) Aortic calcified plaques and cardiovascular disease (the Framingham study). Am J Cardiol 66:1060–1064. doi:10.1016/0002-9149(90)90505-U

    Article  CAS  PubMed  Google Scholar 

  20. Witteman JC, Kok FJ, van Saase JL, Valkenburg HA (1986) Aortic calcification as a predictor of cardiovascular mortality. Lancet 2:1120–1122. doi:10.1016/S0140-6736(86)90530-1

    Article  CAS  PubMed  Google Scholar 

  21. Li J, Galvin HK, Johnson SC, Langston CS, Sclamberg J, Preston CA (2002) Aortic calcification on plain chest radiography increases risk for coronary artery disease. Chest 121:1468–1471. doi:10.1378/chest.121.5.1468

    Article  PubMed  Google Scholar 

  22. Salgueira M, del Toro N, Moreno-Alba R, Jiménez E, Aresté N, Palma A (2003) Vascular calcification in the uremic patient: a cardiovascular risk? Kidney Int 63(Suppl 85):S119–S121. doi:10.1046/j.1523-1755.63.s85.28.x

    Article  Google Scholar 

  23. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM (2001) Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 38:938–942. doi:10.1161/hy1001.096358

    Article  CAS  PubMed  Google Scholar 

  24. Hyman JB, Epstein FH (1954) A study of the correlation between roentgenographic and post-mortem calcification of the aorta. Am Heart J 48:540–543. doi:10.1016/0002-8703(54)90119-2

    Article  CAS  PubMed  Google Scholar 

  25. Stary HC, Chandler AB, Dinsmore RE et al (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the committee on vascular lesions of the council on arteriosclerosis, American heart association. Circulation 92:1355–1374

    CAS  PubMed  Google Scholar 

  26. Wang AY, Wang M, Woo J et al (2003) Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol 14:159–168. doi:10.1097/01.ASN.0000038685.95946.83

    Article  PubMed  Google Scholar 

  27. Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J (2000) Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 15:953–960. doi:10.1093/ndt/15.7.953

    Article  CAS  PubMed  Google Scholar 

  28. Okuno S, Ishimura E, Kitatani K et al (2007) Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients. Am J Kidney Dis 49:417–425. doi:10.1053/j.ajkd.2006.12.017

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Tetsuya Ogawa, Mayuko Akamatsu, Nami Matsuda, Ayuko Fujiu & Kosaku Nitta

  2. Hidaka Hospital, Gunma, Japan

    Hideki Ishida, Kyoko Ito & Yoshitaka Ando

Authors
  1. Tetsuya Ogawa
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  2. Hideki Ishida
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  3. Mayuko Akamatsu
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  4. Nami Matsuda
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  5. Ayuko Fujiu
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  6. Kyoko Ito
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  7. Yoshitaka Ando
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  8. Kosaku Nitta
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Correspondence to Tetsuya Ogawa.

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Ogawa, T., Ishida, H., Akamatsu, M. et al. Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients. Int Urol Nephrol 42, 187–194 (2010). https://doi.org/10.1007/s11255-009-9574-5

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  • DOI: https://doi.org/10.1007/s11255-009-9574-5

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