Sinee Disthabanchong1,2, Kotcharat Vipattawat3, Bunyong Phakdeekitcharoen3,4, Chagriya Kitiyakara3,4, Vasant Sumethkul3,4. 1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, 7th floor, Building 1, Phayathai, Bangkok, 10400, Thailand. sinee.dis@mahidol.ac.th. 2. Ramathibodi Organ Transplant Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. sinee.dis@mahidol.ac.th. 3. Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, 7th floor, Building 1, Phayathai, Bangkok, 10400, Thailand. 4. Ramathibodi Organ Transplant Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Abstract
PURPOSE: Vascular calcification is common in chronic kidney disease (CKD) and predicts poor patient outcomes. While computed tomography is the gold standard for evaluation of vascular calcification, plain radiograph offers a simpler and less costly alternative. The calcification of abdominal aorta, iliac and femoral arteries has been evaluated by plain radiograph, but the data on their outcome predictabilities are still limited. The present study investigated the role of abdominal aortic calcification (AAC) and pelvic arterial calcification (PAC) in predicting overall morality in non-dialysis CKD stages 2-5 (CKD 2-5), maintenance hemodialysis (HD) and long-term kidney transplant (KT) patients. METHODS: Four hundred and nineteen patients were included. Lateral abdominal and pelvic radiographs were obtained. The degree of AAC and PAC was evaluated according to the methods described previously by Kaupplia et al. and Adragao et al. Patients were followed prospectively for 5 years. RESULTS: AAC and PAC scores correlated well with the correlation coefficients of 0.442 for CKD 2-5, 0.438 for HD and 0.586 for KT (p < 0.001). Patients with AAC score > 6 or PAC score > 1 were older, showed higher prevalence of DM and had higher serum phosphate and PTH but lower serum albumin and eGFR. A more severe degree of AAC was associated with an increase in KT duration, whereas a more severe degree of PAC was associated with worsening kidney function and prolonged dialysis vintage. Kaplan-Meier survival curves revealed AAC score > 6 as a significant predictor of all-cause mortality in CKD 2-5 but not in HD or KT, whereas PAC score > 1 was a significant predictor of all-cause mortality in all three populations. After adjusting for age, the predictability of AAC was lost, whereas PAC remained an independent predictor of mortality in all three populations. Adjustments for cardiovascular and CKD risk factors including age, gender, BMI, DM, serum albumin, calcium and phosphate attenuated the predictability of PAC in HD but not in CKD 2-5 or KT patients. CONCLUSION: PAC was better than AAC in predicting mortality in CKD, HD and KT patients.
PURPOSE:Vascular calcification is common in chronic kidney disease (CKD) and predicts poor patient outcomes. While computed tomography is the gold standard for evaluation of vascular calcification, plain radiograph offers a simpler and less costly alternative. The calcification of abdominal aorta, iliac and femoral arteries has been evaluated by plain radiograph, but the data on their outcome predictabilities are still limited. The present study investigated the role of abdominal aortic calcification (AAC) and pelvic arterial calcification (PAC) in predicting overall morality in non-dialysis CKD stages 2-5 (CKD 2-5), maintenance hemodialysis (HD) and long-term kidney transplant (KT) patients. METHODS: Four hundred and nineteen patients were included. Lateral abdominal and pelvic radiographs were obtained. The degree of AAC and PAC was evaluated according to the methods described previously by Kaupplia et al. and Adragao et al. Patients were followed prospectively for 5 years. RESULTS:AAC and PAC scores correlated well with the correlation coefficients of 0.442 for CKD 2-5, 0.438 for HD and 0.586 for KT (p < 0.001). Patients with AAC score > 6 or PAC score > 1 were older, showed higher prevalence of DM and had higher serum phosphate and PTH but lower serum albumin and eGFR. A more severe degree of AAC was associated with an increase in KT duration, whereas a more severe degree of PAC was associated with worsening kidney function and prolonged dialysis vintage. Kaplan-Meier survival curves revealed AAC score > 6 as a significant predictor of all-cause mortality in CKD 2-5 but not in HD or KT, whereas PAC score > 1 was a significant predictor of all-cause mortality in all three populations. After adjusting for age, the predictability of AAC was lost, whereas PAC remained an independent predictor of mortality in all three populations. Adjustments for cardiovascular and CKD risk factors including age, gender, BMI, DM, serum albumin, calcium and phosphate attenuated the predictability of PAC in HD but not in CKD 2-5 or KT patients. CONCLUSION:PAC was better than AAC in predicting mortality in CKD, HD and KT patients.
Authors: Carmine Zoccali; Davide Bolignano; Graziella D'Arrigo; Friedo W Dekker; Danilo Fliser; Gunnar H Heine; Kitty J Jager; Mehmet Kanbay; Francesca Mallamaci; Ziad Massy; Alberto Ortiz; Gianfranco Parati; Patrick Rossignol; Giovanni Tripepi; Raymond Vanholder; Andrzej Wiecek; Gerard London Journal: Hypertension Date: 2015-05-11 Impact factor: 10.190
Authors: Mohamed M NasrAllah; Amr Nassef; Tarik H Elshaboni; Fadia Morise; Noha A Osman; Usama A Sharaf El Din Journal: Int J Cardiol Date: 2016-06-22 Impact factor: 4.164
Authors: Matthew J Budoff; Daniel J Rader; Muredach P Reilly; Emile R Mohler; Jim Lash; Wei Yang; Leigh Rosen; Melanie Glenn; Valerie Teal; Harold I Feldman Journal: Am J Kidney Dis Date: 2011-07-23 Impact factor: 8.860
Authors: Francis Verbeke; Wim Van Biesen; Eero Honkanen; Björn Wikström; Per Bruno Jensen; Jean-Marie Krzesinski; Merete Rasmussen; Raymond Vanholder; Pieter L Rensma Journal: Clin J Am Soc Nephrol Date: 2010-09-09 Impact factor: 8.237
Authors: José L Górriz; Pablo Molina; M Jesús Cerverón; Rocío Vila; Jordi Bover; Javier Nieto; Guillermina Barril; Alberto Martínez-Castelao; Elvira Fernández; Verónica Escudero; Celestino Piñera; Teresa Adragao; Juan F Navarro-Gonzalez; Luis M Molinero; Cristina Castro-Alonso; Luis M Pallardó; Sophie A Jamal Journal: Clin J Am Soc Nephrol Date: 2015-03-13 Impact factor: 8.237
Authors: P Evenepoel; E Goffin; B Meijers; N Kanaan; B Bammens; E Coche; K Claes; M Jadoul Journal: J Clin Endocrinol Metab Date: 2015-10-27 Impact factor: 5.958
Authors: Deborah D Chin; Jonathan Wang; Margot Mel de Fontenay; Anastasia Plotkin; Gregory A Magee; Eun Ji Chung Journal: J Mater Chem B Date: 2019-09-25 Impact factor: 6.331
Authors: Kevin Leow; Pawel Szulc; John T Schousboe; Douglas P Kiel; Armando Teixeira-Pinto; Hassan Shaikh; Michael Sawang; Marc Sim; Nicola Bondonno; Jonathan M Hodgson; Ankit Sharma; Peter L Thompson; Richard L Prince; Jonathan C Craig; Wai H Lim; Germaine Wong; Joshua R Lewis Journal: J Am Heart Assoc Date: 2021-01-13 Impact factor: 5.501
Authors: Paolo Molinari; Carlo Maria Alfieri; Deborah Mattinzoli; Mariarosaria Campise; Angela Cervesato; Silvia Malvica; Evaldo Favi; Piergiorgio Messa; Giuseppe Castellano Journal: Front Med (Lausanne) Date: 2022-03-10
Authors: Jordi Bover; Armando Aguilar; Carolt Arana; Pablo Molina; María Jesús Lloret; Jackson Ochoa; Gerson Berná; Yessica G Gutiérrez-Maza; Natacha Rodrigues; Luis D'Marco; José L Górriz Journal: Front Med (Lausanne) Date: 2021-05-19
Authors: Elsaline Rijkse; Jacob L van Dam; Joke I Roodnat; Hendrikus J A N Kimenai; Jan N M IJzermans; Robert C Minnee Journal: Transpl Int Date: 2020-03-04 Impact factor: 3.842