Antonio Bellasi1, Luca Di Lullo2, Domenico Russo3, Roberto Ciarcia4, Michele Magnocavallo5, Carlo Lavalle5, Carlo Ratti6, Maria Fusaro7,8, Mario Cozzolino9, Biagio Raffaele Di Iorio10. 1. Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy. 2. Department of Nephrology and Dialysis, Ospedale Parodi, Delfino, 00034 Colleferro, Italy. 3. Department of Nephrology, School of Medicine, University "Federico II", 80125 Napoli, Italy. 4. Departments of Vetecerinary Medicine and Animal Productions, University of Naples Federico II, 80137 Naples, Italy. 5. Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00185 Roma, Italy. 6. Department of Cardiology, Ospedale Ramazzini, 41012 Carpi, Italy. 7. National Research Council (CNR)-Institute of Clinical Physiology (IFC), 56124 Pisa, Italy. 8. Department of Medicine, University of Padua, 35122 Padua, Italy. 9. Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy. 10. Nefrology and Dialysis, AORN "San Giuseppe Moscati", 83100 Avellino, Italy.
Abstract
BACKGROUND: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). METHODS: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. RESULTS: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36; interquartile range: 8-36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p < 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p < 0.001) beyond traditional cardiovascular risk factors. CONCLUSIONS: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HD patient management improves survival.
BACKGROUND:Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). METHODS: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. RESULTS: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36; interquartile range: 8-36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p < 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p < 0.001) beyond traditional cardiovascular risk factors. CONCLUSIONS: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HDpatient management improves survival.
Authors: Luca Di Lullo; Giovanni Tripepi; Claudio Ronco; Antonio De Pascalis; Vincenzo Barbera; Antonio Granata; Domenico Russo; Biagio Raffaele Di Iorio; Ernesto Paoletti; Maura Ravera; Maria Fusaro; Antonio Bellasi Journal: J Nephrol Date: 2018-06-07 Impact factor: 3.902
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Authors: Abadi K Gebre; Marc Sim; Alexander J Rodríguez; Jonathan M Hodgson; Lauren C Blekkenhorst; Pawel Szulc; Nicola Bondonno; Kun Zhu; Catherine Bondonno; Douglas P Kiel; John T Schousboe; Richard L Prince; Joshua R Lewis Journal: Atherosclerosis Date: 2021-05-12 Impact factor: 5.162
Authors: Helen Erlandsson; Abdul Rashid Qureshi; Jonaz Ripsweden; Ida Haugen Löfman; Magnus Söderberg; Lars Wennberg; Torbjörn Lundgren; Annette Bruchfeld; Torkel B Brismar; Peter Stenvinkel Journal: J Intern Med Date: 2022-02-11 Impact factor: 13.068