Abdominal aortic calcification score can predict all-cause and cardiovascular mortality in maintenance hemodialysis patients

Abstract

Purpose

Abdominal aortic calcification (AAC) assessed by using standard lateral lumbar radiographs can be graded, and composite summary scores (range, 0–24) have been shown to be highly predictive of subsequent cardiovascular morbidity and mortality in hemodialysis (HD) patients. However, few studies have sought to determine the optimal AAC score cutoff values for the prediction of mortality among HD patients.

Methods

This retrospective cohort study included 408 hemodialysis patients. AAC severity was quantified by the AAC score, which was measured by lateral lumbar radiography with complete follow-up data from January 2015 to December 2021. We used receiver operating characteristic (ROC) analysis to find the cutoff AAC value for the prediction of mortality. The Kaplan–Meier method was used to analyze all-cause and cardiovascular mortality.

Results

The cutoff calcification score for the prediction of mortality was 4.5 (sensitivity, 67.3%; specificity, 70.4%). The patients with AAC scores above 4.5 had significantly higher all-cause (log-rank p < 0.001) and cardiovascular (log-rank p < 0.001) mortality rates than those with AAC scores below 4.5. In the multivariate regression analyses, an AAC score above 4.5 was a significant factor associated with all-cause mortality (HR: 2.079, p = 0.002) and cardiovascular mortality (HR: 2.610, p < 0.001).

Conclusions

AAC is a reliable aortic calcification marker. HD patients with an AAC score > 4.5 have significantly elevated all-cause and cardiovascular mortality compared with those with an AAC score ≤ 4.5. AAC was a better predictor than cardiac valve calcification for mortality in HD patients.

Keywords:

• Abdominal aortic calcification
• mortality
• hemodialysis
• survival

Acknowledgements

The authors appreciate the support of our colleagues from the Department of Blood Purification, General Hospital of Northern Theater Command.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of General Hospital of Northern Theater Command (approval number Y (2022) 056).

Informed consent

The requirement to obtain written informed consent from each patient was waived because this was an observational retrospective study.

Consent for publication

All the authors agree to publish this manuscript.

Author contributions

JXB and NC conceived the study and its design, had full access to the patient records, and take responsibility for the accuracy and integrity of the data. JXB and AHZ contributed to the analysis and interpretation of the data. YPZ, KMR, ZR, CZ, and QW participated in patient inclusion and demographic data collection. All authors critically revised the drafted manuscript. The authors have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Datasets are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Natural Science Foundation of Liaoning Province [20180550009].