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.
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.