nach oben

Erschienen in:

13.12.2017 | Nephrology - Original Paper

Abdominal aorta and pelvic artery calcifications on plain radiographs may predict mortality in chronic kidney disease, hemodialysis and renal transplantation

verfasst von: Sinee Disthabanchong, Kotcharat Vipattawat, Bunyong Phakdeekitcharoen, Chagriya Kitiyakara, Vasant Sumethkul

Erschienen in: International Urology and Nephrology | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

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.

Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32(5 Suppl 3):S112–S119CrossRefPubMed

Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, Wang Y, Chung J, Emerick A, Greaser L, Elashoff RM, Salusky IB (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342(20):1478–1483. https://doi.org/10.1056/NEJM200005183422003 CrossRefPubMed

Kanbay M, Afsar B, Gusbeth-Tatomir P, Covic A (2010) Arterial stiffness in dialysis patients: where are we now? Int Urol Nephrol 42(3):741–752. https://doi.org/10.1007/s11255-009-9675-1 CrossRefPubMed

Covic A, Kanbay M, Voroneanu L, Turgut F, Serban DN, Serban IL, Goldsmith DJ (2010) Vascular calcification in chronic kidney disease. Clin Sci (Lond) 119(3):111–121. https://doi.org/10.1042/CS20090631 CrossRef

Disthabanchong S (2012) Vascular calcification in chronic kidney disease: pathogenesis and clinical implication. World J Nephrol 1(2):43–53. https://doi.org/10.5527/wjn.v1.i2.43 CrossRefPubMedPubMedCentral

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(9):1731–1740CrossRefPubMed

Sag AA, Covic A, London G, Vervloet M, Goldsmith D, Gorriz JL, Kanbay M (2016) Clinical imaging of vascular disease in chronic kidney disease. Int Urol Nephrol 48(6):827–837. https://doi.org/10.1007/s11255-016-1240-0 CrossRefPubMed

Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, Moe SM, Shroff R, Tonelli MA, Toussaint ND, Vervloet MG, Leonard MB (2017) Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD–MBD) Guideline Update: what’s changed and why it matters. Kidney Int 92(1):26–36. https://doi.org/10.1016/j.kint.2017.04.006 CrossRefPubMed

Ogawa T, Ishida H, Matsuda N, Fujiu A, Matsuda A, Ito K, Ando Y, Nitta K (2009) Simple evaluation of aortic arch calcification by chest radiography in hemodialysis patients. Hemodial Int 13(3):301–306CrossRefPubMed

10.

Adragao T, Pires A, Lucas C, Birne R, Magalhaes L, Goncalves M, Negrao AP (2004) A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant 19(6):1480–1488. https://doi.org/10.1093/ndt/gfh217 CrossRefPubMed

11.

An WS, Son YK, Kim SE, Kim KH, Yoon SK, Bae HR, Rha SH (2010) Vascular calcification score on plain radiographs of the feet as a predictor of peripheral arterial disease in patients with chronic kidney disease. Int Urol Nephrol 42(3):773–780. https://doi.org/10.1007/s11255-009-9697-8 CrossRefPubMed

12.

Kauppila LI, Polak JF, Cupples LA, Hannan MT, Kiel DP, Wilson PW (1997) New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis 132(2):245–250CrossRefPubMed

13.

Hong D, Ruan Y, Pu L, Zhong X, Zhang Y, Zhang Y, Deng F, Yang H, Li G, Wang L (2016) Both pelvic radiography and lateral abdominal radiography correlate well with coronary artery calcification measured by computed tomography in hemodialysis patients: a cross-sectional study. Hemodial Int 20(3):399–406. https://doi.org/10.1111/hdi.12399 CrossRefPubMed

14.

Liabeuf S, Desjardins L, Diouf M, Temmar M, Renard C, Choukroun G, Massy ZA (2015) The addition of vascular calcification scores to traditional risk factors improves cardiovascular risk assessment in patients with chronic kidney disease. PLoS ONE 10(7):e0131707. https://doi.org/10.1371/journal.pone.0131707 CrossRefPubMedPubMedCentral

15.

Zoccali C, Bolignano D, D’Arrigo G, Dekker FW, Fliser D, Heine GH, Jager KJ, Kanbay M, Mallamaci F, Massy Z, Ortiz A, Parati G, Rossignol P, Tripepi G, Vanholder R, Wiecek A, European Renal and Cardiovascular Medicine (EURECA-m) Working Group of the European Renal Association–European Dialysis Transplantation Association (ERA-EDTA) (2015) Validity of vascular calcification as a screening tool and as a surrogate end point in clinical research. Hypertension 66(1):3–9. https://doi.org/10.1161/HYPERTENSIONAHA.115.04801 CrossRefPubMed

16.

Evenepoel P, Meijers BK, de Jonge H, Naesens M, Bammens B, Claes K, Kuypers D, Vanrenterghem Y (2008) Recovery of hyperphosphatoninism and renal phosphorus wasting one year after successful renal transplantation. Clin J Am Soc Nephrol 3(6):1829–1836. https://doi.org/10.2215/CJN.01310308 CrossRefPubMedPubMedCentral

17.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612CrossRefPubMedPubMedCentral

18.

Verbeke F, Van Biesen W, Honkanen E, Wikstrom B, Jensen PB, Krzesinski JM, Rasmussen M, Vanholder R, Rensma PL, Investigators CS (2011) Prognostic value of aortic stiffness and calcification for cardiovascular events and mortality in dialysis patients: outcome of the calcification outcome in renal disease (CORD) study. Clin J Am Soc Nephrol 6(1):153–159. https://doi.org/10.2215/CJN.05120610 CrossRefPubMedPubMedCentral

19.

Budoff MJ, Rader DJ, Reilly MP, Mohler ER 3rd, Lash J, Yang W, Rosen L, Glenn M, Teal V, Feldman HI (2011) Relationship of estimated GFR and coronary artery calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 58(4):519–526. https://doi.org/10.1053/j.ajkd.2011.04.024 CrossRefPubMedPubMedCentral

20.

Mazzaferro S, Pasquali M, Taggi F, Baldinelli M, Conte C, Muci ML, Pirozzi N, Carbone I, Francone M, Pugliese F (2009) Progression of coronary artery calcification in renal transplantation and the role of secondary hyperparathyroidism and inflammation. Clin J Am Soc Nephrol 4(3):685–690. https://doi.org/10.2215/CJN.03930808 CrossRefPubMedPubMedCentral

21.

Vipattawat K, Kitiyakara C, Phakdeekitcharoen B, Kantachuvesiri S, Sumethkul V, Jirasiritham S, Stitchantrakul W, Disthabanchong S (2014) Vascular calcification in long-term kidney transplantation. Nephrology (Carlton) 19(4):251–256. https://doi.org/10.1111/nep.12210 CrossRef

22.

Honkanen E, Kauppila L, Wikstrom B, Rensma PL, Krzesinski JM, Aasarod K, Verbeke F, Jensen PB, Mattelaer P, Volck B, CORD Study Group (2008) Abdominal aortic calcification in dialysis patients: results of the CORD study. Nephrol Dial Transplant 23(12):4009–4015. https://doi.org/10.1093/ndt/gfn403 CrossRefPubMedPubMedCentral

23.

Temmar M, Liabeuf S, Renard C, Czernichow S, Esper NE, Shahapuni I, Presne C, Makdassi R, Andrejak M, Tribouilloy C, Galan P, Safar ME, Choukroun G, Massy Z (2010) Pulse wave velocity and vascular calcification at different stages of chronic kidney disease. J Hypertens 28(1):163–169. https://doi.org/10.1097/HJH.0b013e328331b81e CrossRefPubMed

24.

Toussaint ND, Pedagogos E, Lau KK, Heinze S, Becker GJ, Beavis J, Polkinghorne KR, Damasiewicz MJ, Kerr PG (2011) Lateral lumbar X-ray assessment of abdominal aortic calcification in Australian haemodialysis patients. Nephrology (Carlton) 16(4):389–395. https://doi.org/10.1111/j.1440-1797.2010.01420.x CrossRef

25.

Gorriz JL, Molina P, Cerveron MJ, Vila R, Bover J, Nieto J, Barril G, Martinez-Castelao A, Fernandez E, Escudero V, Pinera C, Adragao T, Navarro-Gonzalez JF, Molinero LM, Castro-Alonso C, Pallardo LM, Jamal SA (2015) Vascular calcification in patients with nondialysis CKD over 3 years. Clin J Am Soc Nephrol 10(4):654–666. https://doi.org/10.2215/CJN.07450714 CrossRefPubMedPubMedCentral

26.

Biyik Z, Selcuk NY, Tonbul HZ, Anil M, Uyar M (2016) Assessment of abdominal aortic calcification at different stages of chronic kidney disease. Int Urol Nephrol 48(12):2061–2068. https://doi.org/10.1007/s11255-016-1413-x CrossRefPubMed

27.

Okuno S, Ishimura E, Kitatani K, Fujino Y, Kohno K, Maeno Y, Maekawa K, Yamakawa T, Imanishi Y, Inaba M, Nishizawa Y (2007) Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients. Am J Kidney Dis 49(3):417–425. https://doi.org/10.1053/j.ajkd.2006.12.017 CrossRefPubMed

28.

Yoon HE, Park BG, Hwang HS, Chung S, Park CW, Yang CW, Kim YS, Shin SJ (2013) The prognostic value of abdominal aortic calcification in peritoneal dialysis patients. Int J Med Sci 10(5):617–623. https://doi.org/10.7150/ijms.5773 CrossRefPubMedPubMedCentral

29.

Hong D, Wu S, Pu L, Wang F, Wang J, Wang Z, Gao H, Zhang Y, Deng F, Li G, He Q, Wang L (2013) Abdominal aortic calcification is not superior over other vascular calcification in predicting mortality in hemodialysis patients: a retrospective observational study. BMC Nephrol 14:120. https://doi.org/10.1186/1471-2369-14-120 CrossRefPubMedPubMedCentral

30.

Barreto FC, Barreto DV, Liabeuf S, Massy ZA (2010) Vascular calcification is not an independent predictor of mortality in pre-dialysis adult patients. Nephrol Dial Transplant 25(8):2804–2805. https://doi.org/10.1093/ndt/gfq289 (author reply 2805) CrossRefPubMed

31.

DeLoach SS, Joffe MM, Mai X, Goral S, Rosas SE (2009) Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation. Nephrol Dial Transplant 24(4):1314–1319. https://doi.org/10.1093/ndt/gfn753 CrossRefPubMedPubMedCentral

32.

Munguia P, Caramelo R, Rubio MV, Sahdala L, Arnaudas L, Paul J, Blasco A, Lou LM, Aladren MJ, Sanjuan A, Gutierrez-Dalmau A (2015) Pre-transplant assessment of vascular calcification as a risk factor of mortality, graft loss, and cardiovascular events in renal transplant recipients. Transplant Proc 47(8):2368–2370. https://doi.org/10.1016/j.transproceed.2015.08.038 CrossRefPubMed

33.

NasrAllah MM, Nassef A, Elshaboni TH, Morise F, Osman NA, Sharaf El Din UA (2016) Comparing different calcification scores to detect outcomes in chronic kidney disease patients with vascular calcification. Int J Cardiol 220:884–889. https://doi.org/10.1016/j.ijcard.2016.06.064 CrossRefPubMed

34.

Adragao T, Pires A, Birne R, Curto JD, Lucas C, Goncalves M, Negrao AP (2009) A plain X-ray vascular calcification score is associated with arterial stiffness and mortality in dialysis patients. Nephrol Dial Transplant 24(3):997–1002. https://doi.org/10.1093/ndt/gfn584 CrossRefPubMed

35.

Amann K (2008) Media calcification and intima calcification are distinct entities in chronic kidney disease. Clin J Am Soc Nephrol 3(6):1599–1605. https://doi.org/10.2215/CJN.02120508 CrossRefPubMed

36.

Zoungas S, Kerr PG, Chadban S, Muske C, Ristevski S, Atkins RC, McNeil JJ, McGrath BP (2004) Arterial function after successful renal transplantation. Kidney Int 65(5):1882–1889. https://doi.org/10.1111/j.1523-1755.2004.00595.x CrossRefPubMed

37.

Evenepoel P, Goffin E, Meijers B, Kanaan N, Bammens B, Coche E, Claes K, Jadoul M (2015) Sclerostin serum levels and vascular calcification progression in prevalent renal transplant recipients. J Clin Endocrinol Metab 100(12):4669–4676. https://doi.org/10.1210/jc.2015-3056 CrossRefPubMed

Titel: Abdominal aorta and pelvic artery calcifications on plain radiographs may predict mortality in chronic kidney disease, hemodialysis and renal transplantation
verfasst von: Sinee Disthabanchong
Kotcharat Vipattawat
Bunyong Phakdeekitcharoen
Chagriya Kitiyakara
Vasant Sumethkul
Publikationsdatum: 13.12.2017
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 2/2018
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-017-1758-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abdominal aorta and pelvic artery calcifications on plain radiographs may predict mortality in chronic kidney disease, hemodialysis and renal transplantation

Abstract

Purpose

Methods

Results

Conclusion

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2018

Lymph node dissection during radical cystectomy following prior radiation therapy: results from the SEER database

Association of ALOX12 gene polymorphism with all-cause and cardiovascular mortality in diabetic nephropathy

The effectiveness of multidisciplinary care models for patients with chronic kidney disease: a systematic review and meta-analysis

Anticancer activity of Schiff base–Poloxamer P85 combination against kidney cancer

From bench to the hemodialysis clinic: protein-bound uremic toxins modulate NF-κB/Nrf2 expression

What is the place of POEMS syndrome in the current classification of monoclonal gammopathies of renal significance?

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Metformin rückt in den Hintergrund

Myokarditis nach Infekt – richtig schwierig wird es bei Profisportlern

Thrombophiliescreening – Wenn, dann richtig und nur bei therapeutischer Konsequenz

Bei Senioren mit Prostatakarzinom auf Anämie achten!

Update Innere Medizin