Division of Nephrology, Department of Medicine, University of California San Diego, CA 92161, USA.
Am J Kidney Dis. 2012 Dec;60(6):990-7. doi: 10.1053/j.ajkd.2012.06.018. Epub 2012 Aug 9.
KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend lateral abdominal radiographs to assess vascular calcification in incident dialysis patients. However, nearly all dialysis patients in the United States receive chest radiographs at dialysis therapy inception, which may provide readily available information on coronary artery (CAC) and aortic arch calcification (AAC). We determined the prevalence of CAC and AAC visible on plain chest radiographs and their associations with mortality in our dialysis population.
Retrospective analysis.
SETTING & PARTICIPANTS: 93 participants who received maintenance hemodialysis at the San Diego Veterans Affairs Medical Center in 2009-2010.
Presence of CAC and AAC as evaluated by a radiologist.
All-cause mortality.
Average age was 64 years, 22% were African American, and 97% were men. CAC and AAC prevalences were 25% and 58%, respectively. During 20 months' follow-up, 28% died. CAC was associated with mortality in models including cardiovascular (HR, 2.41; 95% CI, 1.04-5.59) and dialysis-related (HR, 2.86; 95% CI, 1.24-6.60) risk factors. AAC was associated with HRs of 5.25 (95% CI, 1.46-17.72) in cardiovascular risk factor-adjusted models and 7.31 (95% CI, 2.03-26.34) in dialysis models. When CAC and AAC were both included in models, both CAC (HR, 3.40; 95% CI, 1.24-9.36) and AAC (HR, 6.23; 95% CI, 1.64-23.66) remained significantly associated with mortality.
The study sample is relatively small and mostly male.
CAC and AAC are highly prevalent on chest radiographs in dialysis patients and strongly associated with mortality independent of one another. Because these images are nearly ubiquitous, inexpensive, and often obtained for other indications, they should be considered for risk assessment in hemodialysis patients. Future studies are required to determine whether CAC or AAC on chest radiography is additive or duplicative of the risk of aorto-iliac calcification on lateral abdominal radiographs currently suggested by KDIGO.
KDIGO（肾脏疾病：改善全球预后组织）指南建议对新进入透析的患者进行侧腹部 X 光片检查以评估血管钙化。然而，几乎所有在美国接受透析治疗的患者在开始透析治疗时都会接受胸部 X 光检查，这可能会提供有关冠状动脉（CAC）和主动脉弓钙化（AAC）的现成信息。我们确定了在我们的透析人群中，胸部平片上可见 CAC 和 AAC 的患病率及其与死亡率的关系。
回顾性分析。
2009-2010 年在圣地亚哥退伍军人事务医疗中心接受维持性血液透析的 93 名参与者。
放射科医生评估的 CAC 和 AAC 存在情况。
全因死亡率。
平均年龄为 64 岁，22%为非裔美国人，97%为男性。CAC 和 AAC 的患病率分别为 25%和 58%。在 20 个月的随访期间，有 28%的人死亡。CAC 在包括心血管（HR，2.41；95%CI，1.04-5.59）和透析相关（HR，2.86；95%CI，1.24-6.60）风险因素的模型中与死亡率相关。AAC 在心血管危险因素调整模型中的 HR 为 5.25（95%CI，1.46-17.72），在透析模型中的 HR 为 7.31（95%CI，2.03-26.34）。当 CAC 和 AAC 都包含在模型中时，CAC（HR，3.40；95%CI，1.24-9.36）和 AAC（HR，6.23；95%CI，1.64-23.66）都与死亡率显著相关。
研究样本相对较小，且主要为男性。
在透析患者的胸部 X 光片上，CAC 和 AAC 的患病率很高，并且与死亡率独立相关。由于这些图像几乎无处不在，价格低廉，并且通常因其他适应症而获得，因此应考虑将其用于血液透析患者的风险评估。需要进一步的研究来确定胸部 X 光片上的 CAC 或 AAC 是否与 KDIGO 目前建议的侧腹部 X 光片上的腹主动脉-髂动脉钙化的风险相加或重复。
