Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Taiwan, ROC ; Chang Gung University College of Medicine, Taiwan, ROC.
Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
Cardiorenal Med. 2014 Apr;4(1):34-42. doi: 10.1159/000360230. Epub 2014 Mar 1.
Cardiovascular calcification represents a marker of cardiovascular risk in chronic dialysis patients. In the general population, aortic arch calcification (AAC) can predict cardiovascular mortality. We conducted a prospective study to investigate factors associated with AAC in hemodialysis patients and examined its prognostic value in long-term outcome.
A total of 712 hemodialysis patients were enrolled. AAC was identified on postero-anterior chest X-ray films and classified as grade (Gr.) 0, 1, 2 or 3. Demographic data including age, gender, dialysis vintage, co-morbidity and biochemical data were reviewed and recorded. The patients were followed for 10 years.
AAC was present in 164 patients (23%) as Gr. 1, in 116 patients (16.3%) as Gr. 2 and in 126 patients (17.7%) as Gr. 3. An increase in the severity of calcification was associated with older patients who had lower albumin, higher calcium and glucose levels. During the follow-up period of 10 years, we found that the grade of AAC was directly related to cardiovascular mortality (Gr. 0: 5.3%; Gr. 1: 12.7%; Gr. 2: 18.9%, and Gr. 3: 24.4%; p < 0.05) and all-cause mortality (Gr. 0: 19.9%; Gr. 1: 31.1%; Gr. 2: 44.8%, and Gr. 3: 53.2%; p < 0.001). Multivariate Cox proportional hazards analysis revealed that high-grade calcification was associated with cardiovascular and all-cause mortality. Patients with AAC were associated with a worse outcome in survival analysis. The severity of AAC also influenced their survival.
Calcification of the aortic arch detected in plain chest radiography was an important determinant of cardiovascular as well as all-cause mortality in chronic hemodialysis patients. The presence and severity of AAC predicted long-term survival.
心血管钙化是慢性透析患者心血管风险的一个标志物。在普通人群中，主动脉弓钙化（AAC）可预测心血管死亡率。我们进行了一项前瞻性研究，以调查与血液透析患者 AAC 相关的因素，并研究其在长期预后中的预测价值。
共纳入 712 名血液透析患者。使用前后位胸部 X 线片确定 AAC，并分为 0 级、1 级、2 级或 3 级。回顾并记录患者的人口统计学数据，包括年龄、性别、透析年限、合并症和生化数据。患者随访 10 年。
164 例（23%）患者存在 AAC 为 1 级，116 例（16.3%）为 2 级，126 例（17.7%）为 3 级。钙化严重程度增加与年龄较大、白蛋白水平较低、钙和葡萄糖水平较高的患者有关。在 10 年的随访期间，我们发现 AAC 等级与心血管死亡率（0 级：5.3%；1 级：12.7%；2 级：18.9%，3 级：24.4%；p<0.05）和全因死亡率（0 级：19.9%；1 级：31.1%；2 级：44.8%，3 级：53.2%；p<0.001）直接相关。多变量 Cox 比例风险分析显示，重度钙化与心血管和全因死亡率相关。在生存分析中，AAC 患者的预后较差。AAC 的严重程度也影响了他们的生存。
普通胸部 X 线片检测到的主动脉弓钙化是慢性血液透析患者心血管和全因死亡率的重要决定因素。AAC 的存在和严重程度可预测长期生存。
