Tatami Yosuke, Yasuda Yoshinari, Suzuki Susumu, Ishii Hideki, Sawai Akihiro, Shibata Yohei, Ota Tomoyuki, Shibata Kanako, Niwa Misao, Morimoto Ryota, Hayashi Mutsuharu, Kato Sawako, Maruyama Shoichi, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Atherosclerosis. 2015 Dec;243(2):349-55. doi: 10.1016/j.atherosclerosis.2015.10.016. Epub 2015 Oct 22.
The presence of abdominal aortic calcification (AAC) can predict cardiovascular (CV) outcomes in hemodialysis patients. However, little is known about the predictive value of AAC for CV outcomes in chronic kidney disease (CKD) patients without hemodialysis. The aim of this study was to investigate the prevalence and the predictive value of AAC in asymptomatic CKD patients.
We prospectively evaluated 347 asymptomatic CKD patients without hemodialysis [median estimated glomerular filtration rate (eGFR): 43.2 mL/min/1.73 m(2)]. A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) as a semi-quantitative measure of AAC. The patients were divided into three groups according to the tertiles of ACI.
Among the subjects, AAC was found (ACI > 0) in 296 patients (86.3%), and the median ACI was 11.4%. During the median follow-up of 41.5 months, a total of 33 CV events were observed. Patients with the highest tertile of ACI had the highest risk of CV outcomes compared with the other two groups (96.5%, 93.0%, and 74.3%, respectively; p < 0.001). The Cox proportional hazard models showed that ACI was an independent predictor of CV outcomes (hazard ratio 1.36, 95% confidence interval 1.17-1.60, p < 0.001). The C-index was also significantly increased by adding eGFR and ACI values to the model along with the other conventional risk factors (0.79 versus 0.66, p = 0.043).
Evaluation of the AAC provides useful information for predicting adverse clinical outcomes among asymptomatic CKD patients without hemodialysis.
腹主动脉钙化（AAC）的存在可预测血液透析患者的心血管（CV）结局。然而，对于未接受血液透析的慢性肾脏病（CKD）患者，AAC对CV结局的预测价值知之甚少。本研究的目的是调查无症状CKD患者中AAC的患病率及其预测价值。
我们前瞻性评估了347例未接受血液透析的无症状CKD患者[估计肾小球滤过率（eGFR）中位数：43.2 mL/min/1.73 m²]。采用非增强计算机断层扫描来确定腹主动脉钙化指数（ACI），作为AAC的半定量指标。根据ACI的三分位数将患者分为三组。
在这些受试者中，296例患者（86.3%）存在AAC（ACI>0），ACI中位数为11.4%。在中位随访41.5个月期间，共观察到33例CV事件。与其他两组相比，ACI最高三分位数组的患者发生CV结局的风险最高（分别为96.5%、93.0%和74.3%；p<0.001）。Cox比例风险模型显示，ACI是CV结局的独立预测因素（风险比1.36，95%置信区间1.17-1.60，p<0.001）。将eGFR和ACI值与其他传统风险因素一起纳入模型时，C指数也显著增加（0.79对0.66，p=0.043）。
对AAC的评估为预测未接受血液透析的无症状CKD患者的不良临床结局提供了有用信息。
