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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Associations between coronary calcification on chest radiographs and mortality in hemodialysis patients
Joseph A Abdelmalek1, Paul Stark, Carl P Walther
1Division of Nephrology, Department of Medicine, University of California San Diego, CA 92161, USA.
Insights
Chest X-rays reveal high rates of coronary artery (CAC) and aortic arch calcification (AAC) in dialysis patients. These findings, visible on routine chest imaging, are linked to increased mortality risk.
Area of Science:
- Nephrology
- Radiology
- Cardiovascular Medicine
Background:
- KDIGO guidelines suggest lateral abdominal radiographs for vascular calcification in dialysis patients.
- Chest radiographs are commonly performed at dialysis initiation in the US.
- Chest X-rays may offer insights into coronary artery calcification (CAC) and aortic arch calcification (AAC).
Purpose of the Study:
- To determine the prevalence of CAC and AAC on chest radiographs in dialysis patients.
- To assess the association of CAC and AAC with all-cause mortality in this population.
Main Methods:
- Retrospective analysis of 93 maintenance hemodialysis patients.
- Radiologist evaluation for the presence of CAC and AAC on chest radiographs.
- Follow-up for all-cause mortality over 20 months.
Main Results:
- CAC prevalence was 25%, and AAC prevalence was 58%.
- Both CAC and AAC were significantly associated with increased mortality, independent of each other.
- CAC and AAC remained significant predictors of mortality even after adjusting for cardiovascular and dialysis-related risk factors.
Conclusions:
- Chest radiographs can identify prevalent CAC and AAC in dialysis patients.
- These calcifications are strongly associated with mortality.
- Consideration of chest X-rays for cardiovascular risk assessment in hemodialysis patients is warranted.
Background:
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.
Study Design:
Retrospective analysis.
Setting & Participants:
93 participants who received maintenance hemodialysis at the San Diego Veterans Affairs Medical Center in 2009-2010.
Predictor:
Presence of CAC and AAC as evaluated by a radiologist.
Outcome:
All-cause mortality.
Results:
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.
Limitations:
The study sample is relatively small and mostly male.
Conclusions:
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.
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