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Published on: June 2, 2022
Vascular calcification in patients with nondialysis CKD over 3 years
José L Górriz1, Pablo Molina2, M Jesús Cerverón2
1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. jlgorriz@senefro.org.
Insights
Vascular calcification is common in CKD patients and predicts death and hospitalization risk. Adragao score for vascular calcification is a useful tool for identifying high-risk patients with chronic kidney disease.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Radiology
Background:
- Vascular calcification (VC) is prevalent in chronic kidney disease (CKD) but its prognostic impact on non-dialysis patients is unclear.
- Assessing VC prevalence and its predictive value for mortality, hospitalization, and renal progression in non-dialysis CKD patients is crucial.
Purpose of the Study:
- To determine the prevalence of vascular calcification (VC) in non-dialysis CKD patients.
- To evaluate the prognostic significance of VC in predicting death, hospitalization, and renal progression.
- To identify factors associated with VC in this patient population.
Main Methods:
- A prospective, observational, 3-year follow-up study of 742 non-dialysis CKD stages 3-5 patients.
- Vascular calcification (VC) assessed using Adragao score (AS) and Kauppila score (KS) via X-ray.
- Survival analysis using Cox proportional models and logistic regression for associated factors.
Main Results:
- Vascular calcification (VC) was present in 79% of patients; 47% had prominent VC (AS≥3 or KS>6).
- Age, phosphorous, and diabetes were independently related to prominent VC (AS≥3).
- Adragao score (AS≥3) independently predicted all-cause and cardiovascular mortality and shorter hospitalization-free period, but not renal progression.
Conclusions:
- Vascular calcification (VC) is highly prevalent in non-dialysis CKD patients.
- Adragao score (AS) for VC is a valuable tool for predicting mortality and hospitalization risk.
- VC assessment can identify high-risk CKD patients, similar to findings in dialysis patients.
Background And Objectives:
Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed.
Design, Setting, Participants, & Measurements:
The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop >30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models.
Results:
VC was present in 79% of patients and prominent in 47% (AS≥3 or KS>6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P<0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P<0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS≥3. After a median follow-up of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS≥3 but not KS>6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P<0.001). VC did not predict renal progression.
Conclusions:
VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.
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