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Published on: June 2, 2022
Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a
Dahua Ma1,2, Hao Yan1,2, Xiaoxiao Yang1,2
1Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.
Insights
Abdominal aortic calcification score (AACS) predicts adverse outcomes in peritoneal dialysis (PD) patients. Higher AACS is linked to increased risk of major adverse cardiac and cerebrovascular events (MACCE) and mortality, suggesting its utility in risk stratification.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Abdominal aortic calcification (AAC) assessment via X-ray is standard for vascular calcification in dialysis patients.
- Abdominal aortic calcification score (AACS) is a known predictor of adverse outcomes in hemodialysis patients.
- Prognostic value of AACS in peritoneal dialysis (PD) patients requires further investigation.
Purpose of the Study:
- To investigate the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE).
- To assess the association between AACS and all-cause mortality in PD patients.
Main Methods:
- Prospective cohort study of 292 PD patients recruited between July 2011 and July 2014.
- AACS quantified using lateral lumbar radiography; patients followed until August 31, 2018.
- Subdistribution and cause-specific hazards models used to analyze AACS association with MACCE and mortality.
Main Results:
- AACS correlated with age, PD duration, cardiovascular disease (CVD), and diabetes.
- Patients in the highest AACS tertile exhibited significantly higher cumulative incidences of mortality and MACCE.
- AACS independently predicted all-cause mortality (SHR=2.323) and MACCE (SHR=3.063).
Conclusions:
- AACS is associated with key patient factors including age, PD duration, CVD, and diabetes.
- AACS serves as a significant predictor of MACCE and all-cause mortality in PD patients.
- AACS may be a valuable, safe, and feasible tool for identifying PD patients at high risk for adverse outcomes.
Background:
Abdominal aortic calcification assessed by X-ray is recommended to evaluate vascular calcification in dialysis patients. It has been shown that abdominal aortic calcification score (AACS) is a predictor of adverse outcomes in hemodialysis patients, but evidence regarding its prognostic value in peritoneal dialysis (PD) patients is still insufficient. We aimed to examine the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE) and mortality in PD patients.
Methods:
Eligible patients undergoing PD between July 2011 and July 2014 were recruited. AACS was quantified using lateral lumbar radiography at recruitment. Patients were prospectively followed up until death, PD cessation, or to the end of the study (August 31, 2018). Both subdistribution hazards and cause-specific hazards models were used to evaluate the association between AACS and MACCE as well as mortality.
Results:
292 patients were enrolled, including 160 males (54.8%) with mean age 57.1 ± 15.2 years and median PD duration 28.4 (IQR 12.0, 57.8) months. Among them, 75 (25.7%) patients were comorbid with diabetes, and 94 (32.2%) patients had cardiovascular disease (CVD). The average AACS was 2.0 (0.0, 6.0). Patients were categorized on the tertiles of AACS (Low AACS group, AACS = 0, n = 125; Medium AACS group, AACS 1-4, n = 72; and High AACS group, AACS> 4, n = 95). AACS was associated with age (OR = 1.081, P < 0.001), PD duration (OR = 1.012, P = 0.003), CVD (OR = 1.919, P = 0.020) and diabetes (OR = 2.554, P = 0.002). During the follow-up period of 43.6 (24.6, 50.7) months, there were 65 MACCEs and 84 deaths. Significantly higher cumulative incidences of all-cause mortality (Log-rank = 35.992, P<0.001; Gray = 38.662, P < 0.001) and MACCE (Log-rank = 26.146, P<0.001; Gray = 27.810, P < 0.001) were observed in the upper AACS tertile. AACS was an independent predictor of all-cause mortality (HR = 2.438, 95% CI 1.246-4.772, P = 0.009; SHR = 2.323, 95%CI 1.229-4.389, P = 0.009) and MACCE (HR = 3.455, 95% CI 1.734-6.884, P < 0.001; SHR = 3.063, 95%CI 1.460-6.430, P = 0.003) in this study.
Conclusions:
AACS was associated with age, PD duration, CVD and diabetes in PD patients. AACS could predict MACCE and all-cause mortality in this population. It thus might be a safe and feasible method to identify PD patients with adverse outcomes.
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