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Quantified Vascular Calcification at the Dialysis Access Site: Correlations with the Coronary Artery Calcium Score
Hyunsuk Kim1, Bom Lee1, Gwangho Choi1
1Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea.
Insights
Vascular calcification score (VCS) correlates with coronary artery calcium score (CACS) in end-stage renal disease (ESRD) patients. Higher VCS predicts increased risk of interventions and major adverse cardiac and cerebrovascular events (MACCE).
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Vascular calcification significantly increases mortality in end-stage renal disease (ESRD) patients.
- Coronary artery calcium score (CACS) is a known predictor of cardiovascular events.
- The role of vascular calcification score (VCS) in predicting outcomes in ESRD patients requires further investigation.
Purpose of the Study:
- To investigate the correlation between CACS and VCS in ESRD patients.
- To determine if higher VCS is associated with an increased incidence of interventions and major adverse cardiac and cerebrovascular events (MACCE).
- To evaluate VCS as a potential biomarker for predicting outcomes in ESRD patients.
Main Methods:
- ECG-gated CT scans were performed to assess both coronary arteries and vascular access sites.
- Coronary artery calcium score (CACS) and vascular calcification score (VCS) were calculated using the Agatston method.
- Survival analysis was conducted comparing CACS and outcomes between VCS groups (cutoff VCS = 500).
Main Results:
- A significant correlation was found between CACS and VCS.
- Patients with higher VCS (≥500) had significantly higher CACS compared to those with lower VCS.
- Higher VCS was associated with increased hazard ratios for interventions (HR=3.2) and MACCE (HR=2.3).
- Longer hemodialysis duration and higher magnesium levels (>2.5 mg/dL) were associated with lower intervention risk.
Conclusions:
- Vascular calcification score (VCS) is associated with coronary artery calcification in ESRD patients.
- Elevated VCS is a significant predictor of adverse cardiovascular and cerebrovascular events, as well as access interventions.
- VCS of the vascular access site may serve as a valuable biomarker for risk stratification in ESRD patients.
Abstract:
Vascular calcification is a major contributor to mortality in end-stage renal disease (ESRD) patients. In this study, we investigated whether there was a correlation between the coronary artery calcium score (CACS) and the vascular calcification score (VCS), and whether higher VCS increased the incidence of interventions and major adverse cardiac and cerebrovascular events (MACCE). ECG-gated CT, including vascular access and the coronary vessel, was taken. CACS and VCS were calculated by the Agatston method. A comparison of CACS and survival analysis according to VCS groups was performed. Using a cutoff of VCS = 500, 77 patients were divided into two groups. The vintage was significantly older in the higher VCS group. The median CACS was higher in the higher VCS group (21 [0, 171] vs. 552 [93, 2430], p < 0.001). The hazard ratio (HR) for interventions and MACCEs in the higher VCS group increased by 3.2 and 2.3, respectively. Additionally, a longer duration of hemodialysis and higher magnesium levels (>2.5 mg/dL) showed lower HRs for interventions (<1). We quantified VCS and found that it was associated with the CACS. Additionally, higher VCS increased the risk of access interventions and MACCE. VCS of the access site may be suggested as a biomarker to predict ESRD patients.
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