The Assessment of Vascular Calcification, Arterial Stiffness, and Nutritional Status in Patients on Hemodialysis, A 5-Year Follow-up Study

Objectives: This study aimed to find out the relationship between vascular calcification, arterial stiffness, and nutritional status, and investigate their effects on 5-year mortality. Materials and Methods:This study included 79 hemodialysis patients.Fetuin-A and FGF-23 levels were measured.The average blood pressure (BP) of the previous 12 months was used.The abdominal aortic calcification (AAC) score was measured from lateral abdominal radiographs.Carotidfemoral pulse wave velocity (cf-PWV) was used for arterial stiffness assessment.The geriatric nutritional risk index (GNRI) was used for nutritional status, and calculated as the following formula; [14.89*serum albumin (g/dL)] + (41.7* body weight/ideal body weight).Results: Twenty-five (31.6%) of 79 patients died within 5 years.When the alive and deceased groups were compared age (p=0.001),diabetes mellitus (p=0.041),GNRI (p=0.019),AAC score (p=0.009),cf-PWV (p=0.003),albumin (p=0.030),C-reactive protein (p=0.003),mean systolic BP before dialysis (p=0.018), and mean diastolic BP before dialysis (p=0.045) were significantly different between two groups, whereas Fetuin-A and FGF-23 were not.AAC score above 3 points [area under the curve (AUC): 0.682], cf-PWV above 8.1 (AUC: 0.727), and GNRI score 99.2 and lower (AUC: 0.663) had estimated 5-year mortality well.GNRI was the only independent variable (hazard ratio: 0.924, p=0.047) in multivariable cox regression analysis. Conclusion:There was a close relationship between AAC score, GNRI, cf-PWV, and long-term mortality.The cf-PWV and its close relationship with average BP measurements must be assessed for future studies.Following GNRI must be targeted for its crucial role as an independent factor of mortality.