Abdominal aortic calcification index and prognosis in patients with chronic kidney disease: a meta-analysis

Background Abdominal aortic calcification index (ACI), a quantitative computed tomography–based measure of abdominal aortic calcification burden, has been increasingly investigated as a prognostic marker in patients with chronic kidney disease (CKD). However, the association between ACI and clinical outcomes in CKD remains uncertain. This meta-analysis evaluated the association of baseline ACI with cardiovascular event-free survival (CVEFS) and overall survival (OS) in patients with CKD. Methods PubMed, Embase, Web of Science, Wanfang Data, and CNKI were searched for cohort studies evaluating the association between baseline ACI and prognosis in adult patients with CKD. Hazard ratios (HRs) comparing high versus low ACI were pooled using random-effects models accounting for the influence of potential heterogeneity. Prespecified subgroup, sensitivity, and meta-regression analyses were performed. Results Eleven cohort studies involving 1,914 patients with CKD were included. Nine studies reported CVEFS and five reported OS. Pooled analysis showed that a high ACI was associated with poorer CVEFS (HR = 3.20, 95% CI: 2.21–4.64; I 2 = 44%) and OS (HR = 2.69, 95% CI: 1.86–3.89; I 2 = 0%). The association with CVEFS remained significant across study design and renal replacement therapy subgroups. Stronger associations with CVEFS were observed in studies with a mean age < 60 years as compared to ≥ 60 years (HR = 5.46 vs. 2.27; p for subgroup difference = 0.01) and ACI cutoff values ≥ 30% compared to < 30% (HR = 8.53 vs. 2.37; p < 0.001). Meta-regression identified ACI cutoff value as the only significant study characteristic associated with the strength of the association between ACI and CVEFS (coefficient = 0.033, p = 0.02). Conclusion A high baseline ACI was associated with poorer CVEFS and OS in patients with CKD. ACI may have potential as an imaging biomarker for prognostic risk stratification in this population, although these findings should be interpreted cautiously and confirmed in future prospective studies. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420261421928.