Chest CT-estimated aortic arch calcification and its prognostic value for cardiovascular and all-cause mortality in maintenance hemodialysis patients

Q: What are the key findings of this study?

Higher chest CT-derived aortic arch calcification score was independently associated with an increased risk of cardiovascular mortality (HR 1.935) in maintenance hemodialysis patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Maintenance Hemodialysis (n=205). Intervention: Aortic arch calcification (log(AoACS+1)) vs. Lower AoACS / Unexposed group. Primary outcome: Cardiovascular mortality (HR 1.935, 95% CI 1.148-3.263, p=0.013).

Q: What does this research mean for the field?

Higher chest CT-derived aortic arch calcification score is independently associated with an increased risk of cardiovascular and all-cause mortality in maintenance hemodialysis patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yiyi Gao; Kequan Ding; Yongyao Wu; Qiaojing Xia; Pengjie Xu

doi:10.1186/s12882-026-05445-4

October 14, 2026BMC NephrologyOpen Access

Chest CT-estimated aortic arch calcification and its prognostic value for cardiovascular and all-cause mortality in maintenance hemodialysis patients

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Key result

Higher aortic arch calcification score is linked to ~94% higher CV mortality in hemodialysis patients.

HR 1.935
95% CI 1.148-3.263
P=0.013
n=205

Why the study?

Chest X-ray may underestimate aortic arch calcification in hemodialysis patients, and the prognostic value of chest CT-assessed AoAC for mortality is unclear.

Does a higher CT-derived aortic arch calcification score predict cardiovascular and all-cause mortality in maintenance hemodialysis patients?

Key Points

To evaluate the prognostic value of aortic arch calcification quantified via non-gated standard-thickness chest CT for predicting cardiovascular and all-cause mortality in maintenance hemodialysis patients.
Conducted a retrospective cohort study of N=205 maintenance hemodialysis patients who received chest CT scans between January and December 2019, followed for a median duration of 61 months until August 31, 2024.
Quantified aortic arch calcification using an adapted Agatston density-weighted score (AoACS) and analyzed outcomes using Kaplan-Meier survival curves and multivariable Cox proportional hazards models.
During follow-up, 56 patients (27.3%) died, with cardiovascular death accounting for 28 deaths (13.7%).
Higher AoACS was associated with significantly reduced cardiovascular and overall survival rates (p < 0.001).
In multivariable Cox analysis, log(AoACS + 1) was independently associated with cardiovascular mortality (HR 1.935, 95% CI 1.148–3.263, p = 0.013) and all-cause mortality (HR 1.641, 95% CI 1.156–2.329, p = 0.006).

Study Design

Type

Cohort (n=205)

Multicenter

No

Structured PICO

Does a higher CT-derived aortic arch calcification score predict cardiovascular and all-cause mortality in maintenance hemodialysis patients?

P

Population

205 maintenance hemodialysis patients free of prior myocardial infarction or stroke, mean age 58.2 years, followed for a median of 61 months.

E

Exposure

Chest computed tomography (CT)-estimated aortic arch calcification quantified using a density-weighted calcification score (AoACS) on non-gated, standard-thickness scans.

C

Comparator

Patients with no detectable aortic arch calcification (Grade 0) or lower calcification scores (Grade 1, below median), or assessed as a continuous variable.

O

Outcome

Cardiovascular mortality and all-cause mortality at a median follow-up of 61 months.hard clinical

Main Result

Hazard Ratio: 1.935 (95% CI 1.148–3.263)

p-value: p=0.013

Higher aortic arch calcification, as quantified by a density-weighted score on routine non-gated chest CT, is an independent predictor of cardiovascular and all-cause mortality in maintenance hemodialysis patients.

Limitations

Single-centre retrospective design
Restriction to patients with available chest CT data
Exclusion of patients with prior myocardial infarction, stroke, or malignancy may introduce selection bias
Limited number of deaths relative to the number of model predictors risks overfitting
Residual confounding from lack of longitudinal mineral-metabolite trends or detailed dialysis parameters
Requires confirmation in larger, externally validated cohorts
Single-center study
Potential underestimation or misclassification due to non-gated, standard-thickness CT protocol

Implication

May support opportunistic aortic arch calcification assessment on routine CT for mortality risk stratification in hemodialysis; extends prior data but requires prospective validation.

Abstract

Background Cardiovascular complications are the leading cause of death in hemodialysis patients, and vascular calcification, particularly aortic arch calcification (AoAC), is an independent predictor of cardiovascular and all-cause mortality. However, chest X-ray, a commonly used method for assessing AoAC may underestimate calcium deposition. This study aimed to evaluate the prognostic value of AoAC assessed by chest computed tomography (CT) for predicting cardiovascular and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A retrospective cohort study was conducted, including 205 hemodialysis patients who underwent chest CT scans between January and December 2019. Patients were followed up until August 31, 2024, with a median follow-up duration of 61 months. AoAC was quantified using a CT-based density-weighted calcification score (AoACS), adapted from the Agatston weighting principle for non-gated, standard-thickness chest CT. Cox proportional hazards models and Kaplan-Meier survival analysis were used for statistical evaluation. Results Higher AoACS was associated with increased mortality risk and significantly reduced cardiovascular and overall survival rates ( p < 0.001). Multivariable analysis revealed that log(AoACS + 1) was independently associated with cardiovascular mortality (HR 1.935, 95%CI 1.148–3.263, p = 0.013) and all-cause mortality (HR 1.641, 95%CI 1.156–2.329, p = 0.006). Diabetes and serum albumin levels were also independent predictors of all-cause mortality. Conclusions Higher CT-derived AoACS was associated with cardiovascular and all-cause mortality after adjustment for the included covariates. Its incremental predictive value and clinical utility require confirmation in larger, externally validated cohorts. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2500098576) on March 11, 2025.

Discussion

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Cite This Study

Gao et al. (2026) conducted a cohort in Maintenance Hemodialysis (n=205). Aortic arch calcification (log(AoACS+1)) vs. Lower AoACS / Unexposed group was evaluated on Cardiovascular mortality (HR 1.935, 95% CI 1.148-3.263, p=0.013). Higher chest CT-derived aortic arch calcification score was independently associated with an increased risk of cardiovascular mortality (HR 1.935) in maintenance hemodialysis patients.

synapsesocial.com/papers/6ad2187bfc66cec880534e73 https://doi.org/10.1186/s12882-026-05445-4

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Chest CT-estimated aortic arch calcification and its prognostic value for cardiovascular and all-cause mortality in maintenance hemodialysis patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Chest CT-estimated aortic arch calcification and its prognostic value for cardiovascular and all-cause mortality in maintenance hemodialysis patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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