Vascular calcification score was a strong predictor of all-cause (HR 1.9; 95% CI 1.4-2.6) and cardiovascular mortality (HR 2.6; 95% CI 1.5-4.4) in end-stage renal disease patients.
Cohort (n=110)
Do arterial calcifications and arterial stiffness predict cardiovascular and all-cause mortality in end-stage renal disease patients on hemodialysis?
The presence and extent of vascular calcifications, along with carotid incremental elastic modulus, are strong independent predictors of cardiovascular and all-cause mortality in hemodialysis patients.
Effect estimate: HR 1.9 (95% CI 1.4 to 2.6)
p-value: p=<0.001
To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53+/-21 months (mean+/-SD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval CI, 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (P<0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (P<0.01 for both). The results of this study showed that the presence and extent of vascular calcifications were strong predictors of cardiovascular and all-cause mortality. Carotid incremental elastic modulus gave additional predictive value.
Blacher et al. (2001) conducted a cohort in End-Stage Renal Disease (n=110). Vascular calcification score and carotid incremental elastic modulus was evaluated on All-cause mortality (per 1-unit increase in calcification score) (HR 1.9, 95% CI 1.4 to 2.6, p=<0.001). Vascular calcification score was a strong predictor of all-cause (HR 1.9; 95% CI 1.4-2.6) and cardiovascular mortality (HR 2.6; 95% CI 1.5-4.4) in end-stage renal disease patients.