TY - JOUR
T1 - Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients
AU - Mäkelä, Satu
AU - Asola, Markku
AU - Hadimeri, Henrik
AU - Heaf, James
AU - Heiro, Maija
AU - Kauppila, Leena
AU - Ljungman, Susanne
AU - Ots-Rosenberg, Mai
AU - Povlsen, Johan V
AU - Rogland, Björn
AU - Roessel, Petra
AU - Uhlinova, Jana
AU - Vainiotalo, Maarit
AU - Svensson, Maria K
AU - Huhtala, Heini
AU - Saha, Heikki
N1 - Copyright © 2018 International Society for Peritoneal Dialysis.
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.METHODS: We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.RESULTS: The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low (< 0.9) in 17%, and high (> 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS ≥ 7 (p < 0.001). The adjusted hazard ratio for all-cause mortality was 4.85 (95% confidence interval [CI] 1.94 - 24.46) for aortic calcification (AACS ≥ 7), 2.14 for diabetes (yes/no), 0.93 for albumin (per 1 g/L), and 1.04 for age (per year). A low or high ABI were not independently associated with mortality.CONCLUSIONS: Severe aortic calcification was a strong predictor of all-cause mortality in PD patients. The evaluation of aortic calcifications by lateral X ray is a simple method that allows the identification of high-risk patients.
AB - BACKGROUND: Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.METHODS: We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.RESULTS: The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low (< 0.9) in 17%, and high (> 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS ≥ 7 (p < 0.001). The adjusted hazard ratio for all-cause mortality was 4.85 (95% confidence interval [CI] 1.94 - 24.46) for aortic calcification (AACS ≥ 7), 2.14 for diabetes (yes/no), 0.93 for albumin (per 1 g/L), and 1.04 for age (per year). A low or high ABI were not independently associated with mortality.CONCLUSIONS: Severe aortic calcification was a strong predictor of all-cause mortality in PD patients. The evaluation of aortic calcifications by lateral X ray is a simple method that allows the identification of high-risk patients.
KW - Ankle Brachial Index
KW - Aorta, Abdominal/diagnostic imaging
KW - Aortic Diseases/diagnosis
KW - Cause of Death/trends
KW - Critical Illness/mortality
KW - Denmark/epidemiology
KW - Estonia/epidemiology
KW - Female
KW - Finland/epidemiology
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Peritoneal Dialysis/adverse effects
KW - Prognosis
KW - Prospective Studies
KW - Renal Dialysis
KW - Risk Factors
KW - Survival Rate/trends
KW - Sweden/epidemiology
KW - Ultrasonography, Doppler
KW - Vascular Calcification/diagnosis
U2 - 10.3747/pdi.2017.00043
DO - 10.3747/pdi.2017.00043
M3 - Journal article
C2 - 29386304
VL - 38
SP - 366
EP - 373
JO - Peritoneal Dialysis International
JF - Peritoneal Dialysis International
SN - 0896-8608
IS - 5
ER -