Abdominal aortic calcification score among several vascular calcification scores of plain radiograph is the most reliable predictor of severe coronary artery calcification in dialysis patients

Aim: Coronary artery calcification (CAC) score on computed tomography (CT) or vascular calcification (VC) scores on plain radiographs are associated with cardiovascular events and fracture. We investigated which VC score among several VC scores on plain radiographs is predictor of CAC, and whether VC scores are related with bone mineral density (BMD) in dialysis patients. Methods: We checked several plain radiographs (hands and pelvis [HP], feet and lateral lumbar spine), BMD and multidetector CT scans of 55 patients maintaining dialysis in this cross-sectional study. We analyzed data to find predictors for severe CAC which was defined as CAC scores >400 on CT. Results: Patients with severe CAC on CT had a higher proportion of abdominal aortic calcification (AAC) score ≥5, HP score ≥3 and feet ≥1 than those without severe CAC. The CAC score on CT was positively correlated with all VC scores on plain radiographs. The AAC and CAC scores were negatively correlated with T-scores for the BMD at the forearm and positively correlated with osteoprotegerin levels. Among several VC scores on plain radiographs, the AAC ≥5 were independently associated with severe CAC on CT. Conclusions: Several plain radiographs evaluating VC scores, including a lateral lumbar spine view at the very least, can replace CT checking CAC score in dialysis patients. The AAC score ≥5 may not only reveal severe CAC but also give a hint of low bone mass at the forearm.