Cargando…

Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients

Background: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piec...

Descripción completa

Detalles Bibliográficos
Autores principales: Bellasi, Antonio, Di Lullo, Luca, Russo, Domenico, Ciarcia, Roberto, Magnocavallo, Michele, Lavalle, Carlo, Ratti, Carlo, Fusaro, Maria, Cozzolino, Mario, Di Iorio, Biagio Raffaele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863918/
https://www.ncbi.nlm.nih.gov/pubmed/33498192
http://dx.doi.org/10.3390/jcm10030376
_version_ 1783647568361684992
author Bellasi, Antonio
Di Lullo, Luca
Russo, Domenico
Ciarcia, Roberto
Magnocavallo, Michele
Lavalle, Carlo
Ratti, Carlo
Fusaro, Maria
Cozzolino, Mario
Di Iorio, Biagio Raffaele
author_facet Bellasi, Antonio
Di Lullo, Luca
Russo, Domenico
Ciarcia, Roberto
Magnocavallo, Michele
Lavalle, Carlo
Ratti, Carlo
Fusaro, Maria
Cozzolino, Mario
Di Iorio, Biagio Raffaele
author_sort Bellasi, Antonio
collection PubMed
description Background: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). Methods: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. Results: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36; interquartile range: 8–36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p < 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p < 0.001) beyond traditional cardiovascular risk factors. Conclusions: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HD patient management improves survival.
format Online
Article
Text
id pubmed-7863918
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-78639182021-02-06 Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients Bellasi, Antonio Di Lullo, Luca Russo, Domenico Ciarcia, Roberto Magnocavallo, Michele Lavalle, Carlo Ratti, Carlo Fusaro, Maria Cozzolino, Mario Di Iorio, Biagio Raffaele J Clin Med Article Background: Vascular calcification (VC) is a marker of cardiovascular (CV) disease and various methods allow for presence and extension assessment in different arterial districts. Nevertheless, it is currently unclear which one of these methods for VC evaluation best predict outcome and if this piece of information adds to the predictive value of traditional CV risk factors in patients receiving hemodialysis (HD). Methods: data of 184 of the 466 patients followed in the Independent study (NCT00710788) were post hoc examined to assess the association three concurrent measures of vascular calcification and all-cause survival. Specifically, coronary artery calcification (CAC) was determined by the Agatston and the volume score while abdominal aorta calcification was determined by plain X-ray of the lumbar spine (Kauppila score (KS)). Survival and regression models as well as metrics of risk recalculation were used to test the association of VC and outcome beyond the Framingham risk score. Results: Middle-age (62.6(15.8) years) men (51%) and women (49%) starting HD were analyzed. Over 36 (median 36; interquartile range: 8–36) months of follow-up 69 patients expired. Each measure of VC (CAC or KS) predicted all-cause mortality independently factors commonly associated with all-cause survival (p < 0.001). Far more importantly, each measurement of VC significantly improved risk prediction and patient reclassification (p < 0.001) beyond traditional cardiovascular risk factors. Conclusions: Overall, presence and extension of VC, irrespective of the arterial site, predict risk of all-cause of death in patients starting hemodialysis. Of note, both CAC and KS increase risk stratification beyond traditional CV risk factors. However, future efforts are needed to assess whether a risk-based approach encompassing VC screening to guide HD patient management improves survival. MDPI 2021-01-20 /pmc/articles/PMC7863918/ /pubmed/33498192 http://dx.doi.org/10.3390/jcm10030376 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bellasi, Antonio
Di Lullo, Luca
Russo, Domenico
Ciarcia, Roberto
Magnocavallo, Michele
Lavalle, Carlo
Ratti, Carlo
Fusaro, Maria
Cozzolino, Mario
Di Iorio, Biagio Raffaele
Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
title Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
title_full Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
title_fullStr Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
title_full_unstemmed Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
title_short Predictive Value of Measures of Vascular Calcification Burden and Progression for Risk of Death in Incident to Dialysis Patients
title_sort predictive value of measures of vascular calcification burden and progression for risk of death in incident to dialysis patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863918/
https://www.ncbi.nlm.nih.gov/pubmed/33498192
http://dx.doi.org/10.3390/jcm10030376
work_keys_str_mv AT bellasiantonio predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT dilulloluca predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT russodomenico predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT ciarciaroberto predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT magnocavallomichele predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT lavallecarlo predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT ratticarlo predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT fusaromaria predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT cozzolinomario predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients
AT diioriobiagioraffaele predictivevalueofmeasuresofvascularcalcificationburdenandprogressionforriskofdeathinincidenttodialysispatients