Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients

Satu Mäkelä; Markku Asola; Henrik Hadimeri; James Heaf; Maija Heiro; Leena Kauppila; Susanne Ljungman; Mai Ots-Rosenberg; Johan V Povlsen; Björn Rogland; Petra Roessel; Jana Uhlinova; Maarit Vainiotalo; Maria K Svensson; Heini Huhtala; Heikki Saha

doi:10.3747/pdi.2017.00043

Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients

Satu Mäkelä, Markku Asola, Henrik Hadimeri, James Heaf, Maija Heiro, Leena Kauppila, Susanne Ljungman, Mai Ots-Rosenberg, Johan V Povlsen, Björn Rogland, Petra Roessel, Jana Uhlinova, Maarit Vainiotalo, Maria K Svensson, Heini Huhtala, Heikki Saha

Institut for Klinisk Medicin

7 Citationer (Scopus)

Abstract

♦ 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.

Originalsprog	Engelsk
Tidsskrift	Peritoneal Dialysis International
Vol/bind	38
Udgave nummer	5
Sider (fra-til)	366-373
ISSN	0896-8608
DOI	https://doi.org/10.3747/pdi.2017.00043
Status	Udgivet - 1 sep. 2018

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10.3747/pdi.2017.00043

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Mäkelä, S., Asola, M., Hadimeri, H., Heaf, J., Heiro, M., Kauppila, L., Ljungman, S., Ots-Rosenberg, M., Povlsen, J. V., Rogland, B., Roessel, P., Uhlinova, J., Vainiotalo, M., Svensson, M. K., Huhtala, H., & Saha, H. (2018). Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients. Peritoneal Dialysis International, 38(5), 366-373. https://doi.org/10.3747/pdi.2017.00043

Mäkelä, S, Asola, M, Hadimeri, H, Heaf, J, Heiro, M, Kauppila, L, Ljungman, S, Ots-Rosenberg, M, Povlsen, JV, Rogland, B, Roessel, P, Uhlinova, J, Vainiotalo, M, Svensson, MK, Huhtala, H & Saha, H 2018, 'Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients', Peritoneal Dialysis International, bind 38, nr. 5, s. 366-373. https://doi.org/10.3747/pdi.2017.00043

@article{153aaaa785134926b6203ef4c4a4baee,

title = "Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients",

abstract = "♦ 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.",

keywords = "Ankle Brachial Index, Aorta, Abdominal/diagnostic imaging, Aortic Diseases/diagnosis, Cause of Death/trends, Critical Illness/mortality, Denmark/epidemiology, Estonia/epidemiology, Female, Finland/epidemiology, Humans, Incidence, Male, Middle Aged, Peritoneal Dialysis/adverse effects, Prognosis, Prospective Studies, Renal Dialysis, Risk Factors, Survival Rate/trends, Sweden/epidemiology, Ultrasonography, Doppler, Vascular Calcification/diagnosis",

author = "Satu M{\"a}kel{\"a} and Markku Asola and Henrik Hadimeri and James Heaf and Maija Heiro and Leena Kauppila and Susanne Ljungman and Mai Ots-Rosenberg and Povlsen, {Johan V} and Bj{\"o}rn Rogland and Petra Roessel and Jana Uhlinova and Maarit Vainiotalo and Svensson, {Maria K} and Heini Huhtala and Heikki Saha",

note = "Copyright {\textcopyright} 2018 International Society for Peritoneal Dialysis.",

year = "2018",

month = sep,

day = "1",

doi = "10.3747/pdi.2017.00043",

language = "English",

volume = "38",

pages = "366--373",

journal = "Peritoneal Dialysis International",

issn = "0896-8608",

publisher = "Multimed, Inc.",

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}

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

PY - 2018/9/1

Y1 - 2018/9/1

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

SN - 0896-8608

VL - 38

SP - 366

EP - 373

JO - Peritoneal Dialysis International

JF - Peritoneal Dialysis International

IS - 5

ER -

Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients

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