Lateral lumbar X-ray assessment of abdominal aortic calcification in Australian haemodialysis patients.
OBJECTIVE
Vascular calcification is prevalent in patients with chronic kidney disease. Abdominal aortic calcification (AAC) can be detected by X-ray, although AAC is less well documented in anatomical distribution and severity compared with coronary calcification. Using simple radiological imaging we aimed to assess AAC and determine associations in prevalent Australian haemodialysis (HD) patients.


METHODS
Lateral lumbar X-ray of the abdominal aorta was used to determine AAC, which is related to the severity of calcific deposits at lumbar vertebral segments L1 to L4. Two radiologists determined AAC scores, by semi-quantitative measurement using a validated 24-point scale, on HD patients from seven satellite dialysis centres. Regression analysis was used to determine associations between AAC and patient characteristics.


RESULTS
Lateral lumbar X-ray was obtained in 132 patients. Median age of patients was 69 years (range 29-90), 60% were male, 36% diabetic, median duration of HD 38 months (range 6-230). Calcification (AAC score ≥ 1) was present in 94.4% with mean AAC score 11.0 ± 6.4 (median 12). Independent predictors for the presence and severity of calcification were age (P = 0.03), duration of dialysis (P = 0.04) and a history of cardiovascular disease (P = 0.009). There was no significant association between AAC and the presence of diabetes or time-averaged serum markers of mineral metabolism, lipid status and C-reactive protein.


CONCLUSIONS
AAC detected by lateral lumbar X-ray is highly prevalent in our cohort of Australian HD patients and is associated with cardiovascular disease, increasing age and duration of HD. This semi-quantitative method of determining vascular calcification is widely available and inexpensive and may assist cardiovascular risk stratification.
Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia. nigel.toussaint@monash.edu
Nigel D
ND
Toussaint
Eugenie
E
Pedagogos
Kenneth K
KK
Lau
Stefan
S
Heinze
Gavin J
GJ
Becker
Jennifer
J
Beavis
Kevan R
KR
Polkinghorne
Matthew J
MJ
Damasiewicz
Peter G
PG
Kerr
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002908:Chronic Disease; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D016013:Likelihood Functions; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011859:Radiography; D006435:Renal Dialysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014739:Victoria; D055815:Young Adult