title: Vascular calcification estimated by aortic calcification area index is a significant predictive parameter of cardiovascular mortality in hemodialysis patients.
abstract: BACKGROUND
  Vascular calcification is a feature of arteriosclerosis. In hemodialysis (HD) patients, vascular calcification progresses rapidly. This study used the aortic calcification area index (ACAI), an index of vascular calcification, to evaluate vascular calcification factors in HD patients, to investigate correlations between ACAI and long-term prognosis and to assess correlations between various factors and long-term prognosis.
  
  
  METHODS
  Subjects comprised 137 patients on maintenance HD. ACAI was measured as an index of vascular calcification as measured by abdominal plain computed tomography. The patients were divided into a high ACAI (H) group and a low ACAI (L) group according to whether the ACAI was below or above the mean value (21.4%) of ACAI, and long-term all-cause death and cardiovascular death rates were compared between groups. Risk factors for all-cause death and cardiovascular death were examined by Cox hazard analysis.
  
  
  RESULTS
  During follow-up (mean follow-up period 95.3 ± 50.3 months), 76 patients died, including 46 cardiovascular deaths. Deaths included 51 of 70 patients (67.1%) in Group H and 25 of 67 patients (37.3%) in Group L. Cardiovascular death rates were 51.4 and 14.9%, respectively. On Kaplan-Meier analysis, the number of all-cause deaths was significantly higher in Group H (P < 0.001, log-rank test). Similarly, the number of cardiovascular deaths was significantly higher in Group H. Multivariate Cox proportional hazards analysis showed that ACAI (%) was a significant prognostic indicator for cardiovascular death (hazard ratio 1.03; 95% confidence interval 1.00-1.06, P = 0.03).
  
  
  CONCLUSIONS
  High ACAI was clearly correlated with mortality rate in HD patients, particularly cardiovascular mortality rate. ACAI was a useful long-term prognostic indicator in HD patients.
authors.affiliation: Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan. m-ohya@384.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohya
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Otani
authors.forename: Keigo
authors.initials: K
authors.lastname: Kimura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Saika
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Fujii
authors.forename: Susumu
authors.initials: S
authors.lastname: Yukawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Shigematsu
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*