title: Progression of aortic arch calcification over 1 year is an independent predictor of mortality in incident peritoneal dialysis patients.
abstract: OBJECTIVE
  The presence and progression of vascular calcification have been demonstrated as important risk factors for mortality in dialysis patients. However, since the majority of subjects included in most previous studies were hemodialysis patients, limited information was available in peritoneal dialysis (PD) patients. Therefore, the aim of this study was to investigate the prevalence of aortic arch calcification (AoAC) and prognostic value of AoAC progression in PD patients.
  
  
  METHODS
  We prospectively determined AoAC by chest X-ray at PD start and after 12 months, and evaluated the impact of AoAC progression on mortality in 415 incident PD patients.
  
  
  RESULTS
  Of 415 patients, 169 patients (40.7%) had AoAC at baseline with a mean of 18.1±11.2%. The presence of baseline AoAC was an independent predictor of all-cause [Hazard ratio (HR): 2.181, 95% confidence interval (CI): 1.336-3.561, P = 0.002] and cardiovascular mortality (HR: 3.582, 95% CI: 1.577-8.132, P = 0.002). Among 363 patients with follow-up chest X-rays at 12 months after PD start, the proportion of patients with AoAC progression was significantly higher in patients with baseline AoAC (64.2 vs. 5.3%, P<0.001). Moreover, all-cause and cardiovascular death rates were significantly higher in the progression groups than in the non-progression group (P<0.001). Multivariate Cox analysis revealed that AoAC progression was an independent predictor for all-cause (HR: 2.625, 95% CI: 1.150-5.991, P = 0.022) and cardiovascular mortality (HR: 4.008, 95% CI: 1.079-14.890, P = 0.038) in patients with AoAC at baseline.
  
  
  CONCLUSIONS
  The presence and progression of AoAC assessed by chest X-ray were independently associated with unfavorable outcomes in incident PD patients. Regular follow-up by chest X-ray could be a simple and useful method to stratify mortality risk in these patients.
authors.affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Seung Jun
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Yoo
authors.forename: Kwang Il
authors.initials: KI
authors.lastname: Ko
authors.forename: Hyang Mo
authors.initials: HM
authors.lastname: Koo
authors.forename: Chan Ho
authors.initials: CH
authors.lastname: Kim
authors.forename: Fa Mee
authors.initials: FM
authors.lastname: Doh
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011859:Radiography; D012307:Risk Factors; D013997:Time Factors