title: Impact of arterial microcalcification of the vascular access on cardiovascular mortality in hemodialysis patients.
abstract: Gross vascular calcification seen on imaging studies is common in hemodialysis (HD) patients, and is a significant predictor for cardiovascular mortality in HD patients. We have reported that arterial microcalcification (AMiC) of the vascular access is associated with increased aortic stiffness. This study investigated the impact of vascular access AMiC on cardiovascular mortality in HD patients. The study included 149 HD patients (mean age: 59.1 ± 13.9 years, 86 men and 63 women, 65.8% diabetic) who underwent vascular access surgery. Radial or brachial artery specimens were obtained intraoperatively, and pathologic examination was performed using von Kossa stain to identify AMiC. We compared all-cause and cardiovascular mortality between patients with and without AMiC. The mean follow-up was 37.8 ± 34.5 months, and AMiC was present in 38.8% (n = 57) of patients. The presence of diabetes (odds ratio: 16.49, 95% confidence interval: 1.81-150.36, P = 0.013) was the only independent risk factor for vascular access AMiC. During the observational period, there were 27 cardiovascular deaths. Kaplan-Meier analysis showed an increased cardiovascular mortality risk (log rank = 4.83, P = 0.028) in AMiC patients, and Cox regression analysis confirmed that AMiC was an independent predictor for cardiovascular mortality (hazard ratio: 2.35, 95% confidence interval: 1.09-5.09, P = 0.030). In conclusion, vascular access AMiC is a strong risk factor for cardiovascular mortality in HD patients.
authors.affiliation: Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea.
authors.forename: Yu Seon
authors.initials: YS
authors.lastname: Yun
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Choi
authors.forename: Ja Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Sun Ae
authors.initials: SA
authors.lastname: Yoon
authors.forename: Sun Chul
authors.initials: SC
authors.lastname: Park
authors.forename: Ok Ran
authors.initials: OR
authors.lastname: Shin
authors.forename: Eun Joung
authors.initials: EJ
authors.lastname: Jang
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Kim
mesh_terms: D000368:Aged; D001916:Brachial Artery; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D062666:Vascular Access Devices / Q000009:adverse effects*; D061205:Vascular Calcification / Q000209:etiology / Q000401:mortality* / Q000473:pathology
keywords: Hemodialysis; cardiovascular disease; mortality; vascular calcification