title: Aortic arch calcification predicts cardiovascular and all-cause mortality in maintenance hemodialysis patients.
abstract: OBJECTIVE
  Vascular calcification is associated with cardiovascular risk in maintenance hemodialysis (MHD) patients. Previous reports have shown that simple assessment of aortic arch calcification (AoAC) using plain radiography is associated with cardiovascular mortality in the general population. We conducted a prospective study to investigate factors associated with the presence at baseline and progression of AoAC in MHD patients and examined its prognostic value in a short-term outcome.
  
  
  METHODS
  We prospectively evaluated chest X-rays in 301 asymptomatic MHD patients. The extent of AoAC was divided into three Grades (0, 1, 2+3). Demographic data including age, gender, dialysis vintage, co-morbidity and biochemical data were assessed and the patients were then followed for 3 years.
  
  
  RESULTS
  AoAC was observed in 126 patients (41.9%) as Grade 0, in 112 patients (37.2%) as Grade 1, and in 63 patients (20.9%) as Grade 2 and 3 at baseline. An increase in the severity of calcification was associated with older male patients who had lower serum albumin levels. During the follow-up period of 3 years, multivariate Cox proportional hazards analysis revealed that high-grade calcification was associated with cardiovascular and all-cause mortality. Patients with AoAC were associated with a worse outcome in survival analysis and the grade of AAC also influenced their survival. Moreover, all-cause death rates were significantly higher in the progression groups than in the non-progression groups.
  
  
  CONCLUSIONS
  The presence and progression of AoAC assessed by chest X-ray were independently associated with mortality in MHD patients. Regular follow-up by chest X-ray could be a simple and useful method to stratify mortality risk in MHD patients.
authors.affiliation: Department of Nephrology, Jyoban Hospital, Iwaki-city, Fukushima, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Komatsu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Okazaki
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D002114:Calcinosis / Q000401:mortality* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome