title: Is Kauppila method able to detect the progression of vascular calcification and predict cardiovascular events in patients undergoing hemodialysis?
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the main cause of death in hemodialysis (HD) patients. Vascular calcification (VC) is common in these patients. The main objective of this study was to evaluate if a semiquantitative radiographic method is able to detect VC progression in a prospective cohort of patients and predict the risk of cardiovascular events. Secondarily, we intend to identify predictors of the presence and progression of VC.
  
  
  METHODS
  49 patients undergoing HD for ≥ 90 days were included. At the beginning and after 12 months, the VC score (VCS) was determined by the Kauppila method, and clinical, nutritional, and laboratory markers were measured. The rates of fatal and nonfatal cardiovascular events were analyzed from months 13 to 24.
  
  
  RESULTS
  Of 49 patients, 55.1% were male, 46.9% diabetic, and the mean age was 59.5 ± 14.4 years. At the beginning of the follow-up, 65.3% of the patients exhibited VC with a median VCS of 4 points. The intracellular water was negatively associated with VC and its intensity. The presence of VC was the only independent predictor of VC progression. Among patients with VC, 17 showed rapid progression, and 15 showed slow progression. The VCS was independently associated with rapid progression, while ΔCS (final VCS - initial VCS) was an independent predictor of cardiovascular events.
  
  
  CONCLUSIONS
  The Kauppila method was able to detect VC, its progression, and predict cardiovascular events. These results suggest an association of VC with nutritional status.
authors.affiliation: Department of Internal Medicine, and Division of Radiology, Botucatu Medical School; Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil.
authors.forename: Francieli C Delatim
authors.initials: FC
authors.lastname: Vannini
authors.forename: Altamir Santos
authors.initials: AS
authors.lastname: Teixeira
authors.forename: Jacqueline C T
authors.initials: JC
authors.lastname: Caramori
authors.forename: Luis Cuadrado
authors.initials: LC
authors.lastname: Martin
authors.forename: Pasqual
authors.initials: P
authors.lastname: Barretti
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001774:Blood Chemical Analysis / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D048909:Diabetes Complications; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009752:Nutritional Status; D011446:Prospective Studies; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*