title: Abdominal aortic calcification in patients with CKD.
abstract: BACKGROUND
  Abdominal aortic calcification (AAC) is independently associated with cardiovascular events in dialysis patients and in the general population. However, data in non-dialysis chronic kidney disease (CKD) patients are limited. We analyzed determinants and prognostic value of AAC in non-dialysis CKD patients.
  
  
  METHODS
  We included patients with CKD not receiving renal replacement therapy from the MASTERPLAN study, a randomized controlled trial that started in 2004. In the period 2008-2009, an X-ray to evaluate AAC was performed in a subgroup of patients. We studied AAC using a semi-quantitative scoring system by lateral lumbar X-ray. We used baseline and 2-year data to find determinants of AAC. We used a composite cardiovascular endpoint and propensity score matching to evaluate the prognostic value of AAC.
  
  
  RESULTS
  In 280 patients an X-ray was performed. In 79 patients (28 %) the X-ray showed no calcification, in 62 patients (22 %) calcification was minor (<4), while 139 patients (50 %) had moderate or heavy calcification (≥4). Older age, prior cardiovascular disease, higher triglyceride levels, and higher phosphate levels were independent determinants of a calcification score ≥4. AAC score ≥4 was independently associated with cardiovascular events, with a hazard ratio of 5.5 (95 % confidence interval 1.2-24.8).
  
  
  CONCLUSIONS
  Assessment of AAC can identify CKD patients at higher cardiovascular risk, and may provide important information for personalized treatment. Whether this approach will ultimately translate into better outcomes remains to be answered.
authors.affiliation: 464 Department of Nephrology, Radboud University Medical Center, PO box 9101, 6500 HB, Nijmegen, The Netherlands. Mieke.Peeters@radboudumc.nl.
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: Peeters
authors.affiliation: 464 Department of Nephrology, Radboud University Medical Center, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Jan Ajg
authors.initials: JA
authors.lastname: van den Brand
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arjan D
authors.initials: AD
authors.lastname: van Zuilen
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yelka
authors.initials: Y
authors.lastname: Koster
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Vervloet
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: 464 Department of Nephrology, Radboud University Medical Center, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Jack Fm
authors.initials: JF
authors.lastname: Wetzels
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: Abdominal aortic calcification; Cardiovascular risk; Chronic kidney disease; Prognosis