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Abstract: TH-PO351

Quantified Vascular Calcification of Vascular Access: Correlation with Coronary Artery Calcium Score and Survival Analysis of Access and Cardiovascular Outcome

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Kim, Hyunsuk, Hallym university, Kidney research institute, Chuncheon, Korea (the Republic of)
  • Lee, Bom, Chuncheon Sacred Heart Hospital, Chuncheon, GangWon-Do, Korea (the Republic of)
  • Jung, Houn, Hallym University Medical Center, Chuncheon-si, Korea (the Republic of)
  • Choi, Gwangho, Hallym Chuncheon Sacred Heart Hospital, Chuncheon, Please Select, Korea (the Republic of)
  • Yoon, Jong-woo, Hallym university, Kidney research institute, Chuncheon, Korea (the Republic of)
Background

Vascular calcification (VC) is the major contributor to mortality and morbidity in end-stage renal disease (ESRD) patients. We investigated whether there is a correlation between Coronary artery calcium score (CACS) and quantified vascular calcification score (VCS) of the arm including vascular access and whether VC increases the incidence of intervention and major adverse cardiac and cerebrovascular events.

Methods

ECG gated, non-contrast arm CT scan including vascular access and the coronary vessel was taken. Later, CACS and VCS were measured by using Aquarius Ver. 4.4.12 simulating the Agatston Method. We examined if the subjects with CACS>400 was higher in the group of VC>500, a cutoff of the highest 40% of VC. Survival analysis according to VCS groups was also performed.

Results

In the total 77 patients, there were 44 males (57.1%), and the mean age was 63.9 years. The median vintage of hemodialysis was 49.4 [31.5, 99.2] months. When dividing the patients into two groups based on VCS 500 (lower VCS vs. higher VCS), there were no differences between the 2 groups in sex, age, ESRD etiology, and type of vascular access. However, the HD vintage was significantly older in higher VC group. Median VC and CACS were higher in the higher VC group (VC, 144[75,264] vs. 1058 [713, 3355]; CACS, 21 [0, 171] vs. 552 [93, 2430], P<0.001), and the ratio of the subjects with CACS>400 was higher (17.4% vs. 61.3% P<0.001). Since interventions can occur multiple times in one patient and each intervention is not independent, the Prentice, Williams and Peterson Total Time survival analysis model was used. Intervention Hazard ratio (HR) of the higher VCS group increased by 3.2 times. Additionally, longer duration of hemodialysis and higher magnesium (>2.5 mg/dL) had the lower HR of intervention. Moreover, in the higher VCS group, the HR of MACCE increased 2.3 times.

Conclusion

We quantified the VC and found for the first time that it is associated with CACS. Considering that CACS is closely related to the cardiovascular outcome, VC may also be suggested as a new biomarker to predict the outcome of ESRD patients. Higher vascular calcification increased the risk of access intervention and MACCE.

Funding

  • Other NIH Support