A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients

Background. Cardiovascular morbidity and mortality are highly prevalent in haemodialysis (HD) patients and have been recently associated with vascular calcifications. The objective of our study was to assess the value of a simple vascular calcification score for the prediction of cardiovascular death, cardiovascular hospitalizations and fatal and non-fatal cardiovascular events in HD patients, and to correlate this score with cardiovascular disease and with other known predictors of vascular disease. Methods. In this observational, prospective study 123 chronic HD patients (75 males and 48 females; 20% diabetic) were included, who were on low-flux HD treatment for 46.6 +/- 52 months (mean +/- SD). We set up a simple vascular calcification score based on plain radiographic films of pelvis and hands. Brachial pulse pressure and mean arterial pressure (MAP) were measured and cardiovascular events and hospitalization episodes were assessed. Results. During an observational period of 37 months there were 17 cardiovascular deaths; 28 patients needed cardiovascular hospitalizations and 32 patients suffered fatal and non-fatal cardiovascular events. Coronary artery disease was diagnosed in 43 patients (35%), peripheral arterial disease in 33 patients (26.8%), cerebrovascular disease in 16 patients (13%) and vascular disease (coronary artery disease or peripheral arterial disease or cerebral vascular disease) in 61 patients (49.6%). By binary logistic regression, diabetes (P=0.01), male sex (P<0.001), age (P=0.02), HD duration (P=0.02) and MAP (P=0.03) were independently associated with a vascular score >3. This score >3 was independently associated with coronary artery disease (P=0.008), peripheral arterial disease (P<0.001) and vascular disease (P=0.001). Patients with a vascular calcification score >3 had a 3.9-fold higher risk of cardiovascular mortality (P=0.03), a 2.8-fold higher risk of cardiovascular hospitalizations (P=0.02) and a 2.3-fold higher risk of fatal or non-fatal cardiovascular events (P=0.04). Conclusions. The present vascular calcification scoring represents a simple tool for the assessment of cardiovascular risk related with vascular calcifications in chronic HD patients.