Progression of aortic arch calcification and all-cause and cardiovascular mortality in chronic hemodialysis patients

Although aortic arch calcification (AoAC) is reported as a predictor for cardiovascular mortality in the general population, it is unknown whether this is also true in hemodialysis (HD) patients in whom vascular calcification and cardiovascular diseases are highly prevalent. The enrolled study subjects were 401 patients (270 men and 131 women) on chronic HD therapy. Calcification of the aortic arch was semiquantitatively estimated with a score (AoACS) on plain chest radiography. Survival curves were estimated by means of the Kaplan-Meier method and evaluated using the log-rank test. AoAC was present in 203 patients (50.6%). During a follow-up period of 4.0 years, there were 72 all-cause deaths, of which 41 were from cardiovascular diseases. Of patients with and without AoAC, 15.2 and 20.7% died, respectively (11.3 and 6.6% of cardiovascular diseases, respectively). Kaplan-Meier analysis showed that cardiovascular mortality was significantly greater in patients with AoAC compared to those without (P = 0.0396, log-rank test). Multivariate Cox proportional hazards analysis found that the presence of AoAC was significantly associated with increased cardiovascular mortality (hazard ratio, 2.556; 95% confidence interval, 1.006-6.490; P < 0.05) after adjustment for age, presence of diabetes, body mass index, diastolic blood pressure, and serum albumin level. The presence of AoAC is significantly associated with cardiovascular mortality in HD patients, suggesting that careful attention should be given to the presence of AoAC in a plain chest radiograph as a prognostic indicator.