Predictive Value of Measures of Vascular Calcification for Risk of Death in Incident Dialysis Patients

Background: Vascular calcifications (VC) are a useful marker of cardiovascular disease and several methods are available for presence and extension assessment. However, which one of these measures best predicts long-term survival and whether a measure of vascular calcifi cation adds to the predictive value of traditional Framingham risk stratifi cation, has not been determined through a concurrent comparison of these measures in a single prospective cohort. Methods: To addresses these questions, we examined survival amongst 184 patients followed in the independent study for up to 36 months who had three measures for vascular calcifi cation determined at baseline; coronary artery calcifi cation (CAC) by volume or Agatston score, and abdominal aorta calcifi cation by X-ray (Kauppila score-KS). Regression models, ROC were used. Results: for each VC assessment separately, the most parsimonious model to predict all-cause mortality was selected starting from a model adjusted for VC measure (CAC or KS), Pulse Wave Velocity, age, Framingham score, diabetes, ASCVD, systolic blood pressure, serum levels of phosphate, calcium, PTH, use of ARBs, beta-blockers, vitamin D, calcium containing phosphate binder, calcium channel blockers and cinacalcet. The predictive value of the model with and without the measurement of VC was calculated. Conclusions: Overall, it seems that CAC is a better predictor of outcome than abdominal aorta VC though the difference is minimal. Of interest, in each model VC is more important than the Framingham risk score in predicting all-cause mortality.