PREDICTIVE VALUE OF MEASURES OF VASCULAR CALCIFICATION FOR RISK OF DEATH IN INCIDENT DIALYSIS PATIENTS

INTRODUCTION AND AIMS: 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 calcification adds to the predictive value of traditional Framingham risk stratification, 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 calcification determined at baseline; coronary artery calcification (CAC) by volume or Agatston score, and abdominal aorta calcification 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 (table 1). 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.