Role of aortic calcification, stiffness and wave reflections in cardiovascular risk in dialysis patients: Baseline data from the CORD study

BackgroundAccurate cardiovascular risk estimation in dialysis patients remains challenging because different pathogenetic mechanisms act simultaneously in this heterogeneous population. Radiographic calcification, aortic stiffness and wave reflection, have each individually been proven to be reliable surrogate markers for outcome. We aimed to explore to what extent these parameters intermutually provide complementary or overlapping information.MethodsAbdominal aortic calcification scoring of a plain lateral abdominal X-ray, carotid-femoral pulse wave velocity (PWV), and central augmentation index (AIx) were measured in 1084 dialysis patients, recruited from 47 European dialysis centers.ResultsAbdominal calcification correlated well with PWV (R = 0.44, P < 0.001) but poorly with AIx (R = 0.07, P = 0.04). Next to abdominal calcification, tertiles of PWV were associated with a stepwise increase age, blood pressure, and cardiovascular history, and tertiles of AIx with age, heart rate, and anthropometric factors. In multivariate analysis, only PWV remained significantly associated with calcification score. In addition to age and blood pressure, stiffness was mainly related to diabetes and calcification score (R2 = 0.39, P < 0.001), whereas AIx was more dependent on anthropometry, gender and heart rate (R2 = 0.36, P < 0.001).ConclusionsInformation on aortic calcification and arterial abnormalities can be obtained by simple and inexpensive methodologies. Variation in wave reflections was mainly explained by anthropometric parameters. Stiffness and calcification partly provided complementary information, particularly in low-risk patients. In this group, likely to benefit most from preventive strategies and commonly considered for renal transplantation, evaluation of cardiovascular risk could be made more accurate by the assessment of both aortic calcification and arterial stiffness.