An Echocardiography-derived Calcium Score as a Predictor of Major Adverse Cardiovascular Events in Peritoneal Dialysis Patients - A Prospective Cohort Study.

Abstract

BACKGROUND\nAn echocardiography-derived calcium score (ECS) has been shown to predict CV mortality in the general population but has not been utilized in the dialysis population.\n\n\nMETHODS\nWe conducted a prospective cohort study including 125 prevalent PD patients. Two blinded and independent echocardiographers determined the ECS for each subject at baseline. The primary outcome was the three-point major adverse cardiovascular events (MACE) which is a composite outcome comprising CV Death, non-fatal myocardial infarction and non-fatal stroke. The secondary outcome was all-cause mortality.\n\n\nRESULTS\nThe mean age was 61\u2009±\u200913\u2009years. The median follow-up duration was 40\u2009months (range 1-50). Diabetes mellitus (DM) occurred in 76 (60.8%) of the subjects. The median duration of dialysis was 32 (IQR 16-54) months. The incidences of MACE and all-cause mortality were 13.0 per 100 patient-years and 18.3 per 100 patient-years. Multivariate Cox regression analysis identified the following 3 independent predictors of MACE: ECS (HR 1.253 / unit increase in ECS, 95% CI 1.014-1.547, p\xa0=\xa00.036), DM (HR 2.467, 95% CI 1.014-6.005, p\xa0=\xa00.047) and pre-existing CVD (HR 2.441, 95% CI 1.261-4.728, p\xa0=\xa00.008); and the following 2 predictors of all-cause mortality: pre-existing CVD (HR 2.156, 95% CI 1.251-3.714, p\xa0=\xa00.006) and serum albumin (HR 0.887 / g/L increase in serum albumin, 95% CI 0.839-0.937, p\u2009<\u20090.001).\n\n\nCONCLUSION\nThe ECS appears to be a significant predictor of MACE in PD patients independently of DM and pre-existing CVD. This article is protected by copyright. All rights reserved.