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NDT Advance Access originally published online on October 18, 2006
Nephrology Dialysis Transplantation 2007 22(2):508-514; doi:10.1093/ndt/gfl609
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients

Paul Muntner1,2, Emiliana Ferramosca3, Antonio Bellasi4, Geoffrey A. Block5 and Paolo Raggi6

1Department of Epidemiology, 2Department of Medicine, Tulane University, New Orleans, LA, USA, 3Department of Nephrology, Ospedale Malpighi and University of Bologna, Bologna, 4Ospedale San Paolo and University of Milan, Milan, Italy, 5Denver Nephrology, PC, Denver, CO, and 6Division of Cardiology, Emory University, Atlanta, GA, USA

Correspondence and offprint requests to: Paul Muntner, PhD, 1140 Canal Street, Suite 2032, New Orleans, LA 70112, USA. Email: pmuntner{at}tulane.edu



  Abstract

Background. Coronary artery calcification (CAC) is highly prevalent in haemodialysis patients and is associated with cardiovascular outcomes. Though cardiac computed tomography (CCT) is accurate, it is not widely available.

Methods. We developed a cardiovascular calcification index (CCI) to predict the presence of CAC for haemodialysis patients using simple in-office techniques. Prevalent haemodialysis patients (n = 140) underwent CCT imaging for CAC, a lateral abdominal X-ray for calcification of the abdominal aorta, an echocardiogram for valvular calcification, and pulse pressure measurement. A CCI was derived by weighting the prevalence rate ratios of CAC ≥1000. Using bootstrap techniques, validation was performed using receiver operator characteristic curves and likelihood ratios.

Results. Points were assigned for patients’ age (60–69 and ≥70 years, 1 and 2 points, respectively), dialysis vintage ≥2 years (1 point), aortic and mitral valve calcification (3 and 1 points, respectively), and abdominal aorta X-ray scores of 1–6 and ≥7 (2 and 4 points, respectively). Race, sex and pulse pressure did not contribute to the CCI. The CCI ranged from 0 to 11 points. The likelihood ratio of CAC ≥1000 associated with CCI scores of 2–4, 5, 6–8 and 9–11 were 1.28, 2.03, 2.94 and 3.83, respectively. Given the prevalence of CAC ≥1000 of 21% in the current study, the probability of having CAC ≥1000 was 26%, 38%, 43% and 50% for participants with CCI scores of 2–4, 5, 6–8, and ≥9, respectively.

Conclusions. Although refinement is needed, the CCI developed in the current study provides an alternative for predicting CAC when CCT is not available.

Keywords: abdominal aorta calcification; arterial stiffness; cardiovascular calcification; haemodialysis; imaging; valvular calcification


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