Assessment of Abdominal Aortic Calcification in Stage 5 CKD Patients on Hemodialysis

Abstract

Background: Vascular calcification is prevalent in patients with chronic kidney disease (CKD) and significantly contributes to cardiovascular morbidity and mortality. Abdominal aortic calcification (AAC) detected by X-ray is less documented in anatomical distribution and severity than coronary calcification. This study aimed to assess the location, severity, and progression of radiopaque lumbar aortic calcifications in CKD stage 5 patients on maintenance hemodialysis. Methods: A cross-sectional study involved 100 maintenance hemodialysis patients aged 18–50 at Sawai Man Singh dialysis centers. Lateral lumbar X-rays focusing on lumbar vertebral segments L1 to L4 were used to determine AAC. Two radiologists independently assessed AAC scores using a validated 24-point scale developed by Kauppila et al. Patient demographics, duration of hemodialysis, comorbidities, laboratory parameters, and medications were recorded. Regression analysis determined associations between AAC and patient characteristics. Results: AAC was present in 80% of patients, with a mean AAC score of 12 ± 6. Higher AAC scores were significantly associated with increased age (p < 0.01), longer duration of hemodialysis (p < 0.05), presence of diabetes mellitus (p < 0.05), and hypertension (p < 0.05). Multivariate regression analysis identified age and duration of hemodialysis as independent predictors of AAC severity. Elevated intact parathyroid hormone (iPTH) levels were also associated with higher AAC scores. Conclusion: Lateral lumbar X-ray–detected AAC is highly prevalent in young CKD stage 5 patients on hemodialysis and correlates with traditional cardiovascular risk factors and markers of mineral metabolism. This simple and cost-effective method may assist in cardiovascular risk stratification and management in this high-risk group.