Vol.:(0123456789) 1 3 International Urology and Nephrology https://doi.org/10.1007/s11255-017-1758-9 NEPHROLOGY - ORIGINAL PAPER Abdominal aorta and pelvic artery calcifcations on plain radiographs may predict mortality in chronic kidney disease, hemodialysis and renal transplantation Sinee Disthabanchong 1,2  · Kotcharat Vipattawat 1  · Bunyong Phakdeekitcharoen 1,2  · Chagriya Kitiyakara 1,2  · Vasant Sumethkul 1,2 Received: 14 October 2017 / Accepted: 20 November 2017 © Springer Science+Business Media B.V., part of Springer Nature 2017 Abstract Purpose Vascular calcifcation is common in chronic kidney disease (CKD) and predicts poor patient outcomes. While computed tomography is the gold standard for evaluation of vascular calcifcation, plain radiograph ofers a simpler and less costly alternative. The calcifcation of abdominal aorta, iliac and femoral arteries has been evaluated by plain radiograph, but the data on their outcome predictabilities are still limited. The present study investigated the role of abdominal aortic calcifcation (AAC) and pelvic arterial calcifcation (PAC) in predicting overall morality in non-dialysis CKD stages 2–5 (CKD 2–5), maintenance hemodialysis (HD) and long-term kidney transplant (KT) patients. Methods Four hundred and nineteen patients were included. Lateral abdominal and pelvic radiographs were obtained. The degree of AAC and PAC was evaluated according to the methods described previously by Kaupplia et al. and Adragao et al. Patients were followed prospectively for 5 years. Results AAC and PAC scores correlated well with the correlation coefcients of 0.442 for CKD 2–5, 0.438 for HD and 0.586 for KT (p < 0.001). Patients with AAC score > 6 or PAC score > 1 were older, showed higher prevalence of DM and had higher serum phosphate and PTH but lower serum albumin and eGFR. A more severe degree of AAC was associated with an increase in KT duration, whereas a more severe degree of PAC was associated with worsening kidney function and prolonged dialysis vintage. Kaplan–Meier survival curves revealed AAC score > 6 as a signifcant predictor of all-cause mortality in CKD 2–5 but not in HD or KT, whereas PAC score > 1 was a signifcant predictor of all-cause mortality in all three populations. After adjusting for age, the predictability of AAC was lost, whereas PAC remained an independent predic- tor of mortality in all three populations. Adjustments for cardiovascular and CKD risk factors including age, gender, BMI, DM, serum albumin, calcium and phosphate attenuated the predictability of PAC in HD but not in CKD 2–5 or KT patients. Conclusion PAC was better than AAC in predicting mortality in CKD, HD and KT patients. Keywords Medial · Intimal · Coronary · ESRD · Renal · Transplantation Introduction In chronic kidney disease (CKD) patients, vascular calcif- cation (VC) is more common than the general population, occurs earlier in life and predicts poor patient outcomes [1–3]. VC can be diferentiated into two types according the area within the arterial wall. Calcifcation within the intima is frequently observed in large arteries in association with atherosclerosis and lumen obliteration. Calcifcation within the media occurs predominantly in medium-sized and small-sized muscular arteries and is characterized by arte- rial media thickening and poor arterial compliance without lumen obliteration [4, 5]. Risk factors associated with VC * Sinee Disthabanchong sinee.dis@mahidol.ac.th; sineemd@hotmail.com 1 Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, 7th foor, Building 1, Phayathai, Bangkok 10400, Thailand 2 Ramathibodi Organ Transplant Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand