Background. Vascular calcification is common and associated with unfavorable outcomes among patients with end-stage renal disease (ESRD). Nevertheless, little is known whether the progression of vascular calcification outweighs the baseline calcification in association with overall and cardiovascular (CV) mortality in hemodialysis (HD) patients. Methods. This study included 140 maintenance HD patients. Vascular calcification was assessed using the aortic arch calcification (AoAC) score measured from chest radiographs at the baseline and the second year of follow-up. Progression of vascular calcification (ΔAoAC) was defined as the difference between the two measurements of AoAC. The association of ΔAoAC with overall and CV mortality was evaluated using multivariate Cox regression analysis. Results. During the mean follow-up period of 5.8 years, there were 49 (35%) overall mortality and 27 (19.3%) CV mortality. High brachial-ankle pulse wave velocity was positively correlated with ΔAoAC, whereas old age was negatively correlated with ΔAoAC. In multivariate adjusted Cox analysis, increased ΔAoAC (per 1 unit), but not baseline AoAC, was significantly associated with overall mortality (HR, 1.183; 95% CI, 1.056–1.327; ) and CV mortality (HR, 1.194; 95% CI, 1.019–1.398; ). Conclusion. Progression of AoAC outperformed the baseline AoAC in association with increased risk of overall and CV mortality in HD patients. A regular follow-up of chest radiograph and AoAC score assessments are simple and cost-effective to identify the high-risk individuals of unfavorable outcomes in maintenance HD patients.

中文翻译：

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主动脉弓钙化的进展与血液透析中的总体死亡率和心血管死亡率有关。

背景。血管钙化很常见，并且与终末期肾病（ESRD）患者的不良结局相关。然而，鲜为人知的是，血管钙化的进展是否超过了与血液透析 (HD) 患者的总体死亡率和心血管 (CV) 死亡率相关的基线钙化。方法。这项研究包括 140 名维持性 HD 患者。使用从基线和随访第二年的胸片测量的主动脉弓钙化 (AoAC) 评分评估血管钙化。血管钙化的进展 ( ΔAoAC ) 定义为 AoAC 的两次测量值之间的差异。Δ的关联使用多变量 Cox 回归分析评估 AoAC 与总体死亡率和 CV 死亡率。结果。在 5.8 年的平均随访期内，有 49 例（35%）总死亡率和 27 例（19.3%）CV 死亡率。高臂踝脉搏波速度与ΔAoAC呈正相关，而老年与ΔAoAC呈负相关。在多变量调整的 Cox 分析中，增加的ΔAoAC（每 1 个单位），但不是基线 AoAC，与总体死亡率显着相关（HR，1.183；95% CI，1.056–1.327；)和 CV 死亡率 (HR, 1.194; 95% CI, 1.019–1.398;）。 结论。AoAC 的进展优于基线 AoAC，这与 HD 患者的总体和 CV 死亡率风险增加有关。定期随访胸片和 AoAC 评分评估是简单且具有成本效益的，可识别维持性 HD 患者预后不良的高风险个体。