The relationship between poor nutritional status and progression of aortic calcification in patients on maintenance hemodialysis

Background: Although aortic calcification has a significant negative impact on prognosis in patients on hemodialysis (HD), risk factors for aortic calcification progression remain unclear. The aim of this study was to investigate the relationship between malnutrition and aortic calcification progression in patients on HD. Methods: Between April 2015 and October 2016, we treated 232 patients on HD. Of those, we retrospectively evaluated data from 184 patients who had had regular blood tests and computed tomography (CT) scans. The abdominal aortic calcification index (ACI) was quantitatively measured by abdominal CT. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). A normalized treatment ratio of functional urea clearance was evaluated by Kt/V. The difference in ACI values between 2015 and 2016 was evaluated as a Delta ACI, and patients were stratified into two groups according to Delta ACI value: high (>= 75th percentile, Delta ACI-high group) and low (< 75th percentile, Delta ACI-low group). Variables such as age, sex, comorbidities, dialysis vintage, serum data, and GNRI were compared between Delta ACI-high and Delta ACI-low patients. Factors independently associated with a higher Delta ACI progression (Delta ACI >= 75th percentile) were determined using multivariate logistic analysis. Results: Median values of ACIs in 2015 and 2016 were 40.8 and 44.6%, respectively. Of 184 patients, 125 (68%) patients experienced ACI progression for 1 year. The median Delta ACI and 75th percentile of Delta ACI were 2.5% and 5.8%, respectively. The number of patients in the Delta ACI-low and Delta ACI-high groups were 128 (70%) and 56 (30%), respectively. There were significant differences in sex, presence of diabetic nephropathy, HD vintage, serum albumin, serum phosphate, C-reactive protein, intact parathyroid hormone, Kt/V, and GNRI. Multivariate logistic regression analysis revealed that independent factors associated with a higher Delta ACI progression were male sex, serum phosphate levels, HD vintage, and GNRI of < 90. Conclusions: Our results suggest that poor nutritional status is an independent risk factor for the progression of aortic calcification. Nutrition management may have the potential to improve progression of aortic calcification in patients on HD.