Aortic Arch Calcification and Clinical Outcome in Patients with End-Stage Renal Disease

Vascular calcification is very common in end-stage renal disease, especially in hemodialysis patients. Vascular calcification is associated with poor prognosis in hemodialysis patients. The transformation of vascular smooth muscle cells into osteoblast-like cells seems to be a key element in the pathogenesis of vascular calcification. In addition to traditional risk factors including hypertension and dyslipidemia, hemodialysis patients possess a number of non-traditional cardiovascular risk factors, which may be associated with the pathogenesis of vascular calcification, such as duration of dialysis and imbalance of mineral metabolism. The severity of vascular calcification can be assessed with computed tomography (CT), but a simple technique is required as a routine practice. In an attempt to evaluate the extent of vascular calcification, we have proposed a simple non-invasive technique for estimating aortic arch calcification (AoAC) in hemodialysis patients. The present review summarizes the following aspects: (i) a method of estimating AoAC and the correlation between AoAC score estimated by chest X-ray and AoAC volume evaluated by multi-detector CT as a gold standard, (ii) relation of the presence of AoAC to the prevalence of cardiovascular diseases, and (iii) Kaplan-Meier analysis in terms of cardiovascular mortality in patients with AoAC compared to those without AoAC. We suggest that screening patients undergoing dialysis for the presence of AoAC is a cost-effective, efficient way to identify those patients at the highest risk of cardiovascular events and will allow for the treatment strategies to prevent vascular calcification.