Abstract: Objective   To observe the incidence and mortality of adverse cardiovascular events in maintenance hemodialysis (MHD) patients with different aortic calcification index (ACI), and to explore the relationship between ACI and adverse cardiovascular events and mortality in patients during peri-dialysis period.  Method  The MHD patients beginning dialysis at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from July 2014 to June 2018 were recruited. They were divided into high calcification group (ACI≥10%) and low calcification group (0≤ACI <10%) based on the first ACI examination. Long-term survival rate and incidence of adverse cardiovascular and cerebrovascular events were observed in the two groups of patients.  Result  This study enrolled a total of 82 patients, of which 73 cases (89%) had various degrees of aortic calcification, including 38 patients with ACI≥10% in the high calcification group. A total of 37 patients (45.1%) died at the end of follow-up; 15 cases (40.54%) died of infection and 12 cases, 32.43% died of adverse cardiovascular events, being the main causes of death. Multivariate linear regression showed that older age (β=0.214, 95% CI:1.107～1.386, P＜0.001) and history of cardiovascular and cerebrovascular diseases (β=-0.087, 95% CI: 0.203～4.128, P=0.039) were associated with higher ACI. After follow-up for 60 months, the survival rates were 78.2% and 57.3% in low ACI group and high ACI group respectively (OR=0.359, 95% CI:0.186～0.694, P=0.002). Both univariate and multivariate Cox regression analyses showed a significant correlation between high ACI and higher 5-year mortality in dialysis patients (univariate regression, HR=1.024, 95% CI:1.003～1.045, P=0.025; multivariate regression, HR=1.103, 95% CI:0.965～1.201, P=0.039). Multivariate COX analysis also showed that ACI≥10% was the risk factor for adverse cardiovascular and cerebrovascular events (HR=3.935, 95% CI:1.427～10.850, P=0.008) and death (HR=6.242, 95% CI:0.937～41.583, P=0.050) in dialysis patients.  Conclusion  Higher ACI in peri-dialysis period is related to the long-term survival rate and adverse cardiovascular events in MHD patients. The abnormal mineral bone metabolism and vascular calcification should be monitored earlier in CKD patients, and early intervention to these abnormalities may prolong their dialysis survival period.

Key words: Hemodialysis, Aortic calcification, Cardiovascular and cerebrovascular event