SP476THE BASCH STUDY (BELGRADE AACHEN STUDY ON CALCIFICATION IN HEMODIALYSIS PATIENTS): TEN YEAR SURVIVAL DATA

Abstract

Introduction and Aims: BASCH study (Belgrade Aachen Study on Calcifications in Hemodialysis patients) was established in 2003. with aim to confirm the prevalence and risk factors of vascular calcifications in hemodialysis patients. The aim of this study was to analyze the 10-year survival and RF for survival in cohort of patients previously included in BASCH study. Methods: The study included 220 patients from Zvezdara University Medical Center, Belgrade, that were followed for period from 2003-2014. Vascular calcifications (VC) were expressed as a composite calcification score (Adragao score + calcifications detected by X-ray of the fistula arm, echocardiography of heart valves, and carotid ultrasound, total score up to 15). Comorbidity, pulse wave velocity and set of demographic and biochemical biomarkers, including promoters and inhibitors of VC were also analyzed. Results: During 10-year follow-up period, 143 (65%) patients died and among them 100 (45.5%) died from cardiovascular reasons. In regard to survived ones, patients who died were older (65±15 vs. 55±14 years, p=0.000) and they had significantly higher composite calcification score (5±7 vs. 3±5, p=0.000), PWV value (10±2.9 vs.8.8 vs. 2.7 m/s, p=0.001), CRP value (4±10 vs. 3±7 mg/L, p=0.011) and significantly lower level of serum fetuin-A (0.51±0.15 vs. 0.57±0.18 g/L, p=0.001), Kt/V (1.24±0.17 vs. 1.3±0.25, p=0.008) and dialysis hours per week (12±1.3 vs. 12.5±1.3 h, p=0.007). By ROC analysis we confirm the cut-off points for total calcification score of 4 (OR=3.228 CI=1.852-5.628, p=0.000; RR=1.91 CI=1.4-2.61) with sensitivity of 69.2% and specificity of 60%. Kaplan-Meier analysis confirmed that patients with calcification score >4 had significantly lower survival (66 vs. 95 months, log rank p=0.000). Cox regression model revealed the predictors for cardiovascular mortality: age (HR 22.61 CI 8.012-63.821, p= 0.000), family data about CVD (HR 8.289 CI 1.929-35.622, p= 0.04), hepatitis C+ (HR 3.397 CI 1.219-9.465, p=0.019), composite calcification score (HR2.279 CI=1.490-3.484, p=0.000), PWV (HR 1.490 CI 1.217-1.824, p=0.000), triglycerides (HR 1.379 CI 1.063-1.787, p=0.015) and BMI (HR 1.178 CI 1.029-1.356, p= 0.018). Conclusions: Composite score of vascular calcifications, along with high promoter/ low inhibitor levels is a high predictor of cardiovascular mortality in HD patients and predicts 10-year cardiovascular survival.