Effects of overhydration, Kt/Vurea, β2‐microglobulin on coronary artery calcification and mortality in haemodialysis patients

Abstract

AbstractAimWe studied the effects of overhydration (OH), Kt/Vurea and β2‐microglobulin (β2‐MG) on coronary artery calcification and mortality in patients undergoing haemodialysis (HD).MethodsThe Agatston coronary artery calcium score (CACS), postdialysis body composition using bioimpedance analysis, single‐pool Kt/Vurea and predialysis β2‐MG at baseline were assessed and followed up for 3 years in patients undergoing HD. We performed logistic regression analyses for a CACS ≥400 and Cox proportional hazard analyses for all‐cause and cardiovascular mortality.ResultsThe study involved 338 patients with a median age of 67 (56–74) years, dialysis duration of 70 (33–141) months and diabetes prevalence of 39.1% (132/338). Patients with a CACS ≥400 (n = 222) had significantly higher age, dialysis duration, male prevalence, diabetes prevalence, C‐reactive protein, predialysis β2‐MG, OH, extracellular water/total body water and overhydration/extracellular water (OH/ECW) but significantly lower Kt/Vurea than patients with a CACS <400 (n = 116) (p < .05). OH/ECW, Kt/Vurea and predialysis β2‐MG were significant predictors of a CACS ≥400 (p < .05) after adjusting for age, dialysis duration, serum phosphate and magnesium. In all patients, cut‐off values of OH/ECW, Kt/Vurea and predialysis β2‐MG for a CACS ≥400 were 16%, 1.74 and 28 mg/L, respectively. After adjusting for dialysis duration, OH/ECW ≥16%, Kt/Vurea ≥1.74 and β2‐MG ≥28 mg/L were significant predictors of 3‐year all‐cause mortality but not 3‐year cardiovascular mortality.ConclusionHigher OH/ECW, higher predialysis β2‐MG and lower Kt/Vurea values are significant risk factors for a CACS ≥400 and 3‐year all‐cause mortality in patients undergoing maintenance HD.image