Prevalence of Abdominal Artery Calcification in Patients Undergoing Maintenance Dialysis

Prevalence of abdominal artery calcification in patients undergoing maintenance dialysis: A systematic review and meta-analysis

Zhihui Yao1, 2 ·Wang congxia2·Zhang Qiaona1·Ma Shan1·Gui Baosong1 · Duan Chaoyang1, *

1Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong

University, Xi'an, Shaanxi 710004, China

2Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China

Figure Legends

Table 1. Search Strategy
Table 2. Study quality ratings
Table 3. Characteristics of the 44 included studies
Figure 1. Forest plot for overall prevalence of abdominal artery calcification (AAC) in dialysis patients.
Figure 2: Funnel plot of the 44 studies

Table 1. Search Strategy

Source / Search strategy
Pubmed / 1-Renal Dialysis[Mesh]
2-Dialyses, Renal[Title/Abstract]
3-Hemodialysis[Title/Abstract]
4-Peritoneal Dialysis[Title/Abstract]
5-Dialysis Extracorporeal[Title/Abstract]
6-Chronic Kidney Disease[Title/Abstract]
7-Kidney Function, Chronic Disease[Title/Abstract]
8-ESRD[Title/Abstract]
9-1 or 2 or 3 or 4 or 5 or 6 or 7 or 8
10-Vascular Calcification[Mesh]
11-Calcification, Vascular[Title/Abstract]
12-Blood Vessel Calcification[Title/Abstract]
13-Aortic Calcification[Title/Abstract]
14-Vascular Calcinosis[Title/Abstract]
15-Abdominal Artery Calcification[Title/Abstract]
16-Abdominal Aorta Calcification[Title/Abstract]
17-10 or 11 or 12 or 13 or 14 or 15 or 16
18-Prevalence[Mesh]
19-Incidence[Title/Abstract]
20-Morbidity[Title/Abstract]
21-Epidemiology[Title/Abstract]
22-18 or 19 or 20 or 21
23-9 and 17 and 22

Table 2. Study quality ratings

Author, Year / Q1 / Q2 / Q3 / Q4 / Q5 / Q6 / Q7 / Q8 / Q9 / Q10 / Q11 / Q12 / Q13 / Q14 / Overall
Toussaint40,2009 / Yes / Yes / NR / Yes / No / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Honkanen37 2008 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / good
Wang41, 2009 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Cozzolino15,2006 / Yes / Yes / NR / Yes / No / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Chang44, 2011 / Yes / Yes / NR / Yes / NR / No / Yes / No / Yes / No / Yes / Yes / Yes / Yes / good
Freercks45, 2012 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / No / NA / Yes / fair
Toussaint16, 2010 / Yes / Yes / No / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Fusaro46, 2012 / Yes / Yes / NR / Yes / NR / No / Yes / No / Yes / No / Yes / Yes / Yes / Yes / good
Bellas49, 2013 / Yes / Yes / Yes / Yes / NR / No / Yes / No / Yes / No / Yes / Yes / Yes / Yes / good
Chen50,2013 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Kim27,2013 / Yes / Yes / NR / Yes / No / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Pencak32, 2013 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Martino51, 2013 / Yes / Yes / NR / Yes / NR / No / Yes / No / Yes / No / Yes / Yes / Yes / Yes / good
Al-Saedi13, 2013 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / No / NR / NA / No / poor
Kraus28, 2015 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Biyik1, 2016 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Nam29, 2015 / Yes / Yes / No / Yes / No / No / NA / No / Yes / No / Yes / No / NA / No / poor
Lee55, 2016 / Yes / Yes / NR / Yes / No / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Hong54, 2016 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / No / fair
Wang34, 2015 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Osman31, 2016 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / No / NA / No / poor
Rodriguez-
Garcia39, 2009 / Yes / Yes / No / Yes / NR / No / NR / No / Yes / No / No / NR / NR / No / poor
Amrani52, 2015 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / CD / NR / NA / No / poor
Ishimura35, 2004 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Hong25, 2013 / Yes / Yes / NR / Yes / NR / No / NR / No / Yes / No / Yes / NR / Yes / Yes / fair
Valderrama33,
2012 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / No / NA / No / poor
Tang48, 2012 / Yes / Yes / Yes / Yes / NR / No / NR / No / Yes / No / Yes / Yes / Yes / Yes / good
Jeloka58，2012 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Sirivongs14,2010 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Lumlertgul26,
2015 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Breznik59, 2016 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / No / fair
Gorriz60, 2016 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Liuon61, 2016 / Yes / Yes / Yes / Yes / Yes / No / Yes / No / Yes / No / Yes / Yes / NR / Yes / good
An24, 2013 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Schjldeup42,2009 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / No / poor
Muntner36, 2006 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / No / fair
Adragao43, 2012 / Yes / Yes / Yes / Yes / NR / No / Yes / No / Yes / No / Yes / Yes / Yes / Yes / good
Spiegel56, 2004 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / good
Toussaint38,2008 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Ohya30, 2010 / Yes / Yes / NR / Yes / NR / No / NA / No / Yes / No / Yes / Yes / NA / Yes / fair
Shantha47, 2012 / Yes / Yes / Yes / Yes / No / No / NA / No / Yes / No / Yes / NR / NA / No / fair
Okuno6, 2007 / Yes / Yes / Yes / Yes / NR / No / Yes / No / Yes / No / Yes / Yes / NR / No / good
Fan53, 2015 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / Yes / fair
Chudek57, 2010 / Yes / Yes / Yes / Yes / NR / No / NA / No / Yes / No / Yes / NR / NA / No / fair

Abbreviations: NR, Not reported; NA, Not applicable; CD, Cannot determine

Table 3. Characteristic of the 44 included studies.

Author, Year / Continent / Design /
Dialysis
Modes / Duration of Dialysis (months) / AAC Diagnosis / Age(years), BMI, Male(%) / Co-morbidity(%): Diabetes, Hypertension, Smoking, Obesity
Ishimura35, 2004 / Asia / Cro / Hemo / NR / X-ray / Mean age: 58.8, 80% Male, BMI: NR / DM:24%, HTN:NR, SMK:NR
Spiegel56, 2004 / North America / Cro / Hemo / NR / EBCT / Mean age: 59.0, 62.0% Male, BMI: NR / DM:57%, HTN:96.1%, SMK:NR
Cozzolino15,2006 / Europe / Cro / Hemo / Median (Range): 81 (9-437） / Ultrasonography / Mean age: 63, 58.3% Male, BMI: 24.1 / DM:19.1%, HTN:49.6%, SMK:23.5%
Muntner36, 2006 / North America / Cro / Hemo / Median: 48 / X-ray / Mean age: 55.3, 50.7% Male, BMI: 26.5 / DM:50%, HTN:NR, SMK:17.2 %
Okuno6, 2007 / Asia / Coh / Hemo / > 3 / X-ray / Mean age: NR, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Honkanen37,2008 / Europe / Cro / Hemo & Peri / Median (range): 38.2 (3–363) / X-ray / Median age: 61.4, 60.8% Male, BMI:25.1 / DM:22.9%, HTN:NR, SMK:18.5%
Toussaint38, 2008 / Australia / Cro / Hemo / NR / MSCT / Median age: 64.5, 71% Male, BMI: 31.3 / DM:54%, HTN:95.8%, SMK:60%
Toussaint40, 2009 / Australia / Cro / Hemo / Median (range): 24 (3–204) / MSCT / Mean age: 58, 64% Male, BMI: 26.4 / DM:37.8%, HTN:62.5%, SMK:17.8%
Wang41, 2009 / Asia / Cro / Hemo / Mean (SD): 31.8 (30.9) / X-ray / Mean age: 61.90, 52% Male, BMI: NR / DM:24%, HTN:66%, SMK:NR
Rodriguez-
Garcia39, 2009 / Europe / Coh / Hemo / Mean (SD): 37.2 (43.2) / X-ray / Mean age: 64, 62.7% Male, BMI: NR / DM:23.1%, HTN:NR, SMK:NR
Schjelderup42, 2009 / Europe / Cro / Hemo & Peri / > 3 / X-ray / Mean age: NR, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Toussaint15, 2010 / Australia / Cro / Hemo / Median (Range): 38 (6–230) / X-ray / Median age: 69, 59.7% Male, BMI: NR / DM:36.3%, HTN:NR, SMK:57.0%
Sirivongs13, 2010 / Asia / Cro / Peri / Mean (SD): 22.14 (12.56) / X-ray / Mean age: 52, 51.97% Male, BMI: NR / DM:32.84%, HTN:NR, SMK:NR
Ohya30, 2010 / Asia / Cro / Hemo / > 3 / MSCT / Mean age: NR, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Chudek57, 2010 / Europe / Cro / Hemo / Mean (SD): 36 (46) / MSCT / Median age: 56, 50% Male, BMI: NR / DM:NR, HTN:NR, SMK:NR
Chang44, 2012 / Asia / Coh / Hemo / Median ( Range ): 25 (9-60) / X-ray / Mean age: 56.9, 49.5% Male, BMI: 20.8 / DM:46.4%, HTN:NR, SMK:39.1%
Freercks45, 2012 / Africa / Cro / Hemo & Peri / Median: 32 / X-ray / Mean age: 41.8, 43.2% Male, BMI: 23.9 / DM:13.5%, HTN:NR, SMK:41.9%
Fusaro46, 2012 / Europe / Coh / Hemo / > 12 / X-ray / Mean age: 64.2, 63.0% Male, BMI: 25.1 / DM:22%, HTN:78.6%,SMK:36.8%
Valderrama33, 2012 / South America / Cro / Hemo / Median (Range): 44.6 (3–156） / X-ray / Mean age: 60.8, 57.4% Male, BMI: NR / DM:NR, HTN:NR, SMK:NR
Tang48, 2012 / North America / Coh / Peri / NR / X-ray / Mean age: 58, 67% Male, BMI: 26 / DM48%, HTN:NR, SMK:NR
Jeloka58, 2012 / Asia / Crol / 75% Hemo &
25% Peri / Mean (SD): 22.36 (19.17) / X-ray / Mean age: 50.04, 58.82% Male, BMI: NR / DM:42.64%, HTN:NR, SMK:NR
Adragao43, 2012 / Europe / Coh / Hemo / Mean (SD): 82 (74) / X-ray / Mean age: 65, 60% Male, BMI: 23.9 / DM:20%, HTN:NR, SMK:22%
Shantha47, 2012 / Asia / Cro / Hemo / NR / X-ray / Mean age: 51.18, 77.3% Male, BMI: 21 / DM:40.9%, HTN:NR, SMK:4.5%
Bellas49, 2013 / North America / Coh / Hemo / Median (Range): 31.2 (1.2–435.6） / X-ray / Mean age: 55, 51% Male, BMI: NR / DM:49%, HTN:95%, SMK:None
Chen50, 2013 / Asia / Cro / Hemo / Median (Range): 39.1 (1.0–225.5) / X-ray / Mean age: 55.1, 59.2% Male, BMI:21.71 / DM:25%, HTN:None, SMK:None
Kim27, 2013 / Asia / Cro / 50% Hemo &
50% Peri /
Mean (SD): 51.2 (40.1) / X-ray / Mean age: 56, 70% Male, BMI: 22 / DM:56%, HTN:None, SMK: None
Pencak32, 2013 / Europe / Cro / Hemo / Median (Range): 45 (33–54) / MSCT / Median age: 53.6, 51% Male, BMI: 24.9 / DM:18.3%, HTN:84.5%, SMK:59.6%
Martino51, 2013 / Europe / Coh / Peri / NR / X-ray / Age:NR, 45% Male, BMI: NR / DM:17.6%, HTN:51%, SMK:22%
Hong25, 2013 / Asia / Coh / Hemo / Mean (SD): 46 (41） / X-ray / Mean age: 60, 49.8% Male, BMI: NR / DM:27.6%, HTN:88%, SMK:NR
An24, 2013 / Asia / Coh / 61% Hemo &
39% Peri / Mean (SD): 41.3 (34.5) / X-ray / Mean age: 56.3, 33% Male, BMI: NR / DM:49.3%, HTN:NR, SMK:NR
Al-Saedi13, 2014 / Asia / Cro / Hemo / NR / X-ray / Mean age: 50.9, 27.8% Male, BMI: NR / DM:None, HTN:87%, SMK:None
Kraus28, 2015 / North America / Cro / Hemo / Mean (SD): 54 (51.6) / X-ray / Mean age: 56, 63.3% Male, BMI: NR / DM:27.2%, HTN:83.2%, SMK:9.5%
Nam29, 2015 / Asia / Cro / 56% Hemo &
44% Peri / NR / X-ray / Mean age: 62.1, 52.7% Male, BMI: 23.7 / DM:70.9%, HTN:56.4%, SMK:NR
Wang34, 2015 / Asia / Cro / Hemo / Mean (SD): 66.6 (49.5) / X-ray / Mean age: 53.3, 50.5% Male, BMI: NR / DM:29%, HTN:NR, SMK:NR
Amrani52, 2015 / Africa / Cro / Hemo / NR / X-ray / Mean age: 61.4, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Lumlertgul26, 2015 / Asia / Cro / 63% Hemo &
37% Peri / NR / X-ray / Mean age: 54.7, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Fan53, 2015 / Asia / Cro / Peri / NR / X-ray / Mean age: NR, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Biyik1, 2016 / Europe / Cro / Hemo / NR / X-ray / Mean age: 54.7, 53.3% Male, BMI: 26.1 / DM:32.4%, HTN:NR, SMK:46.7%
Lee55, 2016 / Asia / Cro / Hemo / Mean (SD): 103.2 (69.6) / X-ray / Mean age: 63.0, 45% Male, BMI: 23.1 / DM:34%, HTN:71%, SMK:NR
Hong54, 2016 / Asia / Cro / Hemo / Mean (SD): 67 (49) / X-ray / Mean age: 54, 51% Male, BMI: NR / DM:18%, HTN:NR, SMK:NR
Osman31, 2016 / Africa / Cro / Hemo / Mean (SD): 77 (60) / X-ray / Mean age: 40.1, 46% Male, BMI: 24 / DM:31%, HTN:NR, SMK:7%
Breznik59, 2016 / Europe / Cro / Hemo / Median (Range): 52.3 (1-208） / X-ray / Mean age: 61.8, 58.8% Male, BMI: NR / DM:NR, HTN:NR, SMK:NR
Gorriz62, 2016 / Europe / Cro / 84.5% Hemo &
15.5% Peri / NR / X-ray / Mean age: NR, Male: NR, BMI: NR / DM:NR, HTN:NR, SMK:NR
Liuon61, 2016 / Asia / Coh / Hemo & Peri / Median: 52 / X-ray / Mean age: 49, 55 Male, BMI: NR / DM:NR, HTN:NR, SMK:NR

Abbreviations:Cro, cross-sectional; Coh, cohort; Hemo, hemodialysis;Peri, peritoneal dialysis;NR, not reported; EBCT, Electron Beam Computed Tomography; MSCT,Multi-slice Computed Tomography; DM: diabetes; HTN: hypertension; SMK: smoking; OB: obesity

Figure 1. Forest plot for overall prevalence of abdominal artery

calcification (AAC) in dialysis patients

Figure 2: Funnel plot of the 44 studies