Chest CT-estimated aortic arch calcification and its prognostic value for cardiovascular and all-cause mortality in maintenance hemodialysis patients

Abstract Background Cardiovascular complications are the leading cause of death in hemodialysis patients, and vascular calcification, particularly aortic arch calcification (AoAC), is an independent predictor of cardiovascular and all-cause mortality. However, chest X-ray, a commonly used method for assessing AoAC may underestimate calcium deposition. This study aimed to evaluate the prognostic value of AoAC assessed by chest computed tomography (CT) for predicting cardiovascular and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A retrospective cohort study was conducted, including 205 hemodialysis patients who underwent chest CT scans between January and December 2019. Patients were followed up until August 31, 2024, with a median follow-up duration of 61 months. AoAC was quantified using a CT-based density-weighted calcification score (AoACS), adapted from the Agatston weighting principle for non-gated, standard-thickness chest CT. Cox proportional hazards models and Kaplan-Meier survival analysis were used for statistical evaluation. Results Higher AoACS was associated with increased mortality risk and significantly reduced cardiovascular and overall survival rates ( p < 0.001). Multivariable analysis revealed that log(AoACS + 1) was independently associated with cardiovascular mortality (HR 1.935, 95%CI 1.148–3.263, p = 0.013) and all-cause mortality (HR 1.641, 95%CI 1.156–2.329, p = 0.006). Diabetes and serum albumin levels were also independent predictors of all-cause mortality. Conclusions Higher CT-derived AoACS was associated with cardiovascular and all-cause mortality after adjustment for the included covariates. Its incremental predictive value and clinical utility require confirmation in larger, externally validated cohorts. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2500098576) on March 11, 2025.