In e na ional Jou nal o Medical Science and Clinical Resea ch S udies
ISSN(p in ): 2767-8326, ISSN(online): 2767-8342
Volume 05 Issue 11 No embe 2025
Page No: 1797-1813
DOI: h ps://doi.o g/10.47191/ijmsc s/ 5-i11-01, Impac Fac o : 8.188
1797 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h
Main enance Haemodialysis in 2 Selec ed Public Hospi als om Myanma
Khin Phyu Pya 1, Aung Kyaw Myin 2, Moe Zaw Myin 3, Win Kyaw Shwe4, Za Ni H e Aung5, Ye H ook Maung4,
Soe Win Hlaing5, Soe Min Aung5, Nyan LinMaung5, Chan Nyein La 6, Myo Min Than 7, Sein Kyaw8, Tin Moe
Mya9, Wai Lynn Aung6, Tin Aye Win9, Ohma Hlaing10
1P o esso and Senio Consul an Physician, Fo me Head o Depa men o Medicine/ Depa men o Neph ology, De ence Se ices
Medical Academy, No. (1) De ence Se ices Gene al Hospi al (1000-Bedded), Yangon, Myanma
2Consul an Pa hologis , No. (2) De ence Se ices Gene al Hospi al (1000-Bedded), Nay Pyi Taw
3Senio Consul an Physician, No. (2) De ence Se ices Gene al Hospi al (1000-Bedded), Nay Pyi Taw
4Senio Consul an Neph ologis , No. (2) De ence Se ices Gene al Hospi al (1000-Bedded), Nay Pyi Taw
5Senio Consul an Physician, No. (1) De ence Se ices Gene al Hospi al (1000-Bedded), Yangon
6Consul an Endoc inologis , No. (2) De ence Se ices Gene al Hospi al (1000-Bedded), Nay Pyi Taw
7Consul an Neph ologis , Physician, No. (1) De ence Se ices Gene al Hospi al (1000-Bedded), Yangon
8Consul an Radiologis , No. (1) De ence Se ices Gene al Hospi al (1000-Bedded), Yangon
9P o esso / Senio Consul an Pa hologis , No. (1) De ence Se ices Gene al Hospi al (1000-Bedded), Yangon
10P o esso & Head o Depa men o Radiology, De ense Se ices Medical Academy, Myanma
ABSTRACT
ARTICLE DETAILS
In oduc ion: People li ing wi h main enance haemodialysis ha e high mo ali y due o
ca dio ascula e en s which a e ela ed wi h ascula calci ica ion. Vascula calci ica ion is
in luenced by clinical and labo a o y pa ame e s. Some o hem ha e con o e sial issues and a e
no s udied in people li ing wi h main enance haemodialysis in Myanma . This s udy aimed o
ind ou he p e alence o abdominal ao ic calci ica ion and i s de e minan s in people li ing wi h
main enance haemodialysis a ending in 2 selec ed public hospi als om Myanma .
Me hods: A e ge ing in o med consen , clinical assessmen , hemoglobin, se um albumin, se um
lipids, calcium, phospha e, CRP and se um e uin-A le el we e done. And la e al lumbe spine
X ay was aken and abdominal ao ic calci ica ion sco e (AAC) was calcula ed.
Resul s: A o al o 96 people li ing wi h main enance haemodialysis we e en olled. The mean
AAC sco e was 3.64 ± 4.86 and 61.5% (60/96) o pa icipan s had posi i e AAC sco e. A qua e
24.7% (24/96) had signi ican AAC sco e (sco e 5) and 37.5% (36/96) had AAC sco e ‘Ze o’.
Mean age was 51 yea s and mean BMI was 21.6 2.0 kg/m2. Dialysis in age anged om 5
mon hs o 8 yea s. All pa icipan s had hype ension whe eas a qua e (24/96) had diabe es
melli us. All pa icipan s we e clinically pale wi h mean hemoglobin 9.2 gm%. Mean se um
albumin was 43.2 9.9 g/L. Mean se um co ec ed calcium was low no mal (8.8 0.79 mg/dL)
and mean se um phospha e was high no mal (5.0 1.6 mg/dL). Mean as ing o al choles e ol was
195.13 31.43 mg/dL. Mean HDL choles e ol was low (48.49 15.62 mg/dL). Mean LDL
choles e ol was high (130.0 104.3 mg/dL). Mean se um iglyce ide was high (152.44 24.75
mg/dL). Mean CRP was 4.7 1.9 mg/dL.
Mean Fe uin-A le el was 412.3 μg/ml ± 170.5 μg/ml. And mean Fe uin-A le el o hose wi h
AAC sco e ‘Ze o’ was high (545.6 μg/ml ± 84.4 μg/ml) whe eas i was low (181.2 μg/ml ± 90.0
μg/ml) in hose wi h signi ican AAC sco e (AAC sco e 5). Those wi h non-signi ican AAC
sco e (AAC sco e 5) had high Fe uin-A le el (433.7 μg/ml ± 96.1 μg/ml).
Published On:
05 No embe 2025
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1798 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
The e was a s a is ically signi ican posi i e associa ion be ween AAC sco e and age ( ho = 0.296,
p= 0.003); AAC sco e and as ing LDL choles e ol ( ho = 0.226, p = 0.027); AAC sco e and
as ing iglyce ide ( ho = 0.246, p = 0.016) and AAC sco e and CRP ( ho = 0.404, p < 0.001).
The e was a s a is ically signi ican nega i e associa ion be ween AAC sco e and as ing HDL
choles e ol ( ho = - 0.315, p < 0.001); and, AAC sco e and se um e uin-A le els ( ho = - 0.854,
p < 0.001). AAC sco e was no associa ed wi h his o y o diabe es melli us, hype ension, BMI,
dialysis in age, anemia, se um albumin, se um co ec ed calcium, se um phospha e.
Conclusion: In people li ing wi h main enance haemodialysis, a signi ican posi i e associa ion
was ound be ween abdominal ao ic calci ica ion and age, iglyce ide, LDL choles e ol and CRP.
Signi ican nega i e associa ion was seen wi h HDL choles e ol and se um Fe uin-A le el.
KEYWORDS: abdominal ao ic calci ica ion, main enance haemodialysis, de e minan s
A ailable on:
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INTRODUCTION
The global es ima ed p e alence o ch onic kidney disease
was 13.4% (L & Zhang, 2019); in popula ion based s udies,
i inc eased wi h age (Q.-L. Zhang & Ro henbache , 2008).
Mo eo e , he p e alence o ch onic kidney disease was
inc easing wi h ime (Co esh e al., 2007). And, he e iology
o ch onic kidney disease was ela ed mainly wi h non-
communicable diseases like diabe es melli us, hype ension
and glome ula diseases ela ed o au oimmune diso de
(CHEGE & Yadla, 2023). Fo hose wi h la e s age o ch onic
kidney disease i.e., end s age enal disease (ESRD),
hemodialysis is one o he ea men op ions. Pe i oneal
dialysis was no easily accessible in Myanma . And, li ing
dono enal ansplan has been pe o ming (Pya KP e al.,
2022).
The mo bidi y and mo ali y o cases wi h ESRD we e mainly
due o ce eb o ascula acciden , ischemic hea disease and
sudden ca diac dea h (ALI, 2025); hey we e hough o be
ela ed wi h ascula calci ica ion (Si acusa e al.,
2024)(Maka & Pun, 2017). And, people li ing wi h
main enance hemodialysis we e ound o ha e signi ican
ascula calci ica ion (Wang e al., 2018) (E ihani e al.,
2022). The e o e, ascula calci ica ions in people li ing wi h
main enance hemodialysis s ongly in luenced hei
p ognosis. Kal a & Shanahan ound ha ascula
calci ica ion, ega dless o i s ana omical si e, was an
independen isk ac o o ca dio ascula mo ali y (Kal a &
Shanahan, 2012). The p esence o ascula calci ica ion again
caused p og ession o ch onic kidney disease i sel ;
mo eo e , i inc eased in ca dio ascula mo ali y in people
li ing wi h main enance hemodialysis (Jia e al., n.d.).
The e o e, i is impo an o de ec ac o s p o oking ascula
calci ica ions in people li ing wi h main enance
hemodialysis. And, o imp o e he ca dio ascula mo ali y,
p e en ion and ea men o hese ac o s which slow down
he ascula calci ica ion a e essen ial.
Vascula calci ica ion is he abno mal deposi ion o calcium,
phospho us, and o he mine als in he essel wall. I was
commonly obse ed in diabe es, ch onic kidney disease,
uncommon gene ic diseases and ch onic in lamma o y
disease (Lanze e al., 2014) and conside ed o be a passi e
p ocess (Niu e al., 2020) (Goodman e al., 2004). Howe e ,
i was ound o be an ac i e and egula ed p ocess, simila o
bone mine alisa ion (K aus e al., 2015); bo h ascula and
al ula calci ica ion we e highly p e alen in people li ing
wi h main enance hemodialysis. I was highly egula ed by
mul iple ac o s like bone- ela ed p o eins (Qin e al., 2021),
gene ic p edisposi ions and molecula pa hways (M.
Mohamed e al., 2025) (Ta yana A chako a & Liudmila
Nedosugo a, 2018).
The ascula calci ica ions can be isualized by compu ed
omog aphy (CT) scan, ul asonog am and con en ional X-
ay. A compu ed omog aphy (CT) scan pe o med wi h and
wi hou con as showed calci ica ion o co ona y a e ies
(Su ana e al., 2008); and, pe iphe al ascula calci ica ion
was assessed easily using con en ional X ay. Abdominal
ao ic calci ica ion (AAC sco e) om la e al lumba X- ay
was epo ed as a eliable ao ic calci ica ion ma ke
(Honkanen e al., 2008).
Abdominal ao ic calci ica ion (AAC sco e) om la e al
lumba X- ay was calcula ed as ‘Ze o’ o ‘24’. ‘Ze o’ means
no calci ica ion. Signi ican AAC sco e cu o alue in
people li ing wi h main enance hemodialysis by Bai e al was
an AAC sco e > 4.5 (Bai e al., 2023) and he alue by Chen
e al was g ea e han 5.5 (Chen e al., 2018). The
a he oscle osis ela ed ascula calci ica ion in people li ing
wi h main enance hemodialysis was passi e p ocess and
con ined o unica in ima (Ba e o e al., 2005) (Niu e al.,
2020) (Goodman e al., 2004)(Honkanen e al., 2008)
(E ihani e al., 2022) (Dhakshinamoo hy e al., 2017). I was
pa o aging p ocess. Vascula calci ica ion was ound o be
an independen p edic o o ca dio ascula mo bidi y and
mo ali y(Qin e al., 2021) (Lanze e al., 2014) (M. Mohamed
e al., 2025). Mo eo e , ascula calci ica ion in hose wi h
ESRD o people li ing wi h main enance hemodialysis was
ound pa icula ly in unica media and i was no age speci ic.
I was epo ed as an ac i e and egula ed p ocess (Qin e al.,
2021). I also poin ed ou he ole o o he ac o s con ibu ing
ascula calci ica ions in pa ien s on main enance
hemodialysis; in lamma o y pa hways(Ba e o e al., 2005)
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1799 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
(Si acusa e al., 2024a) (An & Son, 2013)
(Dhakshinamoo hy e al., 2017) (Choi e al., 2019) (D agoș
e al., 2023), gene ic p edisposi ions and molecula pa hways
(Qin e al., 2021) (M. Mohamed e al., 2025) (Si acusa e al.,
2024).
I was ela ed wi h hype phospha emia and hype calcemia,
and he loss o speci ic ascula calci ica ion inhibi o s
including py ophospha e, e uin-A, os eop o ege in,
iPTH(M. Li e al., 2025) (Goodman e al., 2004), i amin D,
FGF 23, scle os in and ma ix GLA p o ein (Si acusa e al.,
2024) (Pe o ić e al., 2024) (Ba e o e al., 2005) (Niu e al.,
2020). Se um calcium, phospho us, and iPTH le els in people
li ing wi h main enance hemodialysis we e ela ed wi h
ascula calci ica ion and i ’s p og ession (H. Zhang e al.,
2023) (Goodman e al., 2004) (M. Li e al., 2025) (Klein,
2024) (E ihani e al., 2022) (Spiegel e al., 2004). Those wi h
longe du a ion o dialysis and wi h a his o y o
ca dio ascula and ce eb o ascula e en s, hei AAC sco e
we e signi ican ly highe ” (Pey o-Shabani e al., 2018)
(Honkanen e al., 2008) (E ihani e al., 2022).
Diabe es melli us was he mos signi ican clinical isk ac o s
o ascula calci ica ions (M. Li e al., 2025) (Taniwaki e
al., 2005). Aging had add on e ec on ascula calci ica ion
(Niu e al., 2020) (Goodman e al., 2004). Those wi h highe
BMI p one o ascula calci ica ion (Ba e o e al., 2005).
Ha ing anemia in people li ing wi h main enance
hemodialysis p omo ed ascula calci ica ion h ough
oxida i e s ess and in lamma ion (Si acusa e al., 2024)
(Ta yana A chako a & Liudmila Nedosugo a, 2018) (Choi e
al., 2019) (An & Son, 2013).
Lipids in ol es in a he oscle osis and AAC (Deng & Qin,
n.d.) (MA, 2015). Dyslipidemia oge he wi h diabe es
melli us, and hype ension a ibu ed ascula calci ica ions
in people li ing wi h main enance hemodialysis (Op isiu e
al., 2002) (An e al., 2009) (Si acusa e al., 2024). HDL
choles e ol was epo ed as an i-calci ica ion ac o (Qunibi,
2005) (D.-Y. Li e al., 2024).
Non-calcium-con aining phospha e binde s, low-dose ac i e
i amin D plus cinacalce , modi ica ion o dialysa e calcium
concen a ion, and sodium hiosul a e we e ound o delay
ascula calci ica ion in dialysis pa ien s (Oh ake &
Kobayashi, 2017) (Huyb ech s e al., 2005) (Niu e al., 2020).
METHODS
S udy design and popula ion
A c oss-sec ional desc ip i e s udy was conduc ed in Janua y
2023 o Decembe 2024. People li ing wi h main enance
hemodialysis a public hospi al a Yangon and Nay Pyi Taw
we e selec ed. Non-p obabili y sampling me hod, especially
con enience sampling me hod was used in his s udy.
Sampling p ocedu e was accomplished a e comple ing he
minimum equi ed sample size 96 cases.
W i en in o med consen was aken om all pa icipan s
a e ho ough explaining abou he pu pose and he
p ocedu es o he s udy. His o y aking was ob ained
including age, sex, du a ion o dialysis and imaging eco ds.
This s udy was app o ed by he Hospi al Resea ch and E hics
Commi ee o No.(1) De ence Se ices Gene al Hospi al
(1000-Bedded) Mingaladon, Yangon.
Da a collec ion and p ocedu e
Clinical cha ac e is ics (sex, age, heigh , weigh ,
hype ension, diabe es melli us) we e collec ed using a
s anda dized case epo o m. Body weigh was measu ed a
he end o hemodialysis and BMI was calcula ed.
One millili e (1mL) o enous blood was wi hd awn om he
an e io cubi al ein be o e dialysis. Blood o hemoglobin,
CRP, calcium, phospha e, as ing lipid p o ile and e uin-A
es ima ion we e done. Fo se um e uin-A assay, se um le el
was measu ed by using ELISA (Enzyme- Linked
Immunoso ben Assay) ki , acco ding o he manu ac u e’s
ecommenda ion wi h comme cially a ailable ki (BioTechne
R &D Sys em ).
The abdominal ao ic calci ica ion was de ec ed on a la e al
lumba X- ay. I was done ei he a e hemodialysis o non-
hemodialysis day depending on pa icipan ’s choice. The
g ading was pe o med using kaupilla sco e in which he
ex en o calci ic deposi s is g aded on a pe segmen basis
using he lumba e eb al segmen s L1-L4. Pe segmen a
sco e be ween 0 and 3 was gi en o bo h he an e io and
pos e io wall o he Ao a. These eigh sco es esul ed in a
composi e abdominal ao ic calci ica ion sco e (AAC sco e)
anging be ween 0 and 24 poin s. The se e i y is de e mined
wi h Kaupilla sco e (0-24). Kaupilla sco e ‘1 and abo e’ is
aken as calci ica ion p esen .
Bo h clinical, labo a o y and AAC sco e pa ame e s we e
eco ded. The da a we e checked ca e ully. And, supe ision,
comple eness, and consis ency o collec ed da a we e
pe o med. The esul s we e in o med o a ending
neph ologis o ea men and con iden iali y was
main ained.
Wo king De ini ion
Signi ican abdominal ao ic calci ica ion sco e (AAC sco e)
was de ined as AAC sco e 5 in his s udy. I was calcula ed
on a la e al lumba X- ay.
People li ing wi h main enance hemodialysis was de ined as
pa ien s wi h end s age enal disease ha ing egula
hemodialysis (a leas wice a week) o mo e han 3 mon hs.
HD in age (Hemodialysis in age) was de ined as he
du a ion o main enance hemodialysis which was exp essed
as mon hs.
Body mass index (BMI) was a pe son’s weigh in kilog ams
di ided by he squa e o heigh in me e s, nan indica o o
body a ness. BMI was ca ego ized as unde weigh
(< 18.5 kg/m2), no mal weigh (18.5 o 24.9 kg/m2),
o e weigh (25.0 o 29.9 kg/m2) and (≥ 30.0 kg/m2) obese.
Body weigh was measu ed a e comple ion o hemodialysis
secession.
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1800 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
Diabe es melli us was de ined as known case o diabe es
melli us diagnosed by physician o new case o diabe es
melli us aised HbA1C mo e han 6.5% wi h aised as ing
blood suga mo e han 12 6 mg/dL.
Hype ension was de ined as es ing ( es o 30 minu es)
si ing blood p essu e mo e han 135/85 mmHg o known
case o hype ension diagnosed by physician.
CRP, an acu e‐phase eac an e lec ing he in lamma o y
ac i i y, was de ined as ele a ed when i was highe han
0.5 mg/dL (< 0.5 mg/dL).
Anemia was de ined as clinical pallo plus hemoglobin less
han 11gm%.
Low se um albumin was de ined as se um albumin less han
34 g/li e (no mal 35-55 g/li e ).
Raised co ec ed calcium was de ined as se um calcium
co ec ed wi h se um albumin mo e han 10.5 mg/dl and low
co ec ed calcium was de ined as se um calcium co ec ed
wi h se um albumin less han 8.5 mg/dL (no mal ange 8.5 o
10.5 mg/dL).
Raised phospha e was de ined as aised se um phospha e
mo e han 4.5 mg/dL i espec i e o phospha e lowe ing
d ugs (no mal ange 3.4 o 4.5 mg/dL ).
Fas ing choles e ol was de ined as aised choles e ol mo e
han 200 mg/dL i espec i e o lipid lowe ing d ugs (no mal
<200 mg/dL).
Raised iglyce ide was de ined as aised iglyce ide mo e
han 150 mg/dL i espec i e o lipid lowe ing d ugs (no mal
<150 mg/dL).
Raised LDL choles e ol was de ined as LDL choles e ol mo e
han >100 mg/dL i espec i e o lipid lowe ing d ugs( no mal
<100 mg/dL).
High HDL choles e ol was de ined as HDL choles e ol mo e
han >130 mg/dL) i espec i e o lipid lowe ing d ugs (
no mal 60-130 mg/dL).
S a is ical analysis
The da a we e analyzed in he s a is ical package o social
science (SPSS), e sion 25. Ca ego y a iables we e
desc ibed as numbe and pe cen age. Nume ical a iables
we e exp essed as mean and s anda d de ia ion. The
co ela ion was calcula ed by Spea man’s co ela ion es and
co ela ion coe icien was exp essed as ‘ ho’. P alue < 0.05
was se as s a is ically signi ican .
RESULTS
A o al numbe o 96 people li ing wi h haemodialysis a
1,000 bedded hospi al in Yangon and Nay Pyi Taw we e
en olled. Table (1) shows base line cha ac e is ic. Rega ding
sex dis ibu ion, males cons i u ed 54.2% (n = 52) and
emales made up 45.8% (n = 44). Mean age was 51 yea s; he
minimum was 24 yea s and he maximum was 73 yea s.
Dialysis in age a ied om 5 mon hs o 8 yea s. Diabe es
melli us was seen in 25% (24/96) cases. And nea ly all
pa icipan s (94/96) had hype ension. A qua e had IHD.
Figu e (1.a) demons a es associa ion be ween AAC sco e
and age; AAC sco e became highe wi h inc easing age.
The e was a s a is ically signi ican associa ion be ween AAC
sco e and age (p = 0.003).
Thi y-six cases had AAC sco e ‘Ze o’; hei mean age was
47.7 yea s. In AAC sco e ‘Ze o’ g oup, he younges was 31
yea s and he oldes was 72 yea s. Eigh cases we e o e 60
yea s; and, se en cases we e 31 o 40 yea s. As shown in
igu e (1.b), he majo i y was in he younge age g oup (31-
44 yea s) and he mino i y was o e 58 yea s.
In his s udy, AAC sco e (abdominal ao ic calci ica ion
sco e) was calcula ed om la e al lumba spine X ay. I
anged om ‘Ze o’ o ‘24’. AAC sco e 5 was de ined as
signi ican AAC sco e.
Table (2) e eals equency dis ibu ion o a ious AAC
sco e. Mean AAC sco e in his s udy was 3.64 4.86. The
lowes was ‘Ze o’ and he highes was ‘20’. O e six y
pe cen 61.9% (60/96) had posi i e AAC sco e (1 - 24); and
(38.1%, 36/96) did no ha e AAC i.e., AAC sco e ‘Ze o’.
Because AAC sco e 5 was de ined as signi ican AAC sco e
in his s udy, 24.7% (24/96) had signi ican AAC sco e.
AAC sco e 18 and abo e was ound in 4 cases and hei ages
we e 34 yea s, 48 yea s, 58 yea s and 64 yea s. Maximum
AAC sco e ‘20’ was seen in 65 yea s old man wi h diabe es
melli us wi h HD in age o 26 mon hs.
Diabe es melli us was seen in 25% (24/96) cases. Mean AAC
sco e in his s udy was 3.64 4.86. Mean AAC sco e in
pa icipan s wi h diabe es melli us was 4.8; i was highe han
pa icipan s wi hou diabe es melli us whe e AAC sco e was
3.2.
Mean body mass index (BMI) was 21.6 2.0 kg/m2. The
lowes and he highes BMI we e 18.4 kg/m2 and 26.4 kg/m2
espec i ely. Figu e (2) e eals he associa ion be ween AAC
sco e and BMI. The e was no associa ion be ween AAC sco e
and BMI.
Mean CRP was 4.7 1.9 mg/dL; he ange was 1.5 o 7.0
mg/dL. No mal CRP was less han 1.0 mg/dL. The le el o
CRP became highe wi h inc easing AAC sco e. Figu e (10)
demons a es he associa ion be ween AAC sco e and CRP; i
was s a is ically signi ican (p < 0.001).
Mean se um albumin was 43.2 9.9 g/li e . Figu e (3)
illus a es he associa ion be ween AAC sco e and se um
albumin (p = 0.205). Nine y pe cen o pa icipan s in his
s udy we e anemic; mean hemoglobin was 9.2 gm%.
Mean se um co ec ed calcium was 8.8 0.79 mg/dL (no mal
ange 8.5 o 10.5 mg/dL). Mean se um phospha e was 5.0
1.6 mg/dL (no mal ange 3.4 o 4.5 mg/dL ). Figu e (4)
demons a es he associa ion be ween AAC sco e and
co ec ed calcium (p = 0.111). Figu e (5) shows he
associa ion be ween AAC sco e and se um phospha e (p =
0.341). Nei he se um co ec ed calcium no se um phospha e
was ela ed wi h AAC sco e.
Mean as ing o al choles e ol was 195.13 31.43 mg/dL.
The associa ion be ween AAC sco e and as ing o al
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1801 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
choles e ol was no signi ican (p = 0.181); i was highligh ed
in igu e (6).
Mean HDL choles e ol was low (48.49 15.62 mg/dL).
Figu e (8) e eals he associa ion be ween AAC sco e and
as ing HDL choles e ol. I was s a is ically signi ican (p <
0.001).
Mean LDL choles e ol was high (130.0 104.3 mg/dL).
Figu e (9) demons a es he associa ion be ween AAC sco e
and as ing LDL choles e ol; i was s a is ically signi ican (p
= 0.027).
Mean se um iglyce ide was high (152.44 24.75 mg/dL).
The associa ion be ween AAC sco e and as ing iglyce ide
is e ealed in igu e (7). I was s a is ically signi ican (p =
0.016).
Mean se um Fe uin-A le el o all pa icipan s (people li ing
wi h main enance haemodialysis) was 412.3 μg/ml ± 170.5
μg/ml. And mean Fe uin-A le el o hose wi h AAC sco e
‘Ze o’ was high (545.6 μg/ml ± 84.4 μg/ml) whe eas i was
low (181.2 μg/ml ± 90.0 μg/ml) in hose wi h signi ican AAC
sco e (AAC sco e 5). Those wi h non-signi ican AAC
sco e (AAC sco e 5) had high Fe uin-A le el (433.7 μg/ml
± 96.1 μg/ml). Figu e (11) demons a ed he associa ion
be ween AAC sco e and se um Fe uin-A le el. A signi ican
associa ion was ound be ween AAC sco e and se um e uin-
A le els (p < 0.001).
DISCUSSION
Vascula calci ica ion has now been ecognized as a majo
p oblem in people li ing wi h main enance hemodialysis
because o i s s ong in luence on he p ognosis. Delaying o
imp o ing he ascula calci ica ion was hough o be e y
impo an o imp o e he ca dio ascula mo ali y in hem
(Wang e al., 2018). To p olong he quali y o li e o people
li ing wi h main enance hemodialysis, de ec ion and
su eillance o ascula calci ica ion as well as i s p e en ion
and ea men s a e ex emely impo an .
Abdominal ao ic calci ica ion (AAC sco e) om la e al
lumba X- ay was calcula ed as ‘Ze o’ o ‘24’. ‘Ze o’ means
no calci ica ion. Bai e al epo ed ha people li ing wi h
main enance hemodialysis wi h an AAC sco e > 4.5 had
signi ican ly ele a ed all-cause and ca dio ascula mo ali y
compa ed wi h hose wi h an AAC sco e ≤ 4.5 (Bai e al.,
2023). On he o he hand, AAC sco e g ea e han 5.5 in
people li ing wi h main enance hemodialysis was epo ed as
a eliable abdominal ao ic calci ica ion ma ke (Chen e al.,
2018). Because he bes cu -o alue o AAC sco e was 5.5
by Chen e al and > 4.5 by Bai e al, AAC sco e 5 was
de ined as signi ican AAC sco e in his s udy. One qua e
o pa icipen s in his s udy 24.7% (24/96) had signi ican
AAC sco e; he ange o age was 24 - 73 yea s.
The a he oscle osis ela ed ascula calci ica ion was mainly
con ined o unica in ima. Se e al epo s on ascula
calci ica ion in hose wi h ESRD o people li ing wi h
main enance hemodialysis was ound pa icula ly in unica
media and i was no age speci ic. In his s udy, mean age was
51 yea s; no young. Thei AAC sco e became highe wi h
inc easing age and i was s a is ically signi ican . Ha ing
s a is ically signi ican ela ion be ween AAC sco e and age
in his s udy s ongly suppo ed he known ac ha ascula
calci ica ion was a degene a i e disease which occu ed in
olde adul s. The e o e, his s udy highligh ed he
a he oscle osis ela ed ascula calci ica ion in people li ing
wi h main enance hemodialysis (Ba e o e al., 2005) (Niu e
al., 2020) (Goodman e al., 2004)(Honkanen e al., 2008)
(E ihani e al., 2022) (Dhakshinamoo hy e al., 2017).
People li ing wi h main enance hemodialysis migh p obably
ha e accele a ed a he oscle osis which led o p ema u e
ascula calci ica ion.
The AAC sco e ‘Ze o’ was eco ded in 36 pa icipen s in his
s udy; no calci ica ion in ao a. In AAC sco e ‘Ze o g oup’,
he younges was 31 yea s and he oldes was 72 yea s.
None heless, he p opo ion o younge age g oup (31- 44
yea s) ha ing AAC sco e ‘Ze o’ was highes ; and, olde age
g oup (58 – 72 yea s) had he lowes p opo ion. I was
compa ible wi h o me epo ‘ ascula calci ica ion was an
aging p ocess’ (Ba e o e al., 2005) (Niu e al., 2020)
(Goodman e al., 2004) (E ihani e al., 2022).
In his s udy, mean AAC sco e (abdominal ao ic
calci ica ion sco e) was 3.64 4.86. The lowes was ‘Ze o’
and he highes was ‘19’. Highe AAC sco e (18 and abo e)
was ound in 4 cases and hei espec i e ages we e 34 yea s,
48 yea s, 58 yea s and 64 yea s. Ha ing highe AAC sco e in
ela i ely young age (34 yea s and 48 yea s) could be
explained by possible accele a ed na u e o ascula
calci ica ion, no passi e p ocess like a he oscle osis. I
con i med he ac ha ascula calci ica ion in people li ing
wi h main enance hemodialysis was an ac i e and egula ed
p ocess (Qin e al., 2021). Fu he mo e, i also poin ed ou he
ole o o he ac o s con ibu ing ascula calci ica ions in
people li ing wi h main enance hemodialysis; in lamma o y
pa hways, gene ic p edisposi ions and molecula pa hways
(Qin e al., 2021) (M. Mohamed e al., 2025) (Si acusa e al.,
2024).
His o y o ischemic hea disease was seen in ‘24’ cases; and
hei mean AAC sco e was ‘10’. None o hem had
ce eb o ascula acciden . The e o e, i suppo ed o me
indings “AAC sco e was signi ican ly highe in hose wi h
longe du a ion o dialysis and pa ien s wi h a his o y o
ischemic hea disease” (Pey o-Shabani e al., 2018)
(Honkanen e al., 2008) (E ihani e al., 2022).
Diabe es melli us was epo ed as he mos signi ican clinical
isk ac o o co ona y a e y calci ica ion (M. Li e al., 2025)
as well as ascula calci ica ions. Combina ion o old age and
diabe es melli us was ound o cause apid p og ession o
ascula calci ica ion (Niu e al., 2020) (Goodman e al.,
2004). In his s udy, a qua e o pa icipan s (24/96) we e
diabe ics and hei mean AAC sco e was ‘4.8’; i was highe
han ha o non-diabe ics (3.2). And, maximum AAC sco e
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
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(AAC sco e ‘20’) was seen in male pa icipan , 65 yea s old
wi h diabe es melli us wi h HD in age o 26 mon hs. This
inding suppo ed he o me epo ha AAC sco e in people
li ing wi h main enance hemodialysis wi h diabe es melli us
was ound o be highe han ha o non-diabe ic pa icipan s
e en wi h sho dialysis in age (Taniwaki e al., 2005)
(Pey o-Shabani e al., 2018) (Honkanen e al., 2008) (E ihani
e al., 2022).
BMI was measu ed in d y weigh si ua ion; a e comple ion
o hemodialysis sec ion. No mal ange o BMI was 18.5 o
24.9 kg/m2 in no mal heal hy pe son. Mean BMI was 21.6
2.0 kg/m2 in his s udy. The lowes and he highes BMI we e
18.4 kg/m2 and 26.4 kg/m2 espec i ely. The e was no
associa ion be ween AAC sco e and BMI in his s udy. Mean
AAC sco e o hose ha ing BMI 25 kg/m2 and abo e (18/3)
was ‘6’. Ba e o e al epo ed ha co ona y a e y
calci ica ion was highly p e alen in people li ing wi h
main enance hemodialysis; and i was associa ed wi h olde
age, highe BMI, in lamma ion and educed abecula bone
olume (Ba e o e al., 2005). The e o e, his s udy was no
compa able wi h he indings o Ba e o e al; i was p obably
due o ela i ely low sample size.
No mal CRP was less han 1.0 mg/dL. In his s udy, mean
CRP o people li ing wi h main enance hemodialysis was
high (4.7 1.9 mg/dL); hei ange was 1.5 o 7.0 mg/dL. The
le el o CRP became highe wi h inc easing AAC sco e; i
was s a is ically signi ican . I s ongly sugges ed ha
ascula calci ica ion ound in people li ing wi h
main enance hemodialysis was an in lamma o y p ocess; and
i was in line wi h p e iously epo s (Ba e o e al., 2005)
(Si acusa e al., 2024) (An & Son, 2013) (Dhakshinamoo hy
e al., 2017) (Choi e al., 2019) (D agoș e al., 2023).
In his s udy, mean se um albumin was no low (43.2 9.9
g/li e ). The e was no associa ion be ween AAC sco e and
se um albumin; he possible eason was ha people li ing
wi h main enance hemodialysis in his s udy did no ha e
hypoalbuminemia. Malnu i ion was sugges ed as one
possible cause o AAC and i s p og ession in people li ing
wi h main enance hemodialysis pa ien s (Choi e al., 2019).
In his s udy, almos all pa icipan s had anemia; and, mean
hemoglobin was 9.0 gm%. Ha ing ea ly onse o ascula
calci ica ion and accele a ed pa e n o i s cou se in people
li ing wi h main enance hemodialysis was associa ed wi h
new o non- adi ional isk ac o s such as oxida i e s ess,
anemia, and in lamma ion (Si acusa e al., 2024) (Ta yana
A chako a & Liudmila Nedosugo a, 2018). Choi e al
epo ed ha condi ions which inc ease hemoglobin le el
would e a d p og ession o ascula calci ica ion in people
li ing wi h main enance hemodialysis (Choi e al., 2019) (An
& Son, 2013).
Nei he se um co ec ed calcium no se um phospha e was
ela ed wi h AAC sco e in his s udy. I was sugges ed ha
ha ing signi ican ascula calci ica ion in people li ing wi h
main enance hemodialysis was due o an accumula ion o
calcium and phospha e deposi s wi hin he walls o blood
essels; and, i caused he loss o elas ici y o he a e ial
walls. Se e al epo s men ioned associa ion be ween se um
co ec ed calcium and se um phospha e le els and ascula
calci ica ions in people li ing wi h main enance
hemodialysis. Si acusa e al epo ed ha hype phospha emia
and hype calcemia a ibu ed o ascula calci ica ion in hem
(Si acusa e al., 2024). The s udy om Japan ound ha an
inc ease in se um phospha e le el was associa ed wi h an
inc eased ascula calci ica ion bu den in people li ing
wi hou main enance hemodialysis (ea ly cases o ESRD)
unde going ca dio ascula su ge y (Kinugasa e al., 2016).
Taniwaki e al ound ha hype phospha emia was an
independen isk ac o o inc easing AAC sco e in people
li ing wi h main enance hemodialysis wi hou diabe es
melli us (Taniwaki e al., 2005). In his s udy mean se um
co ec ed calcium le el was lowe limi o no mal ange; and
se um phospha e was sligh ly highe han no mal alue. Bo h
se um co ec ed calcium and se um phospha e we e no
signi ican ly ela ed wi h AAC sco e in his s udy; i did no
suppo o me epo s.
None heless, Zhang e al sugges ed ha main enance o
se um calcium, phospho us, and iPTH a ge le els in people
li ing wi h main enance hemodialysis pa ien s was essen ial
in o de o lowe he isk o p og ession o ascula
calci ica ion; and i was suppo ed by se e al s udies (H.
Zhang e al., 2023) (Goodman e al., 2004) (M. Li e al., 2025)
(Klein, 2024) (E ihani e al., 2022) (Spiegel e al., 2004).
Mo eo e , non-calcium-con aining phospha e binde s, low-
dose ac i e i amin D plus cinacalce , modi ica ion o
dialysa e calcium concen a ion, and sodium hiosul a e
showed bene icial e ec on delaying ascula calci ica ion in
people li ing wi h main enance hemodialysis (Oh ake &
Kobayashi, 2017) (Huyb ech s e al., 2005) (Niu e al., 2020).
Rela ion be ween AAC and iPTH se um le els was posi i e
in ea lie inding (Kimu a e al., 1999); howe e , no
signi ican co ela ion was ound in la e epo s (Pey o-
Shabani e al., 2018). In his s udy, iPTH le el was no
measu ed as we we e in limi ed se ing.
Depending on ela ion be ween AAC and bone ela ed
ac o s, se um calcium, phospho us, and iPTH, he e we e
con o e sial in e en ions in managing ascula
calci ica ions like calcium channel blocke s, enin–
angio ensin sys em inhibi ions, s a ins, bisphosphona es,
denosumab, i amins, and ion condi ioning agen s (Mizui i e
al., 2021) (Pan e al., 2023) (Raggi, 2002) (Spiegel e al.,
2004) (Mccullough & Soman, 2004). In his s udy nea ly 90%
o pa icipan s we e aking calcium channel blocke s o
con ol o hype ension and nea ly 80% o hem had s a ins
o hype choles e olemia. We need long e m s udy whe he
hey ha e eal impac on ascula calci ica ion o no .
Lipids in ol es in a he oscle osis and ascula calci ica ion,
AAC. The e was no associa ion be ween AAC sco e and
as ing o al choles e ol in his s udy; i con i med ea lie
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
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1803 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
esea ch whe e he e was no co ela ion be ween lipid le el
(LDL choles e ol, HDL choles e ol and iglyce ide) and
AAC (Kimu a e al., 1999). A signi ican in e se U-shaped
co ela ion be ween lipop o ein (LAP) and he p e alence o
AAC was no ed by Deng & Qin e al (Deng & Qin, n.d.); LAP
could be a po en ial bioma ke o e alua ing AAC isk.
Ano he inding in 2015 was ha ‘dyslipidemia including
hype iglyce idemia and hypo-HDL choles e ol we e
common in people li ing wi h main enance hemodialysis’
(MA, 2015); and and hey we e po en ially a he ogenic.
On he o he hand, AAC sco e was in e sely associa ed wi h
as ing HDL choles e ol in his s udy. As HDL choles e ol is
a good-lipids, i has p o ec i e e ec on ascula
calci ica ion. HDL choles e ol was epo ed as an i-
calci ica ion ac o (Qunibi, 2005). And, ele a ed se um
HDL3-C le els in people li ing wi h main enance
hemodialysis was an independen isk ac o o
ca dio ascula calci ica ion (D.-Y. Li e al., 2024). In his
s udy, bo h se um LDL choles e ol and iglyce ide we e
di ec ly ela ed wi h AAC sco e. T adi ional isk ac o s like
age, sex, dyslipidemia, diabe es melli us, and hype ension
de e mined ascula calci ica ions in people li ing wi h
main enance hemodialysis (Op isiu e al., 2002) (An e al.,
2009) (Si acusa e al., 2024a). The e o e, ha ing di ec
ela ionship be ween AAC sco e and bad lipids, LDL
choles e ol and iglyce ide in his s udy, s ongly suppo ed
o me epo s.
Fe uin-A, a ci cula ing inhibi o o calci ica ion, is a ma ke
o in lamma o y-nu i ional s a e. The e o e, se um Fe uin-A
eliably p edic ed ascula calci ica ion and ca o id in ima
media hickness in some epo s. Se um Fe uin-A and
ascula calci ica ion eme ged as signi ican isk ac o s o
all-cause and ca dio ascula mo ali y e en in pa ien s wi h
non-dialysis ch onic kidney disease (ea ly s age ESRD).
Dec eased le els o e uin A was hough o be in ol ed in
he pa hogenesis o co ona y a e y disease in people li ing
wi h main enance hemodialysis. In his s udy, nea ly 62% had
posi i e AAC sco e (1-24). Those wi h AAC sco e ‘Ze o’ had
he highes se um e uin-A le el and hose wi h signi ican
AAC sco e (AAC sco e 5) had he lowes le el.
Ha ing low se um Fe uin-A was ela ed wi h high AAC sco e
in his s udy suppo ed o me indings; lowe se um e uin-
A was ound o be associa ed wi h se e e abdominal ao ic
calci ica ion (AAC) in ea ly 2000 (Schoppe e al., 2015).
Se um e uin-A le els had inhibi o y e ec on ascula
calci ica ion (Tu kmen e al., 2011) (Hendig e al., 2006)
(Si acusa e al., 2024a) (O. N. Mohamed e al., 2024) (Gluba-
B zózka e al., 2014).
In his s udy, pa icipan s wi h low se um e uin-A le el
(below no mal ange) had a highe mean AAC sco e compa e
o hose wi h no mal se um e uin-A le els. This da a
sugges ed ha people li ing wi h main enance hemodialysis
wi h lowe se um e uin-A le els had highe mean AAC sco e
(Lyu e al., 2018) (Pe o ić e al., 2024) (Si acusa e al., 2024)
(Schoppe e al., 2015) (Tu kmen e al., 2011) (Hendig e al.,
2006). Gheo ghe e al ound ha e uin-A le els we e
in e sely associa ed wi h co ona y a e y calci ica ion
quan i ied by mul ide ec o compu ed omog aphy (CT) in
pa ien s unde going hemodialysis (Gheo ghe e al., 2024); i
could p edic u u e co ona y e en s.
CONCLUSION
AAC was common among people li ing wi h main enance
hemodialysis. Olde age ela ed posi i ely wi h AAC sco e.
Those wi h high BMI, his o y o diabe es melli us and his o y
o ischemic hea disease had high AAC sco e. Dyslipidemia
(high iglyce ide and LDL choles e ol) inc eased he AAC
sco e whe eas high HDL choles e ol had e e se e ec .
In lamma o y ma ke s (CRP) posi i ely ela ed wi h AAC
sco e. Se um Fe uin-A nega i ely ela ed wi h AAC sco e.
RECOMMENDATION
Se e al isk ac o s o ascula calci ica ion, ci cula ing
soluble h ombomodulin, i amin K de iciency,
py ophospha e, os eop o ege in, and ma ix GLA p o ein,
iPTH, i amin D, FGF 23, scle os in, os eopon in and bone
mo phogene ic p o ein-7 (BMP-7), should be analyzed. We
need o explo e ascula calci ica ion in associa ion wi h
ascula bed di e ences, sex di e ences, and e hnic
di e ences. The apeu ic ials like i amin K he apy, s a in
he apy, ACEI, calcium ee phospha e binde , non-calcium-
con aining phospha e binde s, low-dose ac i e i amin D plus
cinacalce , modi ica ion o dialysa e calcium concen a ion,
and sodium hiosul a e should be done.
ACKNOWLEDGEMENT
We a e hank ul o P o esso Ko Ko Lwin, P o esso Kyaw
Zay Ya, P o esso Myin Zaw and P o esso Aung Mya
Kyaw o hei adminis a i e suppo . We a e also g a e ul o
all heal h p o essionals a hemodialysis cen e s o hei
e o s in p o iding e ec i e ca e o he people li ing wi h
main enance hemodialysis.
ETHICAL CONSIDERATION
The da a collec ion using s anda dized case epo o ms was
app o ed by Ins i u ional Resea ch and E hic Commi ee
om De ence Se ices Medical Academy, Myanma .
In o med consen was also aken om each pa icipen .
P i acy and con iden iali y o in o ma ion we e main ained
h oughou he s udy p ocess.
DECLARATION OF CONFLICT OF INTEREST
The au ho s decla ed no po en ial con lic s o in e es s wi h
espec o au ho ship and publica ion o his a icle.
FUNDING
The au ho s ecei ed no inancial suppo .
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1804 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
Table (1). Baseline cha ac e is ics o people li ing wi h main enance haemodialysis (n=96)
SR
Pa ame e s
Mean SD
1
Age (yea s)
51.0 12.0
2
BMI (kg/m2 )
21.6 2.0
3
CRP (mg/dL)
4.7 1.9
4
AAC sco e (abdominal ao ic calci ica ion sco e)
3.64 4.86
5
Hemoglobin (gm%)
9.2
6
Se um albumin (g/li e ) (30-50)
43.2 9.9
7
Se um co ec ed calcium (mg/dL) (8.5 o 10.5)
8.8 0.79
8
Se um phospha e (mg/dL) (3.4 o 4.5)
5.0 1.6
10
Se um Fas ing o al choles e ol (mg/dL) (<200)
195.13 31.43
11
Se um HDL choles e ol (mg/dL) (>50)
48.49 15.62
12
Se um iglyce ide (mg/dL)(<150)
152.44 24.75
13
Se um Fe uin-A le el (μg/mL) (303-671)
412.32 170.52
Table (2). AAC sco e g oups and Se um Fe uin-A le el (n=96)
AAC sco e g oup
Numbe o people li ing
wi h main enance
hemodialysis (%)
Se um Fe uin-A le el
(303-671 μg/mL)
(Mean ± SD)
Rema k
AAC sco e
(0-24)
96 (100)
412.3 ± 170.5
AAC sco e ‘Ze o’(0)
36 (38.1%,36/96)
545.6 ± 84.4
AAC sco e (1-24)
60 (61.9%,60/96)
AAC sco e ( 5)
24 (24.7%,24/96)
181.2 ± 90.0
AAC cu o alue
5.5 by Chen e al
> 4.5 by Bai e al
AAC sco e (1-4)
36 (37.1%,36/96)
433.7 ± 96.1
Figu e (1.a). Associa ion be ween AAC sco e and age (n=96)
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1805 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
Figu e (1.b). Dis ibu ion o ‘Age g oups’ in AAC sco e ‘Ze o’ g oups (n = 36)
Figu e (2). Associa ion be ween AAC sco e and BMI
Figu e (3). Associa ion be ween AAC sco e and se um albumin
Abdominal Ao ic Calci ica ion and I s De e minan s in People Li ing wi h Main enance Haemodialysis in 2 Selec ed
Public Hospi als om Myanma
1812 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Khin Phyu Pya
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Fou nie , A. (2002). P og ession o ascula
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Diseases, 39(1), 209.
h ps://doi.o g/10.1053/ajkd.2002.30955
LVIII. Ossa eh, S., Raya nia, M., Vahedi, M., Ja a i, H., &
Zeba jadi, M. (2020). Associa ion o Se um Fe uin-
A wi h Vascula Calci ica ion in Hemodialysis
Pa ien s and I s’ Impac on 3-yea Mo ali y. I anian
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LIX. Pan, W., Jie, W., & Huang, H. (2023). Vascula
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h ps://doi.o g/10.1002/mco2.200
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