{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:10:45Z","timestamp":1788952245780,"version":"build-2803163510"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Abdominal aortic calcification index (ACI), a quantitative computed tomography\u2013based measure of abdominal aortic calcification burden, has been increasingly investigated as a prognostic marker in patients with chronic kidney disease (CKD). However, the association between ACI and clinical outcomes in CKD remains uncertain. This meta-analysis evaluated the association of baseline ACI with cardiovascular event-free survival (CVEFS) and overall survival (OS) in patients with CKD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n PubMed, Embase, Web of Science, Wanfang Data, and CNKI were searched for cohort studies evaluating the association between baseline ACI and prognosis in adult patients with CKD. Hazard ratios (HRs) comparing high versus low ACI were pooled using random-effects models accounting for the influence of potential heterogeneity. Prespecified subgroup, sensitivity, and meta-regression analyses were performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eleven cohort studies involving 1,914 patients with CKD were included. Nine studies reported CVEFS and five reported OS. Pooled analysis showed that a high ACI was associated with poorer CVEFS (HR = 3.20, 95% CI: 2.21\u20134.64; I\n 2<\/jats:sup>\n = 44%) and OS (HR = 2.69, 95% CI: 1.86\u20133.89; I\n 2<\/jats:sup>\n = 0%). The association with CVEFS remained significant across study design and renal replacement therapy subgroups. Stronger associations with CVEFS were observed in studies with a mean age &lt; 60 years as compared to \u2265 60 years (HR = 5.46 vs. 2.27;\n p<\/jats:italic>\n for subgroup difference = 0.01) and ACI cutoff values \u2265 30% compared to &lt; 30% (HR = 8.53 vs. 2.37;\n p<\/jats:italic>\n &lt; 0.001). Meta-regression identified ACI cutoff value as the only significant study characteristic associated with the strength of the association between ACI and CVEFS (coefficient = 0.033,\n p<\/jats:italic>\n = 0.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A high baseline ACI was associated with poorer CVEFS and OS in patients with CKD. ACI may have potential as an imaging biomarker for prognostic risk stratification in this population, although these findings should be interpreted cautiously and confirmed in future prospective studies.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n , identifier CRD420261421928.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1907104","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:18:00Z","timestamp":1788949080000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Abdominal aortic calcification index and prognosis in patients with chronic kidney disease: a meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Yicong","family":"Pan","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1016\/S0140-6736(25)01853-7","article-title":"Global, regional, and national burden of chronic kidney disease in adults, 1990–2023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023.","volume":"406","author":"Mark","year":"2025","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1681\/ASN.0000000658","article-title":"Global burden of the key components of cardiovascular-kidney-metabolic syndrome.","volume":"36","author":"Xie","year":"2025","journal-title":"J Am Soc Nephrol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.3390\/biom14111393","article-title":"the dual burden: exploring cardiovascular complications in chronic kidney disease.","volume":"14","author":"Caturano","year":"2024","journal-title":"Biomolecules."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.3390\/biomedicines12102203","article-title":"Chronic kidney disease progression-a challenge.","volume":"12","author":"Maringhini","year":"2024","journal-title":"Biomedicines."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.3390\/ijms27052244","article-title":"Developmental programming of kidney disease across the life course: a narrative review focused on inflammation.","volume":"27","author":"Hsu","year":"2026","journal-title":"Int J Mol Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e70174","DOI":"10.1002\/clc.70174","article-title":"Trends in cardiovascular mortality in patients with chronic kidney disease from 1999 to 2020: a retrospective study in the United States.","volume":"48","author":"Ahmad","year":"2025","journal-title":"Clin Cardiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1053\/j.ajkd.2024.08.003","article-title":"KDOQI US commentary on the KDIGO 2024 clinical practice guideline for the evaluation and management of CKD.","volume":"85","author":"Navaneethan","year":"2025","journal-title":"Am J Kidney Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"13096","DOI":"10.3390\/ijms252313096","article-title":"Understanding vascular calcification in chronic kidney disease: pathogenesis and therapeutic implications.","volume":"25","author":"Siracusa","year":"2024","journal-title":"Int J Mol Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12882-021-02652-z","article-title":"Association between bone mineral metabolism and vascular calcification in end-stage renal disease.","volume":"23","author":"Aaltonen","year":"2022","journal-title":"BMC Nephrol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"5829","DOI":"10.2174\/1381612820666140212194926","article-title":"Vascular calcification in chronic kidney disease: role of disordered mineral metabolism.","volume":"20","author":"Palit","year":"2014","journal-title":"Curr Pharm Des."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1003246","DOI":"10.3389\/fcvm.2022.1003246","article-title":"Calcification of the abdominal aorta is an under-appreciated cardiovascular disease risk factor in the general population.","volume":"9","author":"Sethi","year":"2022","journal-title":"Front Cardiovasc Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"102570","DOI":"10.1016\/j.jacadv.2025.102570","article-title":"Automated abdominal aortic calcification scores and atherosclerotic cardiovascular disease in the UK Biobank imaging study.","volume":"5","author":"Sim","year":"2026","journal-title":"JACC Adv."},{"key":"B13","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1136\/heartjnl-2011-301464","article-title":"Calcification of the abdominal aorta as an independent predictor of cardiovascular events: a meta-analysis.","volume":"98","author":"Bastos Gon\u00e7alves","year":"2012","journal-title":"Heart."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1177\/2047487320919895","article-title":"Abdominal aortic calcification: from ancient friend to modern foe.","volume":"28","author":"Bartstra","year":"2021","journal-title":"Eur J Prev Cardiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"43","DOI":"10.5527\/wjn.v1.i2.43","article-title":"Vascular calcification in chronic kidney disease: pathogenesis and clinical implication.","volume":"1","author":"Disthabanchong","year":"2012","journal-title":"World J Nephrol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e017205","DOI":"10.1161\/JAHA.120.017205","article-title":"Prognostic value of abdominal aortic calcification: a systematic review and meta-analysis of observational studies.","volume":"10","author":"Leow","year":"2021","journal-title":"J Am Heart Assoc."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1093\/ndt\/gfi039","article-title":"Aortic calcification in haemodialysis patients with diabetes mellitus.","volume":"20","author":"Taniwaki","year":"2005","journal-title":"Nephrol Dial Transplant."},{"key":"B18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/s0272-6386(03)00655-3","article-title":"The progression of vascular calcification and serum osteoprotegerin levels in patients on long-term hemodialysis.","volume":"42","author":"Nitta","year":"2003","journal-title":"Am J Kidney Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1177\/107602960501100205","article-title":"Prognostic impact of aortic calcification index and ankle-arm blood pressure index in patients under hemodialysis.","volume":"11","author":"Kushiya","year":"2005","journal-title":"Clin Appl Thromb Hemost."},{"key":"B20","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1159\/000157629","article-title":"Elevated osteoprotegerin levels predict cardiovascular events in new hemodialysis patients.","volume":"29","author":"Nishiura","year":"2009","journal-title":"Am J Nephrol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1093\/ndt\/gfp728","article-title":"Assessment and significance of abdominal aortic calcification in chronic kidney disease.","volume":"25","author":"Hanada","year":"2010","journal-title":"Nephrol Dial Transplant."},{"key":"B22","doi-asserted-by":"publisher","first-page":"870","DOI":"10.3346\/jkms.2012.27.8.870","article-title":"Abdominal aortic calcification is associated with diastolic dysfunction, mortality, and nonfatal cardiovascular events in maintenance hemodialysis patients.","volume":"27","author":"Yoon","year":"2012","journal-title":"J Korean Med Sci."},{"key":"B23","doi-asserted-by":"publisher","first-page":"617","DOI":"10.7150\/ijms.5773","article-title":"The prognostic value of abdominal aortic calcification in peritoneal dialysis patients.","volume":"10","author":"Yoon","year":"2013","journal-title":"Int J Med Sci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.atherosclerosis.2015.10.016","article-title":"Impact of abdominal aortic calcification on long-term cardiovascular outcomes in patients with chronic kidney disease.","volume":"243","author":"Tatami","year":"2015","journal-title":"Atherosclerosis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1016\/j.ijcard.2016.06.064","article-title":"Comparing different calcification scores to detect outcomes in chronic kidney disease patients with vascular calcification.","volume":"220","author":"NasrAllah","year":"2016","journal-title":"Int J Cardiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.transproceed.2017.12.011","article-title":"Slow progression of aortic calcification is a potential benefit of pre-emptive kidney transplantation.","volume":"50","author":"Mursawa","year":"2018","journal-title":"Transplant Proc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1016\/j.numecd.2020.04.029","article-title":"The combined prognostic significance of alkaline phosphatase and vascular calcification in patients with end-stage kidney disease.","volume":"30","author":"Kim","year":"2020","journal-title":"Nutr Metab Cardiovasc Dis."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e21730","DOI":"10.1097\/MD.0000000000021730","article-title":"Abdominal aorta calcification predicts cardiovascular but not non-cardiovascular outcome in patients receiving peritoneal dialysis: a prospective cohort study.","volume":"99","author":"Tsai","year":"2020","journal-title":"Medicine."},{"key":"B29","first-page":"154","article-title":"The correlation between CT abdominal aortic calcification index and serum homocysteine levels and its prognostic value in patients with uremia.","volume":"24","author":"Liu","year":"2026","journal-title":"Chin J CT MRI."},{"key":"B30","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.","volume":"372","author":"Page","year":"2021","journal-title":"BMJ."},{"key":"B31","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.2.","author":"Higgins","year":"2021"},{"key":"B32","unstructured":"Wells\n G\n \n \n Shea\n B\n \n \n O\u2019Connell\n D\n \n \n Peterson\n J\n \n \n Welch\n V\n \n \n Losos\n M\n \n \n The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses.\n \n 2010"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis.","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s12874-020-00966-4","article-title":"Methodological tools and sensitivity analysis for assessing quality or risk of bias used in systematic reviews published in the high-impact anesthesiology journals.","volume":"20","author":"Maru\u0161i\u0107","year":"2020","journal-title":"BMC Med Res Methodol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test.","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ."},{"key":"B36","doi-asserted-by":"publisher","first-page":"5834","DOI":"10.2174\/1381612820666140212195309","article-title":"Abdominal aortic calcification: clinical significance, mechanisms and therapies.","volume":"20","author":"Golledge","year":"2014","journal-title":"Curr Pharm Des."},{"key":"B37","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1002\/ags3.12816","article-title":"Abdominal aortic calcification among gastroenterological and transplant surgery.","volume":"8","author":"Imaoka","year":"2024","journal-title":"Ann Gastroenterol Surg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/j.jvs.2022.07.001","article-title":"Aortic calcification index predicts mortality and cardiovascular events in operatively treated patients with peripheral artery disease: a prospective PURE ASO cohort follow-up study.","volume":"76","author":"Rantasalo","year":"2022","journal-title":"J Vasc Surg."},{"key":"B39","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jcct.2019.01.016","article-title":"Reproducibility of aortic valve calcification scoring with computed tomography - an interplatform analysis.","volume":"13","author":"Eberhard","year":"2019","journal-title":"J Cardiovasc Comput Tomogr."},{"key":"B40","doi-asserted-by":"publisher","first-page":"404","DOI":"10.3390\/biomedicines9040404","article-title":"Vascular calcification in chronic kidney disease: diversity in the vessel wall.","volume":"9","author":"Dube","year":"2021","journal-title":"Biomedicines."},{"key":"B41","doi-asserted-by":"publisher","first-page":"673","DOI":"10.14336\/AD.2021.1024","article-title":"Vascular calcification in chronic kidney disease: an update and perspective.","volume":"13","author":"Ren","year":"2022","journal-title":"Aging Dis."},{"key":"B42","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1161\/HYPERTENSIONAHA.116.08459","article-title":"Increased aortic calcification is associated with arterial stiffness progression in multiethnic middle-aged men.","volume":"69","author":"Guo","year":"2017","journal-title":"Hypertension."},{"key":"B43","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1159\/000501687","article-title":"Impact of abdominal aortic calcification on central haemodynamics and decline of glomerular filtration rate in patients with chronic kidney disease stages 3 and 4.","volume":"44","author":"Jansson","year":"2019","journal-title":"Kidney Blood Press Res."},{"key":"B44","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s00223-013-9712-z","article-title":"Vascular calcification: an update on mechanisms and challenges in treatment.","volume":"93","author":"Wu","year":"2013","journal-title":"Calcif Tissue Int."},{"key":"B45","doi-asserted-by":"publisher","first-page":"2685","DOI":"10.3390\/ijms21082685","article-title":"Vascular calcification-new insights into its mechanism.","volume":"21","author":"Lee","year":"2020","journal-title":"Int J Mol Sci."},{"key":"B46","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1111\/sdi.12840","article-title":"Pathogenesis and management of vascular calcification in CKD and dialysis patients.","volume":"32","author":"Kakani","year":"2019","journal-title":"Semin Dial."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1016\/j.hlc.2021.06.516","article-title":"Vascular ageing in youth: a call to action.","volume":"30","author":"Climie","year":"2021","journal-title":"Heart Lung Circ."},{"key":"B48","doi-asserted-by":"publisher","first-page":"2380","DOI":"10.1161\/CIRCULATIONAHA.113.003341","article-title":"Vascular calcification: an age-old problem of old age.","volume":"127","author":"Leopold","year":"2013","journal-title":"Circulation."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1907104\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:18:04Z","timestamp":1788949084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1907104\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":48,"alternative-id":["10.3389\/fmed.2026.1907104"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1907104","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1907104"}}