Abstract
Abdominal aortic calcification (AAC) is a clinically important marker of systemic vascular disease and cardiovascular
risk in patients receiving maintenance hemodialysis. Evidence from Palestine remains limited. This
study assessed the prevalence and severity of AAC and identified factors associated with increasing calcification
burden among Palestinian hemodialysis patients. This single-center cross-sectional study was conducted
at An-Najah National University Hospital, Palestine, between August 2025 and January 2026. Adults receiving
maintenance hemodialysis for at least 6 months were recruited using convenience sampling. AAC was assessed
on lateral lumbar radiographs using the validated 24-point Kauppila score and categorized as no calcification
(0), mild-to-moderate calcification (1–6), or severe calcification (≥ 7). Clinical, laboratory, medication, and
radiographic data were analyzed using appropriate parametric and non-parametric tests. A multivariable ordinal
logistic regression model was used to identify independent predictors of increasing AAC severity, and a sensitivity
model additionally adjusted for serum calcium and phosphate. A total of 163 patients were included,
representing 95.9% of the prespecified target sample. Overall, 35.6% had no calcification, 23.9% had mildto-
moderate calcification, and 40.5% had severe AAC. Age increased progressively across AAC categories
(p < 0.001) and showed a moderate positive correlation with total AAC score (Spearman’s ρ = 0.531, p < 0.001).
Serum albumin, creatinine, fasting glucose, potassium, and platelet count were associated with AAC in unadjusted
group comparisons or correlation analyses. In the primary multivariable model, age was the only independent
predictor of increasing AAC severity; each additional year of age was associated with a 7.9% increase
in the odds of belonging to a higher AAC category (adjusted OR 1.079, 95% CI 1.049–1.108; p < 0.001). The
proportional-odds assumption was satisfied (p = 0.620), and model fit was acceptable. In the CKD-MBD sensitivity
analysis, age remained significant (adjusted OR 1.082, 95% CI 1.051–1.114; p < 0.001), whereas phosphate
was not significant and calcium showed only a borderline association. Associations involving diabetes
and albumin were sensitive to model specification and were therefore interpreted cautiously. AAC was highly
prevalent in this Palestinian hemodialysis cohort, with severe calcification affecting approximately two in five
patients. Age was the most robust and consistently significant predictor of increasing AAC severity. Lateral lumbar radiography may provide an accessible adjunct to cardiovascular risk assessment, although prospective
multicenter studies are needed to confirm clinical utility and clarify modifiable risk pathways.

Title

Scientific Reports

Publisher

An-Najah National University

Publisher Country

Palestine

Indexing

Scopus

Impact Factor

4.9

Publication Type

Online only

Volume

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Year

2026

Pages

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