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Kidney function and aortic valve and mitral annular calcification in the Multi-Ethnic Study of Atherosclerosis (MESA)
Joachim H Ix1, Michael G Shlipak, Ronit Katz
1Department of Medicine, University of California, San Francisco, CA 94143-0532, USA.
Insights
Mild kidney dysfunction showed a modest link to aortic valve calcification (AVC). However, impaired kidney function was strongly associated with mitral annular calcification (MAC) only in individuals with diabetes.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Epidemiology
Background:
- Aortic valve calcification (AVC) and mitral annular calcification (MAC) are common in kidney disease patients and predict mortality.
- The association between less severe kidney dysfunction and AVC/MAC is not well understood.
Purpose of the Study:
- To investigate the relationship between markers of kidney dysfunction and the prevalence of AVC and MAC in middle-aged adults.
- To explore if diabetes modifies the association between kidney function and valvular calcification.
Main Methods:
- Cross-sectional study of ethnically diverse middle-aged adults from the Multi-Ethnic Study of Atherosclerosis.
- Kidney function assessed by estimated glomerular filtration rate (eGFR), cystatin C, and microalbuminuria.
- AVC and MAC quantified using computed tomography; multivariable logistic regression used for analysis.
Main Results:
- Reduced eGFR and higher cystatin C showed a modest association with AVC.
- Associations between reduced eGFR or higher cystatin C and MAC were significant only in participants with diabetes.
- Microalbuminuria was not independently associated with AVC but showed a significant association with MAC.
Conclusions:
- Impaired kidney function has a modest association with AVC, but a stronger association with MAC in individuals with diabetes.
- Further research is needed to understand how kidney impairment and diabetes interact in causing vascular calcification across different vascular beds.
Background:
Aortic valve calcification (AVC) and mitral annular calcification (MAC) are highly prevalent and predictive of mortality in end-stage renal disease populations. Whether less severe kidney dysfunction is associated with AVC and MAC is uncertain.
Study Design:
Cross-sectional study.
Setting & Participants:
Ethnically diverse middle-aged adults without clinically apparent cardiovascular disease who participated in the Multi-Ethnic Study of Atherosclerosis.
Predictor:
Estimated glomerular filtration rate (eGFR), cystatin C, and microalbuminuria.
Outcomes & Measurements:
AVC and MAC were determined by means of computed tomography. Multivariable logistic regression evaluated the association of kidney function with AVC and MAC.
Results:
Of 6,785 participants, 10% had an eGFR less than 60 mL/min/1.73 m(2) (<1.0 mL/s/1.73 m(2)), mean cystatin C level was 0.9 +/- 0.2 mg/L, 7% had microalbuminuria (albumin >or= 30 mg/g), 15% had diabetes, 13% had AVC, and 9% had MAC. In adjusted analyses for AVC, eGFR less than 60 mL/min/1.73 m(2) (adjusted odds ratio, 1.23; 95% confidence interval, 0.99 to 1.14) and greater cystatin C concentrations (per SD increase; adjusted odds ratio, 1.06; 95% confidence interval, 0.99 to 1.14) had modest associations. Microalbuminuria was not associated independently with AVC (adjusted odds ratio, 1.11; 95% confidence interval, 0.89 to 1.40). For the MAC end point, associations of eGFR less than 60 mL/min/1.73 m(2) and greater cystatin C level differed by diabetes status (P for interaction = 0.1 and 0.02, respectively). In persons with diabetes, eGFR less than 60 mL/min/1.73 m(2) (adjusted odds ratio, 2.03; 95% confidence interval, 1.26 to 3.25) and greater cystatin C level (adjusted odds ratio, 1.38; 95% confidence interval, 1.14 to 1.68) were associated strongly, whereas no association was observed in subjects without diabetes (eGFR < 60 mL/min/1.73 m(2): adjusted odds ratio, 1.13; 95% confidence interval, 0.86 to 1.49; cystatin C: adjusted odds ratio, 1.03; 95% confidence interval, 0.93 to 1.13). The association of microalbuminuria with MAC (adjusted odds ratio, 1.37; 95% confidence interval, 1.06 to 1.76) did not differ by diabetes status (P for interaction = 0.2).
Limitations:
There were few participants with severe kidney disease.
Conclusions:
Impaired kidney function had only a modest association with AVC, whereas its association with MAC was observed only in persons with diabetes. Future studies should evaluate whether associations of kidney impairment with dystrophic calcification differ by diabetes status in other clinical settings and vascular beds.
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