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Is coronary artery calcification associated with vertebral bone density in nondialyzed chronic kidney disease
Agostinho Filgueira1, Aluizio Barbosa Carvalho, Cristiane Tomiyama
1Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
Insights
Low vertebral bone density (VBD) is linked to coronary artery calcification (CAC) in chronic kidney disease (CKD) patients. This finding suggests VBD may be a cardiovascular risk factor in early-stage CKD.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Chronic kidney disease (CKD) patients exhibit high rates of low bone mineral density and coronary artery calcification (CAC).
- Both low bone density and CAC are significant predictors of mortality in CKD patients.
Purpose of the Study:
- To investigate the association between reduced vertebral bone density (VBD) and the presence of CAC.
- To explore this relationship in patients with earlier stages of CKD.
Main Methods:
- Seventy-two nondialyzed CKD patients were assessed.
- Vertebral bone density (VBD) and coronary artery calcification (CAC) were quantified using computed tomography.
Main Results:
- Fifty percent of patients had CAC > 10 Agatston units (AU).
- VBD showed an inverse correlation with age and CAC score.
- Low VBD was independently associated with the presence of CAC after adjusting for confounding factors.
Conclusions:
- Reduced VBD is associated with CAC in nondialyzed CKD patients.
- Low VBD may represent an additional nontraditional risk factor for cardiovascular disease in CKD patients.
Background And Objectives:
Low bone mineral density and coronary artery calcification (CAC) are highly prevalent among chronic kidney disease (CKD) patients, and both conditions are strongly associated with higher mortality. The study presented here aimed to investigate whether reduced vertebral bone density (VBD) was associated with the presence of CAC in the earlier stages of CKD.
Design, Setting, Participants, & Measurements:
Seventy-two nondialyzed CKD patients (age 52 ± 11.7 years, 70% male, 42% diabetics, creatinine clearance 40.4 ± 18.2 ml/min per 1.73 m(2)) were studied. VBD and CAC were quantified by computed tomography.
Results:
CAC > 10 Agatston units (AU) was observed in 50% of the patients (median 120 AU [interquartile range 32 to 584 AU]), and a calcification score ≥ 400 AU was found in 19% (736 [527 to 1012] AU). VBD (190 ± 52 Hounsfield units) correlated inversely with age (r = -0.41, P < 0.001) and calcium score (r = -0.31, P = 0.01), and no correlation was found with gender, creatinine clearance, proteinuria, lipid profile, mineral parameters, body mass index, and diabetes. Patients in the lowest tertile of VBD had expressively increased calcium score in comparison to the middle and highest tertile groups. In the multiple logistic regression analysis adjusting for confounding variables, low VBD was independently associated with the presence of CAC.
Conclusions:
Low VBD was associated with CAC in nondialyzed CKD patients. The authors suggest that low VBD might constitute another nontraditional risk factor for cardiovascular disease in CKD.
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