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Systemic Inflammation Is Associated With Coronary Artery Calcification and All-Cause Mortality in Chronic Kidney
In-Chang Hwang1, Hyo Eun Park, Hack-Lyoung Kim
1Department of Internal Medicine, Seoul National University College of Medicine.
Insights
Systemic inflammation in chronic kidney disease (CKD) worsens coronary artery calcification (CAC) and mortality risk. Coronary evaluation is advised for CKD patients with elevated hsCRP and significant CAC.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Systemic inflammation is linked to coronary artery calcification (CAC) in chronic kidney disease (CKD).
- The prognostic impact of this association on mortality remains unclear.
- Evaluating the interplay between CAC, kidney function, and inflammation is crucial.
Purpose of the Study:
- To investigate the association between CAC, estimated glomerular filtration rate (eGFR), and all-cause mortality.
- To determine if systemic inflammation modifies these associations.
- To identify high-risk CKD patients who may benefit from coronary evaluation.
Main Methods:
- A cohort of 30,703 individuals with CAC measurements was followed for a median of 79 months.
- Patients were stratified by CAC score, eGFR categories, and hsCRP levels (≥2.0 mg/L indicating inflammation).
- Statistical analyses adjusted for potential confounders.
Main Results:
- Lower eGFR and higher hsCRP were independently associated with increased CAC prevalence and extent.
- The association between lower eGFR and high CAC score (≥400) was more pronounced with higher hsCRP.
- In CKD patients (eGFR <60 ml/min/1.73 m²), greater CAC burden predicted worse outcomes only in those with elevated hsCRP.
Conclusions:
- Reduced eGFR and extensive CAC increase mortality risk in CKD patients.
- Systemic inflammation significantly influences the relationship between CAC, kidney function, and mortality.
- Coronary evaluation should be considered for CKD patients with elevated hsCRP and significant CAC.
Background:
Presence of systemic inflammation in chronic kidney disease (CKD) is associated with advanced coronary artery calcification (CAC). The prognostic significance of this association, however, is unknown. We evaluated the associations between CAC, estimated glomerular filtration rate (eGFR) and all-cause mortality, to determine whether the associations differ according to the presence of systemic inflammation.
Methods And Results:
We followed 30,703 consecutive individuals who underwent CAC measurement for a median of 79 months (IQR, 65-96 months). Patients were categorized according to baseline CAC score (0, 1-99, 100-399 and ≥400), eGFR (<45, 45-59, 60-74, 75-89, 90-104, and ≥105 ml/min/1.73 m(2)) and high-sensitivity C-reactive protein (hsCRP; <2.0, and ≥2.0 mg/L). Prevalence and extent of CAC were greater in those with lower eGFR and higher hsCRP accordingly, even after adjustment. Lower eGFR was strongly associated with higher CAC score (≥400), and the association was more significant in patients with higher hsCRP. The greater CAC burden was associated with worse outcome in the CKD patients (eGFR <60 ml/min/1.73 m(2)) only in those with higher hsCRP.
Conclusions:
Patients with low eGFR and more extensive CAC had greater risk of mortality, and associations differed according to the presence of systemic inflammation. Among the CKD patients, coronary evaluation may be considered for those with elevated hsCRP. (Circ J 2016; 80: 1644-1652).
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