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Coronary artery calcification in patients with diabetes mellitus and advanced chronic kidney disease

Marta Cano-Megías1, Hanane Bouarich1, Pablo Guisado-Vasco2

  • 1Unidad de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.

Endocrinologia, Diabetes Y Nutricion
|December 5, 2018
PubMed

Insights

Patients with advanced chronic kidney disease (CKD) and diabetes mellitus (DM) exhibit more severe coronary artery calcification (CaC) and higher mortality rates. This highlights the critical link between these conditions and cardiovascular risk.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Endocrinology

Background:

  • Patients with chronic kidney disease (CKD) and diabetes mellitus (DM) face elevated cardiovascular risk due to shared pathways of atherosclerosis and vascular calcification.
  • Coronary artery calcification (CaC) is more prevalent and severe in diabetic patients, irrespective of kidney function.
  • Limited data exists on the long-term prognostic implications of CaC in diabetic individuals with CKD.

Purpose of the Study:

  • To investigate the association between coronary artery calcification (CaC) and long-term mortality in patients with advanced chronic kidney disease (CKD).
  • To compare the severity of CaC and mortality rates between diabetic and non-diabetic patients with advanced CKD.

Main Methods:

  • A prospective longitudinal study included 137 patients with advanced CKD.
  • Coronary computed tomography (CT) was used to assess coronary artery calcification (CaC) using the Agatston score.
  • Patients were categorized into severe (CaCs≥400HU) and mild-moderate (CaCs<400HU) calcification groups.

Main Results:

  • Diabetes mellitus (DM) was present in 28% of subjects, associated with more severe CaC, lower albumin, and higher C-reactive protein.
  • Serum albumin levels correlated with severe CaC (r=-0.45, P=.009).
  • Overall mortality was 58%; diabetic patients showed higher mortality, particularly those with severe CaC (93% vs. 73% in non-diabetics, P=.04).

Conclusions:

  • Advanced CKD patients with DM demonstrate more severe coronary artery calcification (CaC).
  • These patients exhibit increased markers of inflammation and malnutrition.
  • The presence of both advanced CKD and DM is linked to significantly higher long-term mortality.
Abstract

Keywords:
Advanced chronic kidney diseaseCalcificación arterial coronariaCoronary arterial calcificationDiabetes mellitusEnfermedad renal crónicaHemodialysisHemodiálisisMortalidadMortality

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