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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Coronary Artery Calcification as a Marker for Coronary Artery Stenosis: Comparing Kidney Failure to the General

Thijs T Jansz1, Meike H Y Go2,3, Nolan S Hartkamp2,4

  • 1Departments of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht.

Kidney Medicine
|June 17, 2021
PubMed

Insights

Dialysis patients show higher coronary artery calcification (CAC) but a comparatively lower risk of stenosis than non-CKD patients. High CAC scores in dialysis patients may not always indicate significant coronary artery stenosis.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Radiology

Background:

  • Coronary artery calcification (CAC) is linked to cardiovascular mortality and chronic kidney disease (CKD).
  • The relationship between CAC and coronary artery stenosis in dialysis patients compared to those without CKD is not well understood.

Purpose of the Study:

  • To compare the association between CAC and coronary artery stenosis in patients undergoing dialysis versus those without CKD.
  • To determine if dialysis status modifies the relationship between CAC and coronary artery stenosis.

Main Methods:

  • Observational cohort study comparing 127 dialysis patients and 447 non-CKD patients with cardiovascular risk factors.
  • Cardiac computed tomography (CT) including non-contrast and CT angiography was used to assess CAC score and coronary artery stenosis.
  • Propensity score matching was employed to balance cardiovascular risk factors between the two groups.

Main Results:

  • In a matched cohort of 224 patients, median CAC score was significantly higher in dialysis patients (210) than in non-CKD patients (58).
  • The odds of stenosis (≥50% or ≥70%) decreased significantly with each 100-unit increase in CAC score in the dialysis cohort compared to the non-CKD cohort.
  • Despite higher CAC scores, the prevalence of significant stenosis (≥50%) was similar between groups (35% vs. 36%).

Conclusions:

  • Dialysis patients exhibit a higher risk for coronary artery stenosis associated with higher CAC scores, but this risk is relatively lower than in non-CKD patients with similar CAC levels.
  • A high CAC score in dialysis patients does not always correlate with significant coronary artery stenosis.
  • The findings provide a basis for translating CAC scores to the probability of coronary stenosis in dialysis patients.
Abstract

Keywords:
Coronary calcificationcoronary stenosisend-stage kidney diseasehemodialysisischemic cardiac diseaseperitoneal dialysisrenal failure

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