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Published on: August 28, 2018
Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease
Hae-Ryong Yun1, Young Su Joo1, Hyung Woo Kim2
1Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Elevated coronary artery calcification score (CACS) in patients with chronic kidney disease (CKD) is linked to a higher risk of kidney disease progression and adverse outcomes. This highlights CACS as a significant predictor of CKD worsening.
Area of Science:
- Nephrology
- Cardiology
- Biomedical Imaging
Background:
- Coronary artery calcification score (CACS) is a known cardiovascular disease risk marker.
- The association between CACS and the progression of chronic kidney disease (CKD) remains unclear.
Purpose of the Study:
- To investigate the relationship between CACS and CKD progression.
- To determine if CACS predicts adverse kidney outcomes in patients with CKD.
Main Methods:
- A cohort of 1936 CKD patients (stages G1-G5) was analyzed.
- Coronary artery calcification score (CACS) categories (0 AU, 1-100 AU, >100 AU) were assessed at baseline.
- CKD progression was defined as a ≥50% eGFR decline or kidney failure requiring replacement therapy.
Main Results:
- Higher CACS (1-100 AU and >100 AU) significantly increased the risk of CKD progression.
- A per 1-SD increase in log CACS was associated with a 13% higher risk of CKD progression.
- Elevated CACS was also linked to a faster eGFR decline rate, particularly in older patients, those with type 2 diabetes, and those not on antiplatelet drugs.
Conclusions:
- High coronary artery calcification score (CACS) is a significant predictor of adverse kidney outcomes.
- CACS is associated with an increased risk of chronic kidney disease (CKD) progression.
Background:
An elevated coronary artery calcification score (CACS) is associated with increased cardiovascular disease risk in patients with CKD. However, the relationship between CACS and CKD progression has not been elucidated.
Methods:
We studied 1936 participants with CKD (stages G1-G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1-100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy.
Results:
During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1-100 AU (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1-100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate.
Conclusion:
Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.
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