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The Predictive Value of Serum Aldosterone Level for Coronary Artery Calcium Score in Patients with Chronic Kidney
Viktor V Semenov1, Jizzo R Bosdriesz2, Olexandr Kuryata3
1Department of Internal Medicine 2 and Phthisiology, Dnipro State Medical University, Dnipro, Ukraine. semenovviktvikt@gmail.com.
Insights
Serum aldosterone levels can predict coronary artery calcium scores (CACS) in patients with chronic kidney disease (CKD), particularly for scores over 100 Agatston units (AU). While aldosterone shows predictive ability, age remains a stronger individual predictor for CACS in this population.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Patients with chronic kidney disease (CKD) face elevated cardiovascular risk (CVR), often underestimated by standard risk assessment tools.
- Coronary artery calcium score (CACS) enhances CVR stratification but is frequently unavailable in resource-limited settings.
- Serum aldosterone is explored as a potentially cost-effective alternative for CVR assessment in CKD.
Purpose of the Study:
- To evaluate the predictive capability of serum aldosterone levels for CACS in CKD patients.
- To compare aldosterone's predictive performance against conventional risk factors for CACS.
- To determine if aldosterone improves CVR prediction when combined with established predictors.
Main Methods:
- A single-center study involving 57 CKD patients (eGFR ≥45 ml/min) with arterial hypertension.
- Serum aldosterone, age, sex, BMI, blood pressure, cholesterol, eGFR, and proteinuria were assessed.
- Area under the curve (AUC) and Brier scores were used to analyze the prediction of CACS > 0 AU and CACS > 100 AU.
Main Results:
- Aldosterone significantly predicted CACS > 100 AU (AUC = 0.72) but not CACS > 0 AU.
- Age was a strong predictor for both CACS > 100 AU (AUC = 0.80) and CACS > 0 AU (AUC = 0.75).
- Adding aldosterone to age improved the Brier score for predicting CACS > 100 AU (0.14 vs. 0.16) but did not significantly alter the AUC.
Conclusions:
- Serum aldosterone is a significant predictor of high coronary artery calcium scores (CACS > 100 AU) in patients with chronic kidney disease (CKD).
- However, aldosterone is not a superior predictor compared to age alone for CACS in this cohort.
- Aldosterone may offer adjunctive value in refining cardiovascular risk assessment in CKD patients, especially when combined with age, potentially aiding in resource-limited settings.
Abstract:
Patients with chronic kidney disease (CKD) have high cardiovascular risk (CVR), which is often underestimated by conventional tools. The coronary artery calcium score (CACS) significantly improves CVR stratification by conventional tools, but it is often not available in low-resources settings. Aldosterone may be a cheaper alternative to CACS for CVR assessment in CKD patients. The aim was to assess the ability of serum aldosterone level to predict CACS in patients with CKD in comparison to standard predictors. This single-center study included 57 patients aged 40 to 67 years with CKD (estimated glomerular filtration rate [eGFR] ≥45 ml/min) and arterial hypertension. Serum aldosterone, sex, age, body mass index, blood pressure, total cholesterol, eGFR, and proteinuria were used for prediction of CACS>0 Agatston units (AU) and CACS>100 AU. The area under the curve (AUC) with 95% confidence intervals (CI) and the mean Brier scores were examined for predictors of CACS. Aldosterone predicted a CACS>100 AU (AUC = 0.72, 95% CI: 0.56-0.88), but not a CACS>0 AU. Age predicted a CACS>100 AU (AUC = 0.80, 95% CI: 0.67-0.93) and a CACS>0 AU (AUC = 0.75, 95% CI: 0.62-0.89). The addition of aldosterone to age for prediction of a CACS>100 AU improved the mean Brier score, compared to the model with age alone, from 0.16 to 0.14, but not the AUC (0.83, 95% CI: 0.70-0.95). Aldosterone was a significant predictor of a CACS>100 AU in patients with CKD, but aldosterone was not a better predictor than age alone.
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