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Updated: Jun 27, 2025
A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Association between progression of coronary artery calcification and development of kidney failure with replacement
Cheol Ho Park1, Hyung Woo Kim1, Jung Tak Park1
1Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Coronary artery calcification (CAC) progression significantly increases the risk of kidney failure with replacement therapy (KFRT) in patients with chronic kidney disease (CKD). Monitoring CAC changes may help predict CKD progression.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- High coronary artery calcification (CAC) burden is a known risk factor for cardiovascular and kidney disease.
- The relationship between the progression of coronary atherosclerosis and kidney disease progression remains unclear.
Purpose of the Study:
- To evaluate the association between the progression of coronary artery calcification (CAC) and the risk of kidney failure with replacement therapy (KFRT) in patients with chronic kidney disease (CKD).
Main Methods:
- Analysis of 1173 participants with CKD (G1-G5) from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD).
- Participants were grouped based on CAC score changes over 4 years: non-progressors (≤0 AU), moderate progressors (1-199 AU), and severe progressors (≥200 AU).
- The primary outcome was the incidence of KFRT, assessed over a median follow-up of 4.2 years.
Main Results:
- The incidence of KFRT was higher in moderate (54.3 per 1000 person-years) and severe progressors (80.9 per 1000 person-years) compared to non-progressors (37.6 per 1000 person-years).
- Multivariable analysis showed significantly increased hazard ratios for KFRT in moderate (HR 1.71) and severe progressors (HR 2.55) versus non-progressors.
- Sensitivity analysis using a 100 AU threshold for CAC progression yielded similar results.
Conclusions:
- Progression of coronary artery calcification is independently associated with an elevated risk of kidney failure with replacement therapy in CKD patients.
- Changes in coronary atherosclerosis burden may contribute to the progression of kidney disease.
Background And Aims:
High coronary artery calcification (CAC) burden is a significant risk factor for adverse cardiovascular and kidney outcomes. However, it is unknown whether changes in the coronary atherosclerotic burden can accompany changes in kidney disease progression. Here, we evaluated the relationship between CAC progression and the risk of kidney failure with replacement therapy (KFRT).
Methods:
We analyzed 1173 participants with chronic kidney disease (CKD) G1 to G5 without kidney replacement therapy from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Participants were categorized into three groups according to the change in the CAC score between enrollment and year 4 (non-progressors, ≤0 AU; moderate progressors, 1-199 AU; and severe progressors, ≥200 AU). The primary outcome was the development of KFRT.
Results:
During a follow-up period of 4690 person-years (median, 4.2 years), the primary outcome occurred in 230 (19.6 %) participants. The incidence of KFRT was 37.6, 54.3, and 80.9 per 1000 person-years in the non-, moderate, and severe progressors, respectively. In the multivariable cause-specific hazard model, the hazard ratios (HRs) for the moderate and severe progressors were 1.71 (95 % confidence interval [CI], 1.02-2.87) and 2.55 (95 % CI, 1.07-6.06), respectively, compared with non-progressors. A different definition of CAC progression with a threshold of 100 AU yielded similar results in a sensitivity analysis.
Conclusions:
CAC progression is associated with an increased risk of KFRT in patients with CKD. Our findings suggest that coronary atherosclerosis changes increase the risk of CKD progression.
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