Related Experiment Video
Updated: May 7, 2025
Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Association Between Chronic Kidney Disease Risk Categories and Abdominal Aortic Calcification: Insights From the
Song Peng Ang1, Jackson Rajendran1, Jia Ee Chia2
1Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
Insights
Chronic kidney disease (CKD) patients with mild risk factors (category 2) may have a higher risk of severe abdominal aortic calcification (AAC). This suggests a need for enhanced cardiovascular risk management in this group.
Area of Science:
- Cardiovascular epidemiology
- Nephrology
- Radiology
Background:
- Abdominal aortic calcification (AAC) is a key cardiovascular risk marker.
- Chronic kidney disease (CKD) complicates cardiovascular risk assessment.
- Current risk stratification may underdiagnose risk in moderate CKD.
Purpose of the Study:
- To assess the association between CKD risk categories (eGFR and albuminuria) and severe AAC.
- To investigate if CKD classification refines cardiovascular risk prediction.
- To identify potential markers for severe AAC in CKD patients.
Main Methods:
- Cross-sectional analysis of NHANES 2013-2014 data.
- Inclusion of adults aged ≥40 with AAC assessment.
- Multivariate logistic regression adjusted for cardiovascular risk factors.
Main Results:
- Severe AAC was present in 13.4% of participants.
- Unadjusted analyses showed increased severe AAC in CKD categories 2, 3, and 4.
- Adjusted analyses indicated a trend towards higher severe AAC risk in CKD categories 2 and 4, though not statistically significant.
Conclusions:
- CKD category 2, with mild eGFR reduction and albuminuria, may indicate higher severe AAC risk.
- Findings suggest potential for improved cardiovascular risk stratification in CKD.
- Further research and aggressive risk management in this population are warranted.
Background:
Abdominal aortic calcification (AAC) is a critical indicator of cardiovascular risk, particularly in patients with chronic kidney disease (CKD). Traditional classification systems may underestimate the risk in those with moderate CKD. This study aimed to evaluate the association between CKD risk categories - defined by both estimated glomerular filtration rate (eGFR) and albuminuria - and the prevalence of severe AAC.
Methods:
This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. We included adults aged ≥ 40 years who underwent imaging for AAC assessment, excluding pregnant individuals and those without AAC scores. Survey-weighted and multivariate logistic regression was employed to assess the relationship between CKD risk categories and severe AAC, adjusting for age, hypertension, and smoking history. Subgroup analyses were conducted to explore variability across demographic and clinical subgroups.
Results:
We analyzed data from 3,140 participants in the NHANES, 423 (13.4%) of whom had severe AAC. The cohort was categorized into CKD risk categories 1 through 4, with the majority (76%) in stage 1. Severe AAC was more prevalent among older individuals and those with traditional cardiovascular risk factors. Initial unadjusted analyses revealed that CKD category 2 was associated with a nearly fourfold increase in severe AAC (odds ratio (OR): 3.93), while categories 3 and 4 showed 3.75-fold and over 10-fold increases, respectively (all P < 0.01). However, after adjusting for confounders, categories 2 and 4 showed higher risks of severe AAC compared to category 1, but these associations did not reach statistical significance (OR: 1.72, 95% confidence interval (CI): 0.90 - 1.86, P = 0.06 and OR: 5.70, 95% CI: 0.85 - 38.00, P = 0.07, respectively).
Conclusion:
Our study offers insights that may complement the current reliance on eGFR and albuminuria in risk stratification, highlighting that CKD category 2, defined by mildly reduced eGFR and albuminuria, may be a potential marker for severe AAC. Although statistical significance was narrowly missed after full adjustment, the clinical implications remain significant, advocating for more aggressive cardiovascular risk management in this population. This understanding may contribute to evolving approaches in CKD-related cardiovascular risk assessment and inform potential intervention strategies.
Related Concept Videos
01:21External Anatomy of the Kidney
The kidneys are located in the retroperitoneal space on either side of the vertebral column, protected posteriorly by the 11th and 12th ribs. The right kidney sits slightly lower than the left owing to the presence of the liver...
01:45Kidney Structure