Risk factors for progression of coronary artery calcification in patients with chronic kidney disease: The CRIC study

the CRIC Study Investigators

Research output: Contribution to journalArticle

Abstract

Background and aims: Coronary artery calcification (CAC) is common among patients with chronic kidney disease (CKD) and predicts the risk for cardiovascular disease (CVD). We examined the associations of novel risk factors with CAC progression among patients with CKD. Methods: Among 1123 CKD patients in the Chronic Renal Insufficiency Cohort (CRIC) Study, CAC was measured in Agatston units at baseline and a follow-up visit using electron beam computed tomography or multidetector computed tomography. Results: Over an average 3.3-year follow-up, 109 (25.1%) participants without CAC at baseline had incident CAC and 124 (18.0%) participants with CAC at baseline had CAC progression, defined as an annual increase of ≥100 Agatston units. After adjustment for established atherosclerotic risk factors, several novel risk factors were associated with changes in CAC over follow-up. Changes in square root transformed CAC score associated with 1 SD greater level of risk factors were −0.20 (95% confidence interval, −0.31 to −0.10; p < 0.001) for estimated glomerular filtration rate, 0.14 (0.02–0.25; p = 0.02) for 24-h urine albumin, 0.25 (0.15–0.34; p < 0.001) for cystatin C, −0.17 (−0.27 to −0.07; p < 0.001) for serum calcium, 0.14 (0.03–0.24; p = 0.009) for serum phosphate, 0.24 (0.14–0.33; p < 0.001) for fibroblast growth factor-23, 0.13 (0.04–0.23; p = 0.007) for total parathyroid hormone, 0.17 (0.07–0.27; p < 0.001) for interleukin-6, and 0.12 (0.02–0.22; p = 0.02) for tumor necrosis factor-α. Conclusions: Reduced kidney function, calcium and phosphate metabolism disorders, and inflammation, independent of established CVD risk factors, may progress CAC among CKD patients.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalAtherosclerosis
Volume271
DOIs
StatePublished - Apr 1 2018

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Chronic Renal Insufficiency
Coronary Vessels
Cohort Studies
Cardiovascular Diseases
Cystatin C
X Ray Computed Tomography
Multidetector Computed Tomography
Parathyroid Hormone
Serum
Glomerular Filtration Rate
Albumins
Interleukin-6
Tumor Necrosis Factor-alpha
Phosphates
Urine
Confidence Intervals
Inflammation
Calcium
Kidney

Keywords

  • Chronic kidney disease
  • Coronary artery disease
  • Epidemiology
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk factors for progression of coronary artery calcification in patients with chronic kidney disease : The CRIC study. / the CRIC Study Investigators.

In: Atherosclerosis, Vol. 271, 01.04.2018, p. 53-60.

Research output: Contribution to journalArticle

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title = "Risk factors for progression of coronary artery calcification in patients with chronic kidney disease: The CRIC study",
abstract = "Background and aims: Coronary artery calcification (CAC) is common among patients with chronic kidney disease (CKD) and predicts the risk for cardiovascular disease (CVD). We examined the associations of novel risk factors with CAC progression among patients with CKD. Methods: Among 1123 CKD patients in the Chronic Renal Insufficiency Cohort (CRIC) Study, CAC was measured in Agatston units at baseline and a follow-up visit using electron beam computed tomography or multidetector computed tomography. Results: Over an average 3.3-year follow-up, 109 (25.1{\%}) participants without CAC at baseline had incident CAC and 124 (18.0{\%}) participants with CAC at baseline had CAC progression, defined as an annual increase of ≥100 Agatston units. After adjustment for established atherosclerotic risk factors, several novel risk factors were associated with changes in CAC over follow-up. Changes in square root transformed CAC score associated with 1 SD greater level of risk factors were −0.20 (95{\%} confidence interval, −0.31 to −0.10; p < 0.001) for estimated glomerular filtration rate, 0.14 (0.02–0.25; p = 0.02) for 24-h urine albumin, 0.25 (0.15–0.34; p < 0.001) for cystatin C, −0.17 (−0.27 to −0.07; p < 0.001) for serum calcium, 0.14 (0.03–0.24; p = 0.009) for serum phosphate, 0.24 (0.14–0.33; p < 0.001) for fibroblast growth factor-23, 0.13 (0.04–0.23; p = 0.007) for total parathyroid hormone, 0.17 (0.07–0.27; p < 0.001) for interleukin-6, and 0.12 (0.02–0.22; p = 0.02) for tumor necrosis factor-α. Conclusions: Reduced kidney function, calcium and phosphate metabolism disorders, and inflammation, independent of established CVD risk factors, may progress CAC among CKD patients.",
keywords = "Chronic kidney disease, Coronary artery disease, Epidemiology, Risk factors",
author = "{the CRIC Study Investigators} and Bundy, {Joshua D.} and Jing Chen and Wei Yang and Matthew Budoff and Go, {Alan S.} and Grunwald, {Juan E.} and Kallem, {Radhakrishna R.} and Post, {Wendy S} and Reilly, {Muredach P.} and Ricardo, {Ana C.} and Rosas, {Sylvia E.} and Xiaoming Zhang and Jiang He",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.atherosclerosis.2018.02.009",
language = "English (US)",
volume = "271",
pages = "53--60",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Risk factors for progression of coronary artery calcification in patients with chronic kidney disease

T2 - The CRIC study

AU - the CRIC Study Investigators

AU - Bundy, Joshua D.

AU - Chen, Jing

AU - Yang, Wei

AU - Budoff, Matthew

AU - Go, Alan S.

AU - Grunwald, Juan E.

AU - Kallem, Radhakrishna R.

AU - Post, Wendy S

AU - Reilly, Muredach P.

AU - Ricardo, Ana C.

AU - Rosas, Sylvia E.

AU - Zhang, Xiaoming

AU - He, Jiang

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background and aims: Coronary artery calcification (CAC) is common among patients with chronic kidney disease (CKD) and predicts the risk for cardiovascular disease (CVD). We examined the associations of novel risk factors with CAC progression among patients with CKD. Methods: Among 1123 CKD patients in the Chronic Renal Insufficiency Cohort (CRIC) Study, CAC was measured in Agatston units at baseline and a follow-up visit using electron beam computed tomography or multidetector computed tomography. Results: Over an average 3.3-year follow-up, 109 (25.1%) participants without CAC at baseline had incident CAC and 124 (18.0%) participants with CAC at baseline had CAC progression, defined as an annual increase of ≥100 Agatston units. After adjustment for established atherosclerotic risk factors, several novel risk factors were associated with changes in CAC over follow-up. Changes in square root transformed CAC score associated with 1 SD greater level of risk factors were −0.20 (95% confidence interval, −0.31 to −0.10; p < 0.001) for estimated glomerular filtration rate, 0.14 (0.02–0.25; p = 0.02) for 24-h urine albumin, 0.25 (0.15–0.34; p < 0.001) for cystatin C, −0.17 (−0.27 to −0.07; p < 0.001) for serum calcium, 0.14 (0.03–0.24; p = 0.009) for serum phosphate, 0.24 (0.14–0.33; p < 0.001) for fibroblast growth factor-23, 0.13 (0.04–0.23; p = 0.007) for total parathyroid hormone, 0.17 (0.07–0.27; p < 0.001) for interleukin-6, and 0.12 (0.02–0.22; p = 0.02) for tumor necrosis factor-α. Conclusions: Reduced kidney function, calcium and phosphate metabolism disorders, and inflammation, independent of established CVD risk factors, may progress CAC among CKD patients.

AB - Background and aims: Coronary artery calcification (CAC) is common among patients with chronic kidney disease (CKD) and predicts the risk for cardiovascular disease (CVD). We examined the associations of novel risk factors with CAC progression among patients with CKD. Methods: Among 1123 CKD patients in the Chronic Renal Insufficiency Cohort (CRIC) Study, CAC was measured in Agatston units at baseline and a follow-up visit using electron beam computed tomography or multidetector computed tomography. Results: Over an average 3.3-year follow-up, 109 (25.1%) participants without CAC at baseline had incident CAC and 124 (18.0%) participants with CAC at baseline had CAC progression, defined as an annual increase of ≥100 Agatston units. After adjustment for established atherosclerotic risk factors, several novel risk factors were associated with changes in CAC over follow-up. Changes in square root transformed CAC score associated with 1 SD greater level of risk factors were −0.20 (95% confidence interval, −0.31 to −0.10; p < 0.001) for estimated glomerular filtration rate, 0.14 (0.02–0.25; p = 0.02) for 24-h urine albumin, 0.25 (0.15–0.34; p < 0.001) for cystatin C, −0.17 (−0.27 to −0.07; p < 0.001) for serum calcium, 0.14 (0.03–0.24; p = 0.009) for serum phosphate, 0.24 (0.14–0.33; p < 0.001) for fibroblast growth factor-23, 0.13 (0.04–0.23; p = 0.007) for total parathyroid hormone, 0.17 (0.07–0.27; p < 0.001) for interleukin-6, and 0.12 (0.02–0.22; p = 0.02) for tumor necrosis factor-α. Conclusions: Reduced kidney function, calcium and phosphate metabolism disorders, and inflammation, independent of established CVD risk factors, may progress CAC among CKD patients.

KW - Chronic kidney disease

KW - Coronary artery disease

KW - Epidemiology

KW - Risk factors

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DO - 10.1016/j.atherosclerosis.2018.02.009

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VL - 271

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