TY - JOUR
T1 - Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD
T2 - The CRIC (Chronic Renal Insufficiency Cohort) Study
AU - CRIC Study Investigators
AU - Bundy, Joshua D.
AU - Cai, Xuan
AU - Scialla, Julia J.
AU - Dobre, Mirela A.
AU - Chen, Jing
AU - Hsu, Chi yuan
AU - Leonard, Mary B.
AU - Go, Alan S.
AU - Rao, Panduranga S.
AU - Lash, James P.
AU - Townsend, Raymond R.
AU - Feldman, Harold I.
AU - de Boer, Ian H.
AU - Block, Geoffrey A.
AU - Wolf, Myles
AU - Smith, Edward R.
AU - Pasch, Andreas
AU - Isakova, Tamara
AU - Appel, Lawrence J.
AU - He, Jiang
AU - Rahman, Mahboob
N1 - Publisher Copyright:
© 2019 National Kidney Foundation, Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Rationale & Objective: Coronary artery calcification (CAC) is prevalent among patients with chronic kidney disease (CKD) and increases risks for cardiovascular disease events and mortality. We hypothesized that a novel serum measure of calcification propensity is associated with CAC among patients with CKD stages 2 to 4. Study Design: Prospective cohort study. Setting & Participants: Participants from the Chronic Renal Insufficiency Cohort (CRIC) Study with baseline (n = 1,274) and follow-up (n = 780) CAC measurements. Predictors: Calcification propensity, quantified as transformation time (T50) from primary to secondary calciprotein particles, with lower T50 corresponding to higher calcification propensity. Covariates included age, sex, race/ethnicity, clinical site, estimated glomerular filtration rate, proteinuria, diabetes, systolic blood pressure, number of antihypertensive medications, current smoking, history of cardiovascular disease, total cholesterol level, and use of statin medications. Outcomes: CAC prevalence, severity, incidence, and progression. Analytical Approach: Multivariable-adjusted generalized linear models. Results: At baseline, 824 (65%) participants had prevalent CAC. After multivariable adjustment, T50 was not associated with CAC prevalence but was significantly associated with greater CAC severity among participants with prevalent CAC: 1-SD lower T50 was associated with 21% (95% CI, 6%-38%) greater CAC severity. Among 780 participants followed up an average of 3 years later, 65 (20%) without baseline CAC developed incident CAC, while 89 (19%) with baseline CAC had progression, defined as annual increase ≥ 100 Agatston units. After multivariable adjustment, T50 was not associated with incident CAC but was significantly associated with CAC progression: 1-SD lower T50 was associated with 28% (95% CI, 7%-53%) higher risk for CAC progression. Limitations: Potential selection bias in follow-up analyses; inability to distinguish intimal from medial calcification. Conclusions: Among patients with CKD stages 2 to 4, higher serum calcification propensity is associated with more severe CAC and CAC progression.
AB - Rationale & Objective: Coronary artery calcification (CAC) is prevalent among patients with chronic kidney disease (CKD) and increases risks for cardiovascular disease events and mortality. We hypothesized that a novel serum measure of calcification propensity is associated with CAC among patients with CKD stages 2 to 4. Study Design: Prospective cohort study. Setting & Participants: Participants from the Chronic Renal Insufficiency Cohort (CRIC) Study with baseline (n = 1,274) and follow-up (n = 780) CAC measurements. Predictors: Calcification propensity, quantified as transformation time (T50) from primary to secondary calciprotein particles, with lower T50 corresponding to higher calcification propensity. Covariates included age, sex, race/ethnicity, clinical site, estimated glomerular filtration rate, proteinuria, diabetes, systolic blood pressure, number of antihypertensive medications, current smoking, history of cardiovascular disease, total cholesterol level, and use of statin medications. Outcomes: CAC prevalence, severity, incidence, and progression. Analytical Approach: Multivariable-adjusted generalized linear models. Results: At baseline, 824 (65%) participants had prevalent CAC. After multivariable adjustment, T50 was not associated with CAC prevalence but was significantly associated with greater CAC severity among participants with prevalent CAC: 1-SD lower T50 was associated with 21% (95% CI, 6%-38%) greater CAC severity. Among 780 participants followed up an average of 3 years later, 65 (20%) without baseline CAC developed incident CAC, while 89 (19%) with baseline CAC had progression, defined as annual increase ≥ 100 Agatston units. After multivariable adjustment, T50 was not associated with incident CAC but was significantly associated with CAC progression: 1-SD lower T50 was associated with 28% (95% CI, 7%-53%) higher risk for CAC progression. Limitations: Potential selection bias in follow-up analyses; inability to distinguish intimal from medial calcification. Conclusions: Among patients with CKD stages 2 to 4, higher serum calcification propensity is associated with more severe CAC and CAC progression.
KW - Coronary artery disease
KW - calcification propensity
KW - calciprotein particles
KW - cardiovascular disease (CVD)
KW - chronic kidney disease (CKD)
KW - coronary artery calcium (CAC)
KW - epidemiology
KW - risk factors
KW - transformation time (T)
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U2 - 10.1053/j.ajkd.2019.01.024
DO - 10.1053/j.ajkd.2019.01.024
M3 - Article
C2 - 30935773
AN - SCOPUS:85063535500
SN - 0272-6386
VL - 73
SP - 806
EP - 814
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -