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 - Funding Information:
This work was supported by grants P30DK114857, R01DK102438 (Dr Isakova), R01DK110087 (Dr Isakova), R01DK099199 (Dr de Boer), R01DK081374 (Dr Wolf), R01DK076116 (Dr Wolf), R01DK094796 (Dr Wolf), U01DK099930 (Drs Isakova and Wolf), R01DK111952 (Dr Scialla), and R01HL141846 (Dr Dobre) from the National Institutes of Health (NIH), and a Strategically Focused Research Network Center Grant on Health Disparities from the American Heart Association (Dr Wolf). Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases ( U01DK060990 , U01DK060984 , U01DK061022 , U01DK061021 , U01DK061028 , U01DK060980 , U01DK060963 , and U01DK060902 ). In addition, this study was supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/ National Center for Advancing Translational Sciences UL1TR000003 , the Johns Hopkins Infstitute for Clinical and Translational Research UL1 TR-000424 , University of Maryland General Clinical Research Center M01 RR-16500 , Clinical and Translational Science Collaborative of Cleveland , UL1TR000439 , Michigan Institute for Clinical and Health Research UL1TR000433 , University of Illinois at Chicago Clinical and Translational Science Awards UL1RR029879 , Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases P20 GM109036, and Kaiser Permanente NIH/ National Center for Research Resources UCSF-CTSI UL1 RR-024131. Dr Bundy is supported by the National Heart, Lung, and Blood Institute Cardiovascular Epidemiology training grant T32HL069771. None of the funders of this study had any role in the current study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.
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
VL - 73
SP - 806
EP - 814
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 6
ER -