Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD

The CRIC (Chronic Renal Insufficiency Cohort) Study

CRIC Study Investigators

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)806-814
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume73
Issue number6
DOIs
StatePublished - Jun 1 2019

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Chronic Renal Insufficiency
Coronary Vessels
Cohort Studies
Serum
Social Adjustment
Cardiovascular Diseases
Tunica Intima
Blood Pressure
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Selection Bias
Glomerular Filtration Rate
Proteinuria
Antihypertensive Agents
Linear Models

Keywords

  • calcification propensity
  • calciprotein particles
  • cardiovascular disease (CVD)
  • chronic kidney disease (CKD)
  • coronary artery calcium (CAC)
  • Coronary artery disease
  • epidemiology
  • risk factors
  • transformation time (T)

ASJC Scopus subject areas

  • Nephrology

Cite this

Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD : The CRIC (Chronic Renal Insufficiency Cohort) Study. / CRIC Study Investigators.

In: American Journal of Kidney Diseases, Vol. 73, No. 6, 01.06.2019, p. 806-814.

Research output: Contribution to journalArticle

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title = "Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study",
abstract = "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.",
keywords = "calcification propensity, calciprotein particles, cardiovascular disease (CVD), chronic kidney disease (CKD), coronary artery calcium (CAC), Coronary artery disease, epidemiology, risk factors, transformation time (T)",
author = "{CRIC Study Investigators} and Bundy, {Joshua D.} and Xuan Cai and Scialla, {Julia J.} and Dobre, {Mirela A.} and Jing Chen and Hsu, {Chi yuan} and Leonard, {Mary B.} and Go, {Alan S.} and Rao, {Panduranga S.} and Lash, {James P.} and Townsend, {Raymond R.} and Feldman, {Harold I.} and {de Boer}, {Ian H.} and Block, {Geoffrey A.} and Myles Wolf and Smith, {Edward R.} and Andreas Pasch and Tamara Isakova and Lawrence Appel and Jiang He and Mahboob Rahman",
year = "2019",
month = "6",
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doi = "10.1053/j.ajkd.2019.01.024",
language = "English (US)",
volume = "73",
pages = "806--814",
journal = "American Journal of Kidney Diseases",
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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

AU - He, Jiang

AU - Rahman, Mahboob

PY - 2019/6/1

Y1 - 2019/6/1

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 - calcification propensity

KW - calciprotein particles

KW - cardiovascular disease (CVD)

KW - chronic kidney disease (CKD)

KW - coronary artery calcium (CAC)

KW - Coronary artery disease

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

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SP - 806

EP - 814

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 6

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