Incidence and progression of coronary calcification in chronic kidney disease: the Multi-Ethnic Study of Atherosclerosis

Abstract

We studied the incidence and progression of coronary artery calcification in people with early chronic kidney disease. We used a cohort of 562 adult patients with chronic kidney disease who had an estimated glomerular filtration rate of <60 ml/min/1.73 m(2), in a community-based study of people without clinical cardiovascular disease, the Multi-Ethnic Study of Atherosclerosis. The majority had stage 3 disease. Coronary artery calcification was measured at baseline and again approximately 1.6 or 3.2 years later. The prevalence of coronary artery calcification at baseline was 66%, and its adjusted prevalence was 24% lower in African Americans as compared to Caucasians. The incidence of coronary artery calcification was 6.1% per year in women and 14.8% in men. Coronary artery calcification progressed in approximately 17% of subjects per year across all subgroups, and diabetes was associated with a 65% greater adjusted risk of progression. Male gender and diabetes were the only factors associated with adjusted coronary artery calcification incidence and progression, respectively. Our study shows that coronary artery calcification is common in people with stage 3 disease, progresses rapidly, and may contribute to cardiovascular risk.

Figure 1. Flow chart of study participation

CAC, coronary artery calcification; eGFR, estimated glomerular filtration rate.

Figure 2. Distribution of non-zero coronary artery calcium scores

Distribution of (a) all nonzero coronary artery calcium scores and (b) of coronary artery calcium scores between 1 and 100. Eight participants with coronary artery calcification scores > 2000 not shown in panel a.

Figure 3. Definitions of CAC progression according to baseline score

(a) Annual absolute increase in coronary calcium score as a function of baseline score. (b) Annual percentage change in coronary calcium score as a function of baseline score. (c) Proportion progressing as a function of baseline score. Proportion progressing defined by a change in coronary calcium score that exceeds the 95% reproducibility limits of the scanner, as described in methods. All panels restricted to participants with prevalent coronary calcium at baseline. CAC, coronary artery calcification.

Figure 4. Progression of coronary artery calcification by age, race, and sex categories

^*Rates adjusted for age, race, sex, body mass index, estimated glomerular filtration rate, time between scans, and scanner pair.