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. 2019 Jun;73(6):806-814.
doi: 10.1053/j.ajkd.2019.01.024. Epub 2019 Mar 29.

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

Joshua D Bundy  1 , Xuan Cai  2 , Julia J Scialla  3 , Mirela A Dobre  4 , Jing Chen  5 , Chi-Yuan Hsu  6 , Mary B Leonard  7 , Alan S Go  8 , Panduranga S Rao  9 , James P Lash  10 , Raymond R Townsend  11 , Harold I Feldman  12 , Ian H de Boer  13 , Geoffrey A Block  14 , Myles Wolf  3 , Edward R Smith  15 , Andreas Pasch  16 , Tamara Isakova  17 ; CRIC Study Investigators
Collaborators, Affiliations

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

Joshua D Bundy et al. Am J Kidney Dis. 2019 Jun.

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: Coronary artery disease; calcification propensity; calciprotein particles; cardiovascular disease (CVD); chronic kidney disease (CKD); coronary artery calcium (CAC); epidemiology; risk factors; transformation time (T(50)).

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Figures

Figure 1.
Figure 1.
Flowchart describing the study sample selection for cross-sectional and longitudinal analyses.
Figure 2.
Figure 2.
Bar chart describing the proportions of participants in CAC categories, by quartile of T50.
See this image and copyright information in PMC

References

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