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Meta-Analysis
. 2019 Nov;41(1):244-256.
doi: 10.1080/0886022X.2019.1595646.

Prevalence of coronary artery calcification and its association with mortality, cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis

Xue-Rong Wang  1   2 , Jing-Jing Zhang  1   2 , Xing-Xin Xu  1 , Yong-Gui Wu  1
Affiliations
Meta-Analysis

Prevalence of coronary artery calcification and its association with mortality, cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis

Xue-Rong Wang et al. Ren Fail. 2019 Nov.

Abstract

Purpose: To date, the prevalence and prognostic role of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD) have been investigated in several studies, but have yielded conflicting results. The aim of this meta-analysis is to derive a more precise estimation of CAC prevalence in CKD patients and its association with cardiovascular events and mortality.

Methods: The relevant literature was identified and evaluated from inception until July 2018 through multiple search strategies on PubMed, Embase, and Web of Science. Cross-sectional or cohort (baseline data) studies reporting CAC prevalence were included. Data extracted from eligible studies were used to calculate effect estimates (ESs) and 95% confidence intervals (95%CI). We searched databases for observational studies that explored baseline CAC and subsequent cardiovascular or all-cause mortality risk in CKD patients.

Results: The meta-analysis included 47 studies; 38 of these were included in the final analysis of CAC prevalence. The pooled prevalence of CAC in random effect model was 60% (95%CI 53-68%). CAC was positively associated with an increased risk of all-cause mortality (hazard ratio [HR] 3.44; 95%CI 2.40-4.94), cardiovascular mortality (HR 3.87; 95%CI 2.06-7.26), and cardiovascular events (HR 2.09; 95%CI 1.19-3.67), when comparing individuals in the top CAC score group to those in the bottom CAC score group.

Conclusions: The pooled prevalence of CAC is highly prevalent. CAC is independently associated with all-cause and cardiovascular mortality risk as well as cardiovascular events among CKD patients. In view of the high heterogeneity, larger clinical trials are still needed.

Keywords: Chronic kidney disease; all-cause mortality; cardiovascular events; cardiovascular mortality; coronary artery calcification.

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Figures

Figure 1.
Figure 1.
Flowchart of the study selection process.
Figure 2.
Figure 2.
Forest plot of prevalence estimates of CAC in CKD patients.
Figure 3.
Figure 3.
Prevalence of CAC in patients with different CKD stages.
Figure 4.
Figure 4.
Prevalence of CAC among CKD patients in different regions.
Figure 5.
Figure 5.
All-cause death among CKD patients in the highest versus lowest CAC score group.
Figure 6.
Figure 6.
Cardiovascular death among CKD patients in the highest versus lowest CAC score group.
Figure 7.
Figure 7.
Cardiovascular events among CKD patients in the highest versus lowest CAC score group.
See this image and copyright information in PMC

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