Association of Body Weight Variability With Progression of Coronary Artery Calcification in Patients With Predialysis Chronic Kidney Disease

Abstract

Background: We investigated whether high body weight variability (BWV) is associated with a higher prevalence of coronary artery calcification (CAC) or more rapid progression of CAC in patients with predialysis chronic kidney disease (CKD).

Methods: A total of 1,162 subjects from a nationwide prospective cohort of predialysis CKD were analyzed. The subjects were divided into the tertile (T1, T2, and T3) by BWV. CAC was assessed at the baseline and a 4-year follow-up by CT scan. Rapid progression of coronary artery calcification was defined as an increase in coronary artery calcium score (CACS) more than 200 Agatston units during a 4-year follow-up.

Results: One-way ANOVA revealed that CACS change during the follow-up period is significantly higher in the subjects with high BWV, although CACS at the baseline and 4-year follow-up was not different among the tertile groups by BWV. Logistic regression analysis revealed that compared to low BWV (T1), both moderate (T2, adjusted odds ratio (OR) 2.118, 95% CI 1.075-4.175) and high (T3, adjusted OR 2.602, 95% CI 1.304-5.191) BWV was associated with significantly increased risk of rapid progression of CAC. Importantly, the association between BWV and progression of CAC remained robust even among the subjects without significant BW gain or loss during follow-up periods (T2, adjusted OR 2.007, 95% CI 1.011-3.984; T3, adjusted OR 2.054, 95% CI 1.003-4.207).

Conclusion: High BWV is independently associated with rapid progression of CAC in patients with predialysis CKD.

Keywords: body weigh variability; cardiovascular disease; cardiovascular event; chronic kidney disease; coronary artery calcification.

Figure 1

Flow diagram of the study participants. ASV, average successive variability; BW, body weight; CACS, coronary artery calcium score; T1, 1st tertile; T2, 2nd tertile; T3, 3rd tertile.

Figure 2

Comparison of the CACS at the baseline and at 4-year follow-up and the CACS change during 4-year follow-up period by BWV. CACS at the baseline (A) and at 4-year follow-up (B) and the CACS change during the 4-year follow-up period (C) were compared by BWV. *P < 0.05 vs. T1 by one-way ANOVA with Scheffe's post-hoc test. Error bars indicate SE of means. AU, Agatston unit; BWV, body weight variability; CACS, coronary artery calcium score; T1, 1st tertile; T2, 2nd tertile; T3, 3rd tertile.

Figure 3

The restricted cubic spline of BWV on the risk of rapid progression of CAC. Adjusted OR of BWV as a continuous variable for the risk of rapid progression of CAC is depicted. The model was adjusted for age, gender, Charlson comorbidity index, smoking history, BMI, SBP, DBP, medication (ACEi/ARBs, diuretics, number of antihypertensive drugs, statins), hemoglobin, albumin, HDL-C, fasting serum glucose, 25(OH) vitamin D, hs-CRP, eGFR, spot urine ACR, and baseline CACS. BWV, body weight variability; OR, odds ratio.