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Multicenter Study
. 2024 Dec;46(2):2365393.
doi: 10.1080/0886022X.2024.2365393. Epub 2024 Jun 14.

Predictive nomogram model for severe coronary artery calcification in end-stage kidney disease patients

Xinfang Tang  1   2 , Hanyang Qian  1   3 , Shijiu Lu  1 , Hui Huang  4 , Jing Wang  1 , Fan Li  1   5 , Anning Bian  1   6 , Xiaoxue Ye  1 , Guang Yang  1 , Kefan Ma  7 , Changying Xing  1 , Yi Xu  7 , Ming Zeng  1 , Ningning Wang  1
Affiliations
Multicenter Study

Predictive nomogram model for severe coronary artery calcification in end-stage kidney disease patients

Xinfang Tang et al. Ren Fail. 2024 Dec.

Abstract

Introduction: The Agatston coronary artery calcification score (CACS) is an assessment index for coronary artery calcification (CAC). This study aims to explore the characteristics of CAC in end-stage kidney disease (ESKD) patients and establish a predictive model to assess the risk of severe CAC in patients.

Methods: CACS of ESKD patients was assessed using an electrocardiogram-gated coronary computed tomography (CT) scan with the Agatston scoring method. A predictive nomogram model was established based on stepwise regression. An independent validation cohort comprised of patients with ESKD from multicentres.

Results: 369 ESKD patients were enrolled in the training set, and 127 patients were included in the validation set. In the training set, the patients were divided into three subgroups: no calcification (CACS = 0, n = 98), mild calcification (0 < CACS ≤ 400, n = 141) and severe calcification (CACS > 400, n = 130). Among the four coronary branches, the left anterior descending branch (LAD) accounted for the highest proportion of calcification. Stepwise regression analysis showed that age, dialysis vintage, β-receptor blocker, calcium-phosphorus product (Ca × P), and alkaline phosphatase (ALP) level were independent risk factors for severe CAC. A nomogram that predicts the risk of severe CAC in ESKD patients has been internally and externally validated, demonstrating high sensitivity and specificity.

Conclusion: CAC is both prevalent and severe in ESKD patients. In the four branches of the coronary arteries, LAD calcification is the most common. Our validated nomogram model, based on clinical risk factors, can help predict the risk of severe coronary calcification in ESKD patients who cannot undergo coronary CT analysis.

Keywords: Agatston coronary artery calcification score; End-stage kidney disease; chronic kidney disease-mineral and bone disorders; coronary artery calcification; left anterior descending artery; nomogram.

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Conflict of interest statement

The authors have no conflicts of interest to declare. A preliminary version of the manuscript has been published in a preprint form: Tang X et al. [60].

Figures

Figure 1.
Figure 1.
Comparison of CAC in ESKD patients with different dialysis modalities. Abbreviations: ESKD: end-stage kidney disease; CAC: coronary artery calcification; HD: hemodialysis; PD: peritoneal dialysis.
Figure 2.
Figure 2.
Percentage of CAC in the four coronary branches. Abbreviations: LAD: left anterior descending branch; LM: left main trunk; CX: circumflex branch; RCA: right coronary artery; CAC: coronary artery calcification.
Figure 3.
Figure 3.
Cross-sectional CT images of ESKD patients with varying degrees of CACS. (A) An ESKD patient without coronary calcification. (B) An ESKD patient with calcification only in the LAD. (C–D) An ESKD patient with calcification in all four coronary branches. (C) Calcification in the left main trunk and left anterior descending branch. (D) Calcification in the circumflex branch and right coronary artery. Different colors represent each coronary branch with calcification (green: left main trunk; yellow: left anterior descending branch; blue: circumflex branch; red: right coronary artery), and the arrows indicated the calcified branches. Abbreviations: CT: computed tomography; ESKD: end-stage kidney disease; LAD: left anterior descending branch.
Figure 4.
Figure 4.
Nomogram model to predict the risks of severe CAC based on clinical data of ESKD patients. Based on the value assigned to each patient indicator (0 or 1 for diabetes history and medication history), a dot was plotted on the horizontal line corresponding to the respective item. A vertical line was then drawn upwards to intersect the horizontal line representing the score, thus determining the specific score for that particular item. The total score was calculated by adding up the scores from each item. A dot was plotted on the horizontal line representing the total score. A vertical line was then drawn downwards to intersect the horizontal line corresponding to the risk of severe coronary calcification, giving us the specific value for calcification risk.
Figure 5.
Figure 5.
ROC curves of nomogram model. (A) ROC curve of the nomogram in the training cohort; (B) ROC curve of the nomogram in the validation cohort. Note. The red curve represents the model’s performance in predicting the risks of severe coronary calcification, with the horizontal axis representing specificity and the vertical axis representing sensitivity. Abbreviations. AUC: area under curve; ROC: receiver operating characteristic.
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