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

CRIC Study Investigators

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)806-814
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume73
Issue number6
DOIs
StatePublished - Jun 2019

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)

ASJC Scopus subject areas

  • Nephrology

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