Michelle C Lamarche1, Wilma M Hopman2,3, Jocelyn S Garland1, Christine A White1, Rachel M Holden1. 1. Department of Medicine, Queen's University, Kingston, ON, Canada. 2. Clinical Research Centre, Kingston Health Sciences Centre, Kingston, ON, Canada. 3. Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND: Patients with chronic kidney disease (CKD) have higher levels of coronary artery calcification (CAC) compared with the general population. The role of CAC in renal function decline is not well understood. METHODS: In this prospective cohort study of Stages 3-5 CKD patients with CAC scores kidney function decline, development of end-stage kidney disease (ESKD) and all-cause mortality were determined at 5 and 10 years. Baseline variables included markers of CKD and chronic kidney disease mineral and bone disorder (CKD-MBD), demographics and comorbidities. Multivariable analyses identified predictors of outcomes, and survival curves demonstrated the association of CAC score with ESKD and mortality. RESULTS: One hundred and seventy-eight patients were enrolled between 2005 and 2007. Independent predictors of ESKD at 5 years were estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR); at 10 years, eGFR was no longer a predictor, but CAC was now significant. Those who developed ESKD at the fastest rate either had the highest CAC score (≥400 AU) or were youngest and had the lowest calcidiol, and highest serum phosphate, UACR and percentage change in CAC per year. Predictors of eGFR decline over 5 years were UACR, parathyroid hormone and CAC score. Predictors of mortality at 5 years were age, diabetes and eGFR and at 10 years also included CAC score. CONCLUSIONS: In Stages 3-5 CKD patients, CAC is an independent predictor of both ESKD and mortality at 10 years. Those who developed ESKD at the fastest rate either had the highest CAC score or the worst CKD-MBD derangements.
BACKGROUND:Patients with chronic kidney disease (CKD) have higher levels of coronary artery calcification (CAC) compared with the general population. The role of CAC in renal function decline is not well understood. METHODS: In this prospective cohort study of Stages 3-5 CKDpatients with CAC scores kidney function decline, development of end-stage kidney disease (ESKD) and all-cause mortality were determined at 5 and 10 years. Baseline variables included markers of CKD and chronic kidney disease mineral and bone disorder (CKD-MBD), demographics and comorbidities. Multivariable analyses identified predictors of outcomes, and survival curves demonstrated the association of CAC score with ESKD and mortality. RESULTS: One hundred and seventy-eight patients were enrolled between 2005 and 2007. Independent predictors of ESKD at 5 years were estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR); at 10 years, eGFR was no longer a predictor, but CAC was now significant. Those who developed ESKD at the fastest rate either had the highest CAC score (≥400 AU) or were youngest and had the lowest calcidiol, and highest serum phosphate, UACR and percentage change in CAC per year. Predictors of eGFR decline over 5 years were UACR, parathyroid hormone and CAC score. Predictors of mortality at 5 years were age, diabetes and eGFR and at 10 years also included CAC score. CONCLUSIONS: In Stages 3-5 CKDpatients, CAC is an independent predictor of both ESKD and mortality at 10 years. Those who developed ESKD at the fastest rate either had the highest CAC score or the worst CKD-MBD derangements.
Authors: Caitlyn Vlasschaert; Amy J M McNaughton; Michael Chong; Elina K Cook; Wilma Hopman; Bryan Kestenbaum; Cassianne Robinson-Cohen; Jocelyn Garland; Sarah M Moran; Guillaume Paré; Catherine M Clase; Mila Tang; Adeera Levin; Rachel Holden; Michael J Rauh; Matthew B Lanktree Journal: J Am Soc Nephrol Date: 2022-02-23 Impact factor: 14.978
Authors: Helen Erlandsson; Abdul Rashid Qureshi; Jonaz Ripsweden; Ida Haugen Löfman; Magnus Söderberg; Lars Wennberg; Torbjörn Lundgren; Annette Bruchfeld; Torkel B Brismar; Peter Stenvinkel Journal: J Intern Med Date: 2022-02-11 Impact factor: 13.068