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

Publication ,  Journal Article
Bundy, JD; Cai, X; Scialla, JJ; Dobre, MA; Chen, J; Hsu, C-Y; Leonard, MB; Go, AS; Rao, PS; Lash, JP; Townsend, RR; Feldman, HI; de Boer, IH ...
Published in: Am J Kidney Dis
June 2019

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.

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Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

June 2019

Volume

73

Issue

6

Start / End Page

806 / 814

Location

United States

Related Subject Headings

  • Vascular Calcification
  • Urology & Nephrology
  • Survival Analysis
  • Sex Factors
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Propensity Score
  • Middle Aged
  • Male
  • Incidence
 

Citation

APA
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Bundy, J. D., Cai, X., Scialla, J. J., Dobre, M. A., Chen, J., Hsu, C.-Y., … CRIC Study Investigators, . (2019). Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis, 73(6), 806–814. https://doi.org/10.1053/j.ajkd.2019.01.024
Bundy, Joshua D., Xuan Cai, Julia J. Scialla, Mirela A. Dobre, Jing Chen, Chi-Yuan Hsu, Mary B. Leonard, et al. “Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study.Am J Kidney Dis 73, no. 6 (June 2019): 806–14. https://doi.org/10.1053/j.ajkd.2019.01.024.
Bundy JD, Cai X, Scialla JJ, Dobre MA, Chen J, Hsu C-Y, et al. Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis. 2019 Jun;73(6):806–14.
Bundy, Joshua D., et al. “Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study.Am J Kidney Dis, vol. 73, no. 6, June 2019, pp. 806–14. Pubmed, doi:10.1053/j.ajkd.2019.01.024.
Bundy JD, Cai X, Scialla JJ, Dobre MA, Chen J, Hsu C-Y, Leonard MB, Go AS, Rao PS, Lash JP, Townsend RR, Feldman HI, de Boer IH, Block GA, Wolf M, Smith ER, Pasch A, Isakova T, CRIC Study Investigators. Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis. 2019 Jun;73(6):806–814.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

June 2019

Volume

73

Issue

6

Start / End Page

806 / 814

Location

United States

Related Subject Headings

  • Vascular Calcification
  • Urology & Nephrology
  • Survival Analysis
  • Sex Factors
  • Renal Insufficiency, Chronic
  • Prospective Studies
  • Propensity Score
  • Middle Aged
  • Male
  • Incidence