Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease

Yun, Hae‐Ryong; Joo, Young Su; Kim, Hyung Woo; Park, Sun-Hee; Chang, Tae Ik; Son, Nak‐Hoon; Yoo, Tae‐Hyun; Kang, Shin-Wook; Sung, Suah; Lee, Kyu‐Beck; Lee, Joongyub; Oh, Kook‐Hwan; Han, Seung Hyeok

doi:10.1681/asn.2022010080

Cited by 22 publications

(14 citation statements)

References 40 publications

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“… 32 In patients with CKD, high CAC was associated with an increased risk of adverse kidney outcomes and CKD progression. 33 These studies demonstrate the importance of inter-organ interactions in patients with CKD and the potential involvement of ectopic calcification in the cardiorenal syndrome.…”

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confidence: 76%

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

Hutcheson

Goettsch

2023

Circulation Research

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Patients with chronic kidney disease (CKD) exhibit tremendously elevated risk for cardiovascular disease, particularly ischemic heart disease, due to premature vascular and cardiac aging and accelerated ectopic calcification. The presence of cardiovascular calcification associates with increased risk in patients with CKD. Disturbed mineral homeostasis and diverse comorbidities in these patients drive increased systemic cardiovascular calcification in different manifestations with diverse clinical consequences, like plaque instability, vessel stiffening, and aortic stenosis. This review outlines the heterogeneity in calcification patterning, including mineral type and location and potential implications on clinical outcomes. The advent of therapeutics currently in clinical trials may reduce CKD-associated morbidity. Development of therapeutics for cardiovascular calcification begins with the premise that less mineral is better. While restoring diseased tissues to a noncalcified homeostasis remains the ultimate goal, in some cases, calcific mineral may play a protective role, such as in atherosclerotic plaques. Therefore, developing treatments for ectopic calcification may require a nuanced approach that considers individual patient risk factors. Here, we discuss the most common cardiac and vascular calcification pathologies observed in CKD, how mineral in these tissues affects function, and the potential outcomes and considerations for therapeutic strategies that seek to disrupt the nucleation and growth of mineral. Finally, we discuss future patient-specific considerations for treating cardiac and vascular calcification in patients with CKD—a population in need of anticalcification therapies.

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confidence: 76%

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

Hutcheson

Goettsch

2023

Circulation Research

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“…Coronary artery calcification is a well-known indicator of coronary artery atherosclerosis and an established risk factor for CVD [37]. CACS has been reported as a non-invasive and reliable predictive tool for coronary artery calcification and CVD [6,7,37,38]. Previous studies have revealed that activin is closely related to vascular calcification [19].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular disease (CVD) is the leading cause of death in patients with KT [4,5]. Among the assessment tools, the coronary artery calcification score (CACS), measured using multi-detector computed tomography (MDCT), is a highly specific index for coronary artery atherosclerosis and can predict major cardiovascular events as a surrogate marker [6,7].…”

Section: Introductionmentioning

confidence: 99%

Association of Serum Activin Levels with Allograft Outcomes in Patients with Kidney Transplant: Results from the KNOW-KT

Jung,

Ryu,

Kim

et al. 2024

Am J Nephrol

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Introduction: Serum activin A has been reported to contribute to vascular calcification and kidney fibrosis in chronic kidney disease. We aimed to investigate whether higher serum activin levels were associated with poor allograft outcomes in patients with kidney transplants (KT). Methods: A total of 860 KT patients from KNOW-KT (KoreaN cohort study for Outcome in patients With Kidney Transplantation) were analyzed. We measured serum activin levels at pre-KT and 1 year after KT. The primary outcome was the composite of a ≥ 50% decline in eGFR and graft failure. Multivariable cause-specific hazard model was used to analyze association of 1-year activin levels with the primary outcome. The secondary outcome was coronary artery calcification score (CACS) at 5 years after KT. Results: During the median follow-up of 6.7 years, the primary outcome occurred in 109 (12.7%) patients. The serum activin levels at 1 year were significantly lower than those at pre-KT (488.2 ± 247.3 vs. 704.0 ± 349.6). When patients were grouped based on the median activin level at 1 year, the high-activin group had a 1.91-fold higher risk (95% CI, 1.25-2.91) for the primary outcome compared to the low-activin group. A one standard deviation increase in activin levels as a continuous variable was associated with a 1.36-fold higher risk (95% CI, 1.16-1.60) for the primary outcome. Moreover, high activin levels were significantly associated with 1.56-fold higher CACS (95% CI, 1.12-2.18). Conclusion: Post-transplant activin levels were independently associated with allograft functions as well as coronary artery calcification in kidney transplant patients.

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“…As our results revealed, despite the high cost and unsatisfactory operability of CAC evaluation, the presence of CAC was associated with poor clinical outcomes, which is consistent with the results of a recently published study. 35 This finding may be related to the special structure and function of coronary arteries or to the relatively precise assessment method for CAC. Hence, we focused on the CAC-related results.…”

Section: Discussionmentioning

confidence: 99%

Progression of Vascular Calcification and Clinical Outcomes in Patients Receiving Maintenance Dialysis

Zhang

Li²,

et al. 2023

JAMA Netw Open

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ImportanceBaseline findings from the China Dialysis Calcification Study (CDCS) revealed a high prevalence of vascular calcification (VC) among patients with end-stage kidney disease; however, data on VC progression were limited.ObjectivesTo understand the progression of VC at different anatomical sites, identify risk factors for VC progression, and assess the association of VC progression with the risk of cardiovascular events and death among patients receiving maintenance dialysis.Design, Setting, and ParticipantsThis cohort study was a 4-year follow-up assessment of participants in the CDCS, a nationwide multicenter prospective cohort study involving patients aged 18 to 74 years who were undergoing hemodialysis or peritoneal dialysis. Participants were recruited from 24 centers across China between May 1, 2014, and April 30, 2015, and followed up for 4 years. A total of 1489 patients receiving maintenance dialysis were included in the current analysis. Data were analyzed from September 1 to December 31, 2021.ExposuresPatient demographic characteristics and medical history; high-sensitivity C-reactive protein laboratory values; serum calcium, phosphorus, and intact parathyroid hormone (iPTH) values; and previous or concomitant use of medications.Main Outcomes and MeasuresThe primary outcome was progression of VC at 3 different anatomical sites (coronary artery, abdominal aorta, and cardiac valves) and identification of risk factors for VC progression. Participants received assessments of coronary artery calcification (CAC), abdominal aortic calcification (AAC), and cardiac valve calcification (CVC) at baseline, 24 months, 36 months, and 48 months. Secondary outcomes included (1) the association between VC progression and the risk of all-cause death, cardiovascular (CV)–related death, and a composite of all-cause death and nonfatal CV events and (2) the association between achievement of serum calcium, phosphorus, and iPTH target levels and the risk of VC progression.ResultsAmong 1489 patients, the median (IQR) age was 51.0 (41.0-60.0) years; 59.5% of patients were male. By the end of 4-year follow-up, progression of total VC was observed in 86.5% of patients; 69.6% of patients had CAC progression, 72.4% had AAC progression, and 33.4% had CVC progression. Common risk factors for VC progression at the 3 different anatomical sites were older age and higher fibroblast growth factor 23 levels. Progression of CAC was associated with a higher risk of all-cause death (model 1 [adjusted for age, sex, and body mass index]: hazard ratio [HR], 1.97 [95% CI, 1.16-3.33]; model 2 [adjusted for all factors in model 1 plus smoking status, history of diabetes, and mean arterial pressure]: HR, 1.89 [95% CI, 1.11-3.21]; model 3 [adjusted for all factors in model 2 plus calcium, phosphorus, intact parathyroid hormone, and fibroblast growth factor 23 levels and calcium-based phosphate binder use]: HR, 1.92 [95% CI, 1.11-3.31]) and the composite of all-cause death and nonfatal CV events (model 1: HR, 1.98 [95% CI, 1.19-3.31]; model 2: HR, 1.91 [95% CI, 1.14-3.21]; model 3: HR, 1.95 [95% CI, 1.14-3.33]) after adjusting for all confounding factors except the presence of baseline calcification. Among the 3 targets of calcium, phosphorus, and iPTH, patients who achieved no target levels (model 1: odds ratio [OR], 4.75 [95% CI, 2.65-8.52]; model 2: OR, 4.81 [95% CI, 2.67-8.66]; model 3 [for this analysis, adjusted for all factors in model 2 plus fibroblast growth factor 23 level and calcium-based phosphate binder use]: OR, 2.76 [95% CI, 1.48-5.16]), 1 target level (model 1: OR, 3.71 [95% CI, 2.35-5.88]; model 2: OR, 3.62 [95% CI, 2.26-5.78]; model 3: OR, 2.19 [95% CI, 1.33-3.61]), or 2 target levels (model 1: OR, 2.73 [95% CI, 1.74-4.26]; model 2: OR, 2.69 [95% CI, 1.71-4.25]; model 3: OR, 1.72 [95% CI, 1.06-2.79]) had higher odds of CAC progression compared with patients who achieved all 3 target levels.Conclusions and RelevanceIn this study, VC progressed rapidly in patients undergoing dialysis, with different VC types associated with different rates of prevalence and progression. Consistent achievement of serum calcium, phosphorus, and iPTH target levels was associated with a lower risk of CAC progression. These results may be useful for increasing patient awareness and developing appropriate strategies to improve the management of chronic kidney disease–mineral and bone disorder among patients undergoing dialysis.

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Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease

Cited by 22 publications

References 40 publications

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

Association of Serum Activin Levels with Allograft Outcomes in Patients with Kidney Transplant: Results from the KNOW-KT

Progression of Vascular Calcification and Clinical Outcomes in Patients Receiving Maintenance Dialysis

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