Risk Factors for Coronary Artery Calcium Among Patients With Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort Study)

He, Jiang; Yang, Wei; Chen, Jing; Go, Alan S.; Lash, James P.; Rahman, Mahboob; deFilippi, Christopher; Gadegbeku, Crystal A.; Kanthety, Radhika; Tao, Kaixiang; Hamm, L. Lee; Townsend, Ray; Budoff, Matthew J.

doi:10.1016/j.amjcard.2012.07.044

Cited by 44 publications

(52 citation statements)

References 30 publications

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“…In multivariable-adjusted models, participants with eGFR,30 ml/min per 1.73 m 2 had higher CAC levels than those with eGFR.60. In addition, greater serum calcium and serum phosphate were independent risk factors for high CAC, whereas parathyroid hormone level was inversely associated with CAC (40). However, neither markers of inflammation (high-sensitivity C-reactive protein, IL-6, TNF-a) nor FGF23 were independently associated with CAC.…”

Section: Arterial Calcificationmentioning

confidence: 82%

Chronic Renal Insufficiency Cohort Study (CRIC)

Denker¹,

Boyle²,

Anderson³

et al. 2015

Clinical Journal of the American Society of Nephrology

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108

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The Chronic Renal Insufficiency Cohort (CRIC) Study is a United States multicenter, prospective study of racially and ethnically diverse patients with CKD. Although the original aims of the study were to identify novel predictors of CKD progression and to elucidate the risk and manifestations of cardiovascular disease among nearly 4000 individuals with CKD, the CRIC Study has evolved into a national resource for investigation of a broad spectrum of CKD-related topics. The study has produced >90 published scientific articles, promoted many young investigative careers in nephrology, and fostered international collaborations focused on understanding the global burden of CKD. The third phase of the CRIC Study will complete enrollment of 1500 additional study participants in 2015 and is designed to answer questions regarding morbidity and mortality in mild-to-moderate CKD and to assess the burden of CKD in older persons. This review highlights some of the salient findings of the CRIC Study in the areas of race and ethnicity, CKD progression, CKD and cognition, and cardiovascular disease outcomes; it also outlines the ongoing and forthcoming opportunities for the global nephrology community to enhance its understanding of CKD and related complications through the study.

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Section: Arterial Calcificationmentioning

confidence: 82%

Chronic Renal Insufficiency Cohort Study (CRIC)

Denker¹,

Boyle²,

Anderson³

et al. 2015

Clinical Journal of the American Society of Nephrology

Self Cite

108

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“…ABI ≥1.4 was associated with vascular calcification in peripheral and distal arteries among dialysis patients 8. Vascular calcification is highly prevalent in CKD patients 18, 19. Medial arterial calcification is common in CKD patients and causes arterial stiffness, a decrease in perfusion, and impairment of collateral circulation formation,20, 21, 22, 23 which may contribute to PAD.…”

Section: Discussionmentioning

confidence: 99%

Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease

Chen

Mohler

Garimella

et al. 2016

JAHA

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BackgroundThe clinical implications of ankle‐brachial index (ABI) cutpoints are not well defined in patients with chronic kidney disease (CKD) despite increased prevalence of high ABI attributed to arterial stiffness. We examined the relationship of ABI with cardiovascular disease (CVD) and all‐cause mortality among CKD patients.Methods and ResultsThree thousand six hundred twenty‐seven participants without clinical peripheral artery disease (PAD) at baseline from the Chronic Renal Insufficiency Cohort Study were included. ABI was obtained per standard protocol and CVD events were confirmed by medical record adjudication. A U‐shaped association of ABI with PAD, myocardial infarction (MI), composite CVD, and all‐cause mortality was observed. Individuals with an ABI between 1.0 and <1.4 had the lowest risk of outcomes. Compared to participants with an ABI between 1.0 and <1.4, multiple‐adjusted hazard ratios (95% confidence intervals) for those with an ABI of <0.9, 0.9 to <1.0, and ≥1.4 were 5.78 (3.57, 9.35), 2.76 (1.56, 4.88), and 4.85 (2.05, 11.50) for PAD; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for MI; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite CVD; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all‐cause mortality, respectively.ConclusionsThis study indicates that ABI <1.0 was related to risk of PAD, MI, composite CVD, and all‐cause mortality whereas ABI ≥1.4 was related to clinical PAD. These findings suggest that ABI cutpoints of <1.0 or ≥1.4 for diagnosing PAD and ABI <1.0 for CVD risk stratification should be further evaluated among CKD patients.

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“…Also, factors independently associated with ECW/TBW in multivariable linear regression analysis were considered as covariates in multivariable logistic analysis. Factors such as serum calcium and phosphate levels and hypertension history were also included in the multivariable model because of its established significance with CAC despite the lack of statistical significance in our results 17. An incremental adjustment was performed using the following factors: (1) demographic characteristics including age, sex, waist‐to‐hip ratio, diabetes mellitus, history of cardiovascular disease, smoking status, and pulse pressure; (2) biochemical variables including eGFR, hemoglobin, lipid profiles, albumin, calcium, and phosphate18; and (3) use of lipid‐lowering agents, antithrombotic agents, and phosphate binders.…”

Section: Methodsmentioning

confidence: 99%

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

Park

Jhee

Yun

et al. 2018

JAHA

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BackgroundExtracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD).Methods and ResultsA total of 1741 patients at all stages of pre‐dialysis CKD from the prospective observational cohort of CMERC‐HI (Cardiovascular and Metabolic Disease Etiology Research Center‐High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water‐to‐total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R 2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis.Conclusions ECF status is independently associated with a high risk of CAC in patients with CKD.Study Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02003781.

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Risk Factors for Coronary Artery Calcium Among Patients With Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort Study)

Cited by 44 publications

References 30 publications

Chronic Renal Insufficiency Cohort Study (CRIC)

Chronic Renal Insufficiency Cohort Study (CRIC)

Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease

Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

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