Vascular Calcification in Patients with Nondialysis CKD over 3 Years

Abstract

Background and objectives Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed.Design, setting, participants, & measurements The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop .30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models.Results VC was present in 79% of patients and prominent in 47% (AS$3 or KS.6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P,0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P,0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS$3. After a median followup of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS$3 but not KS.6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P,0.001). VC did not predict renal progression.Conclusions VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.

Vascular Calcification in Predialysis CKD

“…In this issue of CJASN, Górriz et al assessed VC using the Kauppila and Adragao scores (16). VC occurs in both large elastic arteries and medium-size muscular arteries.…”

“…Górriz et al found that correlates of VC in predialysis CKD included age, diabetes mellitus, serum phosphorus levels, diastolic BP, pulse pressure, and waist circumference, as well as the use of anticoagulant therapy for models of medial calcification and statins for intimal calcification (16). The findings of associations with anticoagulant therapy and statins are unclear and require further investigation.…”

What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

“…OSERCE-2 was a 3-year follow-up prospective, observational, study which enrolled 742 adults with 3 to 5-stage CKD not on dialysis subjects attending 39 centres in Spain, to evaluate the effects of vascular calcifications and CKD-mineral bone disorders on mortality, hospitalization and kidney progression [32] . Inclusion criteria were age ≥ 18 years and CKD Stages 3-5.…”

“…The study protocol of the OSERCE-2 study has been previously reported [32] . All patients were assessed at baseline for blood pressure measurement, lateral lumbar, pelvis and hands X-ray, an ankle brachial pressure index (ABPI) determination and laboratory blood sampling.…”

“…All blood samples were analyzed in a central laboratory, including 25(OH)D, 1,25(OH)2 vitamin D, creatinine, calcium, phosphorus, intact PTH, albumin, and highsensitive C-reactive protein. 25(OH)D levels were assessed by radioimmunoassay (Biosource), which were transformed to the usual method of reference (DiaSorin Liaison chemiluminescent radioimmunoassay) for improving the comparability of the results, as previously described [32] . To study the renal progression, blood samples for determination of serum creatinine levels were obtained every 12 mo.…”