Association of Mild to Moderate Kidney Dysfunction with Coronary Artery Calcification in Patients with Suspected Coronary Artery Disease

Abstract

Objectives: To report the association between kidney dysfunction and coronary artery calcification (CAC) score (CACS) among patients with clinically suspected coronary artery disease (CAD). Methods: We prospectively included 1,572 consecutive patients with clinically suspected CAD who underwent ECG-gated cardiac CT scans using 64-multidetector row computed tomography. CACS was quantified using a previously described method. Renal function was assessed by the estimated glomerular filtration rate (eGFR). Ordinal logistic regression and Pearson correlation were used to analyze the association between eGFR and CACS. Results: Patients with higher CACS were older, more had a history of hypertension, diabetes and tobacco use, and they were more likely to have an atherogenic lipid profile, higher systolic blood pressure, diastolic blood pressure, hemoglobin A1c, body mass index and C-reactive protein (CRP) and lower eGFR when compared with those patients without CAC or with lower CACS. The unadjusted correlation coefficient of eGFR and CACS was –0.259 (p < 0.001). This remained significant after adjustment for age, gender, hypertension, diabetes, hyperlipidemia, tobacco use and CRP (R = –0.156, p < 0.001). Ordinal logistic regression analysis showed that age, hypertension, diabetes, CRP and eGFR exerted independent influences on CACS. Conclusions: Kidney dysfunction was an independent predictor of CACS in patients with clinically suspected CAD. Further prospective multicenter studies are needed to confirm this finding.

Association of Cystatin C-Based Glomerular Filtration Rate with SYNTAX Score in Patients with Diabetes

“…Kiyosue et al [ 39 ] investigated the association of severity of CAD with CKD and revealed that the number of stenotic coronary arteries were higher in the CKD group. Our previous study [ 40 ] demonstrated that mild to moderate renal kidney dysfunction was an independent predictor of CAC score in patients with clinically suspected CAD. Our recent study retrospectively investigated the relationship between kidney function and angiographically derived SXscore and suggested that kidney function estimated by GFR based on serum creatininebased equations was an independent predictor of SXscore in patients with established CAD.…”

Growing Evidence Showing Association of Chronic Kidney Disease and Coronary Artery Disease Should Impact Clinical Practice

“…Cao et al [2] presents the latest evidence that we as physicians must more aggressively treat patients with CKD to meet cardiovascular treatment goals.…”

“…It is becoming increasingly evident that patients with CKD are more likely to die of cardiovascular disease than their kidney dysfunction [1] . The latest study from Cao et al [2] in this issue of Cardiology correlating CKD and cardiovascular disease is based on one of the largest cohorts to date. It is the first study showing that kidney dysfunction is an independent predictor of coronary artery calcium (CAC) scores in patients with clinically suspected coronary artery disease (CAD).…”

“…It is the first study showing that kidney dysfunction is an independent predictor of coronary artery calcium (CAC) scores in patients with clinically suspected coronary artery disease (CAD). In 1,572 patients undergoing multidetector computed tomography, Cao et al [2] showed that age, hypertension, diabetes, C-reactive protein and estimated glomerular filtration rate all exerted independent influences on CAC scores. This comes on the heels of a recently published study based on the Chronic Renal Insufficiency Cohort (CRIC) showing a graded relationship between CAC score and CKD in the general population [3] , and another cohort study demonstrating a graded increase in CAC with worsening CKD among asymptomatic persons [4] .…”

“…The NICE guidelines, developed by the National Clinical Guideline Centre for Acute and Chronic Conditions in the United Kingdom, recommend CAC scoring as the first diagnostic intervention in patients with chest pain without known CAD, who have a 10-29% likelihood of having CAD [14] . The findings of Cao et al [2] suggest that CAC scoring may have a role to play not only in asymptomatic patients with CKD, but in symptomatic patients as well, to help guide treatment.…”