Coronary calcification as a predictor of cardiovascular mortality in advanced chronic kidney disease: a prospective long-term follow-up study

Abstract

Background Patients with advanced chronic kidney disease (CKD) exhibit higher prevalence of coronary artery calcification (CaC) than general population. CaC has been proposed as a risk factor for mortality in end-stage CKD, but most studies in the field are based on short-term follow-up. Methods We conducted a cohort, 10-year prospective longitudinal study of consecutive cases referred to the renal unit. A non-enhanced multislice coronary computed tomography was performed at baseline. CaC was assessed by Agatston method. Patients were stratified according to their CaC score: severe calcification group (CaCs< 400 HU) and mild-moderate calcification group (CaCs≥400 HU). The overall and cardiovascular (CV) mortality, CV events, and factors potentially associated with CaC development were recorded. Results 137 patients with advanced CKD were enrolled and provided consent. Overall mortality rate was 58%; 40% due to CV events. The rate of overall mortality in the severe calcification group was 75%, and 30% in the low calcification group, whereas the rate of CV mortality was 35% vs. 6%, respectively ( p < 0.001). The severe calcification group was older, had higher prevalence of type 2 diabetes mellitus, former cardiologic events, and lower albumin serum levels than the mild-moderate calcification group. In a multivariate Cox model, severe CaC was a significant predictor of CV mortality (HR 5.01; 95%CI 1.28 to 19.6, p = 0.02). Conclusions Among advanced CKD, there was a significantly increase of CV mortality in patients with severe CaCs during a 10-year follow-up period. CaCs could be a useful prognostic tool to predict CV mortality risk in CKD patients. Electronic supplementary material The online version of this article (10.1186/s12882-019-1367-1) contains supplementary material, which is available to authorized users.

Alcohol consumption and subclinical atherosclerosis among South Asians: Findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

“…Alcohol also reduces hyperglycemia through the inhibition of hepatic gluconeogenesis, with a resulting reduction in plasma glucose levels [38]. Chronic kidney disease (CKD) has shown to be associated with atherosclerosis [39,40]. Although few studies have suggested a harmful association between alcohol consumption and CKD, our study found no such association [41,42].…”

Sirtuin-1 and Its Relevance in Vascular Calcification

“…The presence of vascular calcification (VC) is highly associated with an increased risk of cardiovascular disease and all-cause mortality [1][2][3]. Patients with advanced age, diabetes mellitus (DM), and chronic kidney disease (CKD) are at risk for VC.…”

Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry

“…Multiple pathophysiological explanations have been proposed in favour of a causal link underlying the adverse cardiovascular profile of CKD patients [1,24]. These include increased intravascular calcium phosphate deposition and coronary artery calcification, [25][26][27] arterial stiffness, enhanced coagulability, endothelial dysfunction, increased subclinical inflammation, [28] volume overload [29], and left ventricular remodeling and dysfunction [30,31]. In addition, patients with CKD undergoing percutaneous coronary intervention for an acute coronary syndrome have been shown to have less complete revascularization, a condition associated with a poorer prognosis [32].…”