Regional distribution and severity of arterial calcification in patients with chronic kidney disease stages 1–5: a cross-sectional study of the Copenhagen chronic kidney disease cohort

Abstract

Background Patients with chronic kidney disease (CKD) and arterial calcification are considered at increased risk of adverse cardiovascular outcomes. However, the optimal site for measurement of arterial calcification has not been determined. The primary aim of this study was to examine the pattern of arterial calcification in different stages of CKD. Methods This was an observational, cross-sectional study that included 580 individuals with CKD stages 1–5 (no dialysis) from the Copenhagen CKD Cohort. Calcification of the carotid, coronary and iliac arteries, thoracic and abdominal aorta was assessed using non-contrast multidetector computed tomography scans and quantified according to the Agatston method. Based on the distribution of Agatston scores in the selected arterial region, the subjects were divided into calcium score categories of 0 (no calcification), 1–100, 101–400 and > 400. Results Participants with CKD stages 3–5 had the highest prevalence of calcification and the highest frequency of calcium scores > 400 in all arterial sites. Calcification in at least one arterial site was present in > 90% of patients with CKD stage 3. In all five CKD stages prevalence of calcification was greatest in both the thoracic and abdominal aorta, and in the iliac arteries. These arterial sites also showed the highest calcium scores. High calcium scores (> 400) in all five arterial regions were independently associated with prevalent cardiovascular disease. In multivariable analyses, after adjusting for cardiovascular risk factors, declining creatinine clearance was associated with increasing calcification of the coronary arteries (p = 0.012) and the thoracic aorta (p = 0.037) only. Conclusions Arterial calcification is highly prevalent throughout all five CKD stages and is most prominent in both the thoracic and abdominal aorta, and in the iliac arteries. Follow-up studies are needed to explore the potential of extracardiac calcification sites in prediction of cardiovascular events in the CKD population.

Carotid plaque thickness is increased in chronic kidney disease and associated with carotid and coronary calcification

“…The present carotid ultrasound study was a cross-sectional baseline study of a sub-group of patients from the Copenhagen (CPH) CKD Cohort described in details elsewhere [ 19 ]. In brief, the CPH CKD Cohort is a single-centre prospective, observational study examining novel risk factors and imaging methods for early detection of cardiovascular disease in a cohort of patients aged 30–75 years with any diagnosis of CKD stages 1–5 (no dialysis).…”

“…Among included patients, 580 accepted to undergo computed tomography (CT) scanning of the major arterial regions: The carotid and coronary arteries, the thoracic and abdominal aorta and the iliac arteries [ 19 ]. The carotid ultrasound study was restricted to patients with CKD stage 3 (eGFR 30–59 ml/min per 1.73 m 2 ).…”

“…Information on demographic and clinical data, medical history, medications and lifestyle factors were retrieved from in-person interviews, physical examination and electronic medical records [ 19 ]. Biochemical data were obtained from a fasting blood sample and a urine sample.…”

“…Cardiovascular disease was defined as a composite of prevalent coronary artery disease, a history with previous cerebrovascular infarction, carotid endarterectomy or stenting and/or peripheral artery disease as described in detail [ 19 ].…”

End-stage renal disease, calcification patterns and clinical outcomes after TAVI

“…Main risk factors include hypertension and diabetes leading to renal fibrosis [12]. Furthermore, CKD and ESRD are associated with an earlier and faster progression of AS severity and severe vascular calcifications [13][14][15]. Impaired outcomes were reported after TAVI [10,16].…”