Relation between Mild to Moderate Chronic Kidney Disease and Coronary Artery Disease Determined with Coronary CT Angiography

Abstract

BackgroundBoth end-stage and milder stages of chronic kidney disease (CKD) are associated with an increased risk of adverse cardiovascular events. Several studies found an association between decreasing renal function and increasing coronary artery calcification, but it remains unclear if this association is independent from traditional cardiovascular risk factors. Therefore, the aim of this study was to investigate whether mild to moderate CKD is independently associated with coronary plaque burden beyond traditional cardiovascular risk factors.MethodsA total of 2,038 patients with symptoms of chest discomfort suspected for coronary artery disease underwent coronary CT-angiography. We assessed traditional risk factors, coronary calcium score and coronary plaque characteristics (morphology and degree of luminal stenosis). Patients were subdivided in three groups, based on their estimated glomerular filtration rate (eGFR) Normal renal function (eGFR ≥90 mL/min/1.73 m2); mild CKD (eGFR 60–89 mL/min/1.73 m2); and moderate CKD (eGFR 30–59 mL/min/1.73 m2).ResultsCoronary calcium score increased significantly with decreasing renal function (P<0.001). Coronary plaque prevalence was higher in patients with mild CKD (OR 1.83, 95%CI 1.52–2.21) and moderate CKD (OR 2.46, 95%CI 1.69–3.59), compared to patients with normal renal function (both P<0.001). Coronary plaques with >70% luminal stenosis were found significantly more often in patients with mild CKD (OR 1.67 (95%CI 1.16–2.40) and moderate CKD (OR2.36, 95%CI 1.35–4.13), compared to patients with normal renal function (both P<0.01). After adjustment for traditional cardiovascular risk factors, the association between renal function and the presence of any coronary plaque as well as the association between renal function and the presence of coronary plaques with >70% luminal stenosis becomes weaker and were no longer statistically significant.ConclusionAlthough decreasing renal function is associated with increasing extent and severity of coronary artery disease, mild to moderately CKD is not independently associated with coronary plaque burden after adjustment for traditional cardiovascular risk factors.

Systemic Inflammation Is Associated With Coronary Artery Calcification and All-Cause Mortality in Chronic Kidney Disease

“…In contrast, according to Joosen et al, mild-moderate CKD was not independently associated with coronary plaque burden after adjusting for traditional cardiovascular risk factors. 21 We noted similar results to the Dallas Heart Study and CRIC: the presence of CAC and its severity were closely related to decreased eGFR. 4, 6 The association between CAC and eGFR remained significant after adjusting for traditional risk factors.…”

Does a Reduction in the Glomerular Filtration Rate Increase the Overall Severity of Coronary Artery Stenosis?

“…The results of previous studies regarding the change in the coronary plaque volume by CKD are inconsistent (14)(15)(16)(17)(18), and the effect of CKD on the development of coronary stenosis has not yet been elucidated. In the present study, the multiple regression analysis using data from both men and women indicated that the association between the eGFR and the log-GS was marginally significant (Table 4).…”

“…Increased vulnerability of coronary plaque by increased lipid deposition and necrosis within the plaque has been suggested by several studies using integrated backscatter intravascular ultrasound (IB-IVUS) imaging and intracoronary angioscopy (9)(10)(11)(12)(13). In contrast, reported results regarding the change in the coronary plaque volume by CKD in earlier studies are inconsistent (14)(15)(16)(17)(18). However, the numbers of patients with severe renal dysfunction were not large, and the overall severity of coronary artery disease has not been determined for the comparison of patients with and without CKD in those studies.…”

Differential Impact of Chronic Kidney Disease on Coronary Calcification and Atherosclerosis in Asymptomatic Individuals with or without Diabetes: Analysis from a Coronary Computed Tomographic Angiography Registry

“…Although it remains unclear whether impaired renal function is associated with coronary calcification independent of traditional cardiovascular risk factors, the development and progression of calcification seem to be linked to disrupted mineral metabolism in end-stage renal disease [18]. Conversely, other studies demonstrate that decreased renal function is not associated with greater plaque volume or growth, and luminal stenosis [19][20][21]. However, most studies included diabetic patients and did not distinguish diabetic from nondiabetic CKD.…”