Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease. Issue 8 (August 2022)

• Record Type: Journal Article
• Authors: Yun, Hae-Ryong; Joo, Young Su; Kim, Hyung Woo; Park, Jung Tak; Chang, Tae Ik; Son, Nak-Hoon; Yoo, Tae-Hyun; Kang, Shin-Wook; Sung, Suah; Lee, Kyu-Beck; Lee, Joongyub; Oh, Kook-Hwan; Han, Seung Hyeok
• Other Names: author non-byline.; Ahn Curie author non-byline.; Oh Kook-Hwan author non-byline.; Han Seung Seok author non-byline.; Lee Hajeong author non-byline.; Koh Young Ok author non-byline.; So Jeongok author non-byline.; Ko Seonui author non-byline.; Lee Aram author non-byline.; Chae Dong Wan author non-byline.; Jeong Jong Cheol author non-byline.; Cho Hyun Jin author non-byline.; Oh Jung Eun author non-byline.; Lee Kyu Jin author non-byline.; Yoo Tae-Hyun author non-byline.; Choi Kyu Hun author non-byline.; Han Seung Hyeok author non-byline.; Park Jung Tak author non-byline.; Hong Hui Kyung author non-byline.; You Ji Young author non-byline.; Lee Kyu-Beck author non-byline.; Hyun Young Youl author non-byline.; Kim Hyun Jung author non-byline.; Kim Yong-Soo author non-byline.; Kim Yaeni author non-byline.; Kim Sol Ji author non-byline.; Chung Wookyung author non-byline.; Jung Ji Yong author non-byline.; Jin Kwon Eun author non-byline.; Sung Suah author non-byline.; Min Hyang Ki author non-byline.; Ku Ja Yung author non-byline.; Kim Soo Wan author non-byline.; Kwon Seong author non-byline.; Bae Eun Hui author non-byline.; Kim Chang Seong author non-byline.; Kim Ha Yeon author non-byline.; Oh Tae Ryom author non-byline.; Choi Hong Sang author non-byline.; Kim Minah author non-byline.; Myeong Chana author non-byline.; Lee Jeong Ho author non-byline.; Lee Ji Seon author non-byline.; Kim Yeong Hoon author non-byline.; Kang Sun Woo author non-byline.; Kim Tae Hee author non-byline.; Kim Yunmi author non-byline.; Oh Young Eun author non-byline.; Koo Ja Ryong author non-byline.; Seo Jang Won author non-byline.; Baek Seon Ha author non-byline.; Kim Myung Sun author non-byline.; Chang Tae Ik author non-byline.; Park Kyoung Sook author non-byline.; Choi Aei Kyung author non-byline.; Oh Yun Kyu author non-byline.; Lee Jung Pyo author non-byline.; Lee Jeong Hwan author non-byline.; Park Jeong Mi author non-byline.; Seong Eun Young author non-byline.; Heon Song Sang author non-byline.; Rhee Harin author non-byline.; Kim Hyo Jin author non-byline.; Woon Kim Da author non-byline.; Ji Seung Hee author non-byline.; Kim Young Taek author non-byline.; Na Ki Ryang author non-byline.; Choi Dae Eun author non-byline.; Ham Young Rok author non-byline.; Lee Eu Jin author non-byline.; Cha Yoon Jung author non-byline.;
• Is Part Of: Journal of the American Society of Nephrology. Volume 33:Issue 8(2022)
• Page Start: 1590
• Page End: 1601
• Publication Date: 2022-08
• Subjects: coronary calcification -- coronary artery disease -- chronic renal disease -- clinical nephrology -- vascular calcification
• DOI: 10.1681/ASN.2022010080
• Languages: English
• ISSNs: 1046-6673

Abstract

Significant Statement: Coronary artery calcification (CAC) is an independent risk factor of cardiovascular disease (CVD) regardless of CKD status, and the CAC score (CACS) may have clinical implications beyond an increased CVD risk. In a prospective cohort study from 1936 patients with CKD in South Korea, higher CACS (1–100 AU and >100 AU) was associated with an increased risk of CKD progression (1.29-fold and 1.42-fold, respectively) compared with a CACS of 0. This association was consistent even after adjustment of nonfatal cardiovascular events being treated as a time-varying covariate. Moreover, the slope of eGFR decline was significantly greater in patients with higher CACS. These findings suggest that CACS may represent potential risk of CKD progression and high odds for adverse CVD. Visual Abstract: Abstract : Background: An elevated coronary artery calcification score (CACS) is associated with increased cardiovascular disease risk in patients with CKD. However, the relationship between CACS and CKD progression has not been elucidated. Methods: We studied 1936 participants with CKD (stages G1–G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1–100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy. Results: During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1–100 AU (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1–100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate. Conclusion: Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.