Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

• DOI: 10.1053/j.ajkd.2019.01.024
• Publication Date: 2019-03-29T22:47:29Z
• Authors: Joshua D. Bundy; Xuan Cai; Julia J. Scialla; Mirela A. Dobre; Jing Chen; Chi-yuan Hsu; Mary B. Leonard; Alan S. Go; Panduranga S. Rao; James P. Lash; Raymond R. Townsend; Harold I. Feldman; Ian H. de Boer; Geoffrey A. Block; Myles Wolf; Edward R. Smith; Andreas Pasch; Tamara Isakova; Lawrence J. Appel; Harold I. Feldman; Alan S. Go; Jiang He; James P. Lash; Panduranga S. Rao; Mahboob Rahman; Raymond R. Townsend
• Keywords: Male; Kidney Disease; Comorbidity; Coronary Artery Disease; Cardiovascular; Cohort Studies; 0302 clinical medicine; cardiovascular disease; risk factors; Renal Insufficiency; Prospective Studies; Chronic; Incidence; Age Factors; Pharmacology and Pharmaceutical Sciences; Urology & Nephrology; Middle Aged; 16. Peace & justice; 3. Good health; Heart Disease; Public Health and Health Services; Disease Progression; calciprotein particles; calcification propensity; epidemiology; Female; Glomerular Filtration Rate; Clinical Sciences; Renal and urogenital; 03 medical and health sciences; Sex Factors; Clinical Research; Humans; Renal Insufficiency, Chronic; Propensity Score; Vascular Calcification; Heart Disease - Coronary Heart Disease; coronary artery calcium; Aged; transformation time (T(50)); Biomedical and Clinical Sciences; Prevention; Atherosclerosis; Survival Analysis; Good Health and Well Being; CRIC Study Investigators; chronic kidney disease; Follow-Up Studies

Coronary artery calcification (CAC) is prevalent among patients with chronic kidney disease (CKD) and increases risks for cardiovascular disease events and mortality. We hypothesized that a novel serum measure of calcification propensity is associated with CAC among patients with CKD stages 2 to 4.Prospective cohort study.Participants from the Chronic Renal Insufficiency Cohort (CRIC) Study with baseline (n=1,274) and follow-up (n=780) CAC measurements.Calcification propensity, quantified as transformation time (T50) from primary to secondary calciprotein particles, with lower T50 corresponding to higher calcification propensity. Covariates included age, sex, race/ethnicity, clinical site, estimated glomerular filtration rate, proteinuria, diabetes, systolic blood pressure, number of antihypertensive medications, current smoking, history of cardiovascular disease, total cholesterol level, and use of statin medications.CAC prevalence, severity, incidence, and progression.Multivariable-adjusted generalized linear models.At baseline, 824 (65%) participants had prevalent CAC. After multivariable adjustment, T50 was not associated with CAC prevalence but was significantly associated with greater CAC severity among participants with prevalent CAC: 1-SD lower T50 was associated with 21% (95% CI, 6%-38%) greater CAC severity. Among 780 participants followed up an average of 3 years later, 65 (20%) without baseline CAC developed incident CAC, while 89 (19%) with baseline CAC had progression, defined as annual increase≥100 Agatston units. After multivariable adjustment, T50 was not associated with incident CAC but was significantly associated with CAC progression: 1-SD lower T50 was associated with 28% (95% CI, 7%-53%) higher risk for CAC progression.Potential selection bias in follow-up analyses; inability to distinguish intimal from medial calcification.Among patients with CKD stages 2 to 4, higher serum calcification propensity is associated with more severe CAC and CAC progression.