Progression of Coronary Artery Calcification and Cardiac Events in Patients with Chronic Renal Disease Not Receiving Dialysis

Overview

Journal Kidney Int

Publisher Elsevier

Specialty Nephrology

Date 2011 Apr 1

PMID 21451461

Citations 73

Authors

Domenico Russo

Salvatore Corrao

Yuri Battaglia

Michele Andreucci

Antonella Caiazza

Angelo Carlomagno

Monica Lamberti

Nicoletta Pezone

Andrea Pota

Luigi Russo

Maurizio Sacco

Bernadette Scognamiglio

Affiliations

Soon will be listed here.

Abstract

We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population.

Citing Articles

Understanding Vascular Calcification in Chronic Kidney Disease: Pathogenesis and Therapeutic Implications.

Siracusa C, Carabetta N, Morano M, Manica M, Strangio A, Sabatino J Int J Mol Sci. 2024; 25(23).

PMID: 39684805 PMC: 11642360. DOI: 10.3390/ijms252313096.

Novel Perspectives in Chronic Kidney Disease-Specific Cardiovascular Disease.

Xu C, Tsihlis G, Chau K, Trinh K, Rogers N, Julovi S Int J Mol Sci. 2024; 25(5).

PMID: 38473905 PMC: 10931927. DOI: 10.3390/ijms25052658.

Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association.

Zoccali C, Mallamaci F, Adamczak M, Oliveira R, Massy Z, Sarafidis P Cardiovasc Res. 2023; 119(11):2017-2032.

PMID: 37249051 PMC: 10478756. DOI: 10.1093/cvr/cvad083.

Cardiac Imaging Biomarkers in Chronic Kidney Disease.

Valbuena-Lopez S, Camastra G, Cacciotti L, Nagel E, Puntmann V, Arcari L Biomolecules. 2023; 13(5).

PMID: 37238643 PMC: 10216582. DOI: 10.3390/biom13050773.

A small circulating miRNAs signature predicts mortality and adverse cardiovascular outcomes in chronic hemodialysis patients.

Bolignano D, Greco M, Presta P, Duni A, Vita C, Pappas E Clin Kidney J. 2023; 16(5):868-878.

PMID: 37151423 PMC: 10157794. DOI: 10.1093/ckj/sfad017.

References

Bielak L, Rumberger J, Sheedy 2nd P, Schwartz R, Peyser P . Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata. Circulation. 2000; 102(4):380-5. DOI: 10.1161/01.cir.102.4.380. View

Adragao T, Pires A, Lucas C, Birne R, Magalhaes L, Goncalves M . A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant. 2004; 19(6):1480-8. DOI: 10.1093/ndt/gfh217. View

Mielke C, Shields J, Broemeling L . Coronary artery calcium, coronary artery disease, and diabetes. Diabetes Res Clin Pract. 2001; 53(1):55-61. DOI: 10.1016/s0168-8227(01)00239-x. View

Garg A, Clark W, Haynes R, House A . Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int. 2002; 61(4):1486-94. DOI: 10.1046/j.1523-1755.2002.00270.x. View

Achenbach S, Ropers D, Pohle K, Leber A, Thilo C, Knez A . Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Circulation. 2002; 106(9):1077-82. DOI: 10.1161/01.cir.0000027567.49283.ff. View

Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft F . Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis. 1996; 27(3):394-401. DOI: 10.1016/s0272-6386(96)90363-7. View

Shioi A, Katagi M, Okuno Y, Mori K, Jono S, Koyama H . Induction of bone-type alkaline phosphatase in human vascular smooth muscle cells: roles of tumor necrosis factor-alpha and oncostatin M derived from macrophages. Circ Res. 2002; 91(1):9-16. DOI: 10.1161/01.res.0000026421.61398.f2. View

Kestenbaum B, Adeney K, de Boer I, Ix J, Shlipak M, Siscovick D . Incidence and progression of coronary calcification in chronic kidney disease: the Multi-Ethnic Study of Atherosclerosis. Kidney Int. 2009; 76(9):991-8. PMC: 3039603. DOI: 10.1038/ki.2009.298. View

Watanabe R, Lemos M, Manfredi S, Draibe S, Canziani M . Impact of cardiovascular calcification in nondialyzed patients after 24 months of follow-up. Clin J Am Soc Nephrol. 2009; 5(2):189-94. PMC: 2827590. DOI: 10.2215/CJN.06240909. View

10.

Shanahan C . Inflammation ushers in calcification: a cycle of damage and protection?. Circulation. 2007; 116(24):2782-5. DOI: 10.1161/CIRCULATIONAHA.107.749655. View

11.

Culleton B, Larson M, Wilson P, Evans J, Parfrey P, Levy D . Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int. 1999; 56(6):2214-9. DOI: 10.1046/j.1523-1755.1999.00773.x. View

12.

McCullough P, Chinnaiyan K . Annual progression of coronary calcification in trials of preventive therapies: a systematic review. Arch Intern Med. 2009; 169(22):2064-70. DOI: 10.1001/archinternmed.2009.382. View

13.

Drey N, Roderick P, Mullee M, Rogerson M . A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis. 2003; 42(4):677-84. DOI: 10.1016/s0272-6386(03)00916-8. View

14.

Nadra I, Mason J, Philippidis P, Florey O, Smythe C, McCarthy G . Proinflammatory activation of macrophages by basic calcium phosphate crystals via protein kinase C and MAP kinase pathways: a vicious cycle of inflammation and arterial calcification?. Circ Res. 2005; 96(12):1248-56. DOI: 10.1161/01.RES.0000171451.88616.c2. View

15.

Kern M, Meier B . Evaluation of the culprit plaque and the physiological significance of coronary atherosclerotic narrowings. Circulation. 2001; 103(25):3142-9. DOI: 10.1161/01.cir.103.25.3142. View

16.

Cozzolino M, Brancaccio D, Gallieni M, Slatopolsky E . Pathogenesis of vascular calcification in chronic kidney disease. Kidney Int. 2005; 68(2):429-36. DOI: 10.1111/j.1523-1755.2005.00421.x. View

17.

Libby P, Theroux P . Pathophysiology of coronary artery disease. Circulation. 2005; 111(25):3481-8. DOI: 10.1161/CIRCULATIONAHA.105.537878. View

18.

Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D . Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation. 2004; 110(22):3424-9. DOI: 10.1161/01.CIR.0000148131.41425.E9. View

19.

Bonow R . Clinical practice. Should coronary calcium screening be used in cardiovascular prevention strategies?. N Engl J Med. 2009; 361(10):990-7. DOI: 10.1056/NEJMcp0902177. View

20.

Greenland P, Bonow R, Brundage B, Budoff M, Eisenberg M, Grundy S . ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology.... Circulation. 2007; 115(3):402-26. DOI: 10.1161/CIRCULATIONAHA..107.181425. View