Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study.
Am J Kidney Dis
; 73(6): 806-814, 2019 06.
Article
em En
| MEDLINE
| ID: mdl-30935773
ABSTRACT
RATIONALE & OBJECTIVE:
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. STUDYDESIGN:
Prospective cohort study. SETTING &PARTICIPANTS:
Participants from the Chronic Renal Insufficiency Cohort (CRIC) Study with baseline (n=1,274) and follow-up (n=780) CAC measurements. PREDICTORS 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.OUTCOMES:
CAC prevalence, severity, incidence, and progression. ANALYTICALAPPROACH:
Multivariable-adjusted generalized linear models.RESULTS:
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.LIMITATIONS:
Potential selection bias in follow-up analyses; inability to distinguish intimal from medial calcification.CONCLUSIONS:
Among patients with CKD stages 2 to 4, higher serum calcification propensity is associated with more severe CAC and CAC progression.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Progressão da Doença
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Insuficiência Renal Crônica
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Calcificação Vascular
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Taxa de Filtração Glomerular
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2019
Tipo de documento:
Article