Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium

Abstract

Background

It is increasingly evident that patients with chronic kidney disease (CKD) are more likely to die from heart disease than kidney failure. This study evaluated whether pre- dialysis CKD is an independent risk factor for coronary artery calcium (CAC).

Methods

A total of 544 consecutive patients who underwent CAC scoring were analyzed. Eleven patients requiring hemodialysis were excluded. Patients were divided into three groups: normal glomerular filtration rate (GFR) (GFR > 90 mL/min/1.73 m ²), mild CKD (90 ≥ GFR > 60 mL/min/1.73 m ²), and moderate CKD (60 ≥ GFR > 30 mL/min/1.73 m ²). Continuous and categorical variables were compared using analysis of variance and the χ ² statistic. A multiple logistic regression model was used for detecting the association between total CAC score and GFR. An unadjusted model was used, followed by a second model adjusted for covariates known to be related to CAC. Another multivariable binary logistic model predicting the presence of CAC (>10) was performed and odds of incidence of CAC (>10) were calculated among the three GFR subgroups.

Results

After adjustment for covariates, patients with mild CKD had mean CAC scores 175 points higher than those with the referent normal GFR ( P = 0.048), while those with moderate CKD had mean CAC scores 693 points higher than the referent ( P < 0.001). After adjustment for covariates, patients with mild CKD were found to be 2.2 times more likely (95% confidence interval 1.3–3.7, P = 0.004) and patients with moderate CKD were 6.4 times more likely (95% confidence interval 2.9–14.3, P < 0.001) to have incident CAC compared with the group with normal GFR.

Conclusion

Mild and moderate pre-dialysis CKD are independent risk factors for increased mean and incident CAC.