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      Cardiovascular disease: Coronary artery calcification predicts risk of CVD in patients with CKD

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      Journal: Nature Reviews Nephrology
      Publisher: Springer Nature

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          Abstract

          A recent study reports that coronary artery calcification (CAC) predicts the risk of heart failure, myocardial infarction and stroke in patients with moderate chronic kidney disease (CKD). This finding suggests that even in CKD, CAC is a marker of cardiovascular risk rather than a benign indicator of vessel healing and stability.

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          Coronary calcification in patients with chronic kidney disease and coronary artery disease.

          F Yoshihara, Satoko Nakamura, Hatsue Ishibashi-Ueda … (2009)
          A close linkage between chronic kidney disease (CKD) and cardiovascular disease (CVD) has been demonstrated. Coronary artery calcification (CAC) is considered to be the causal link connecting them. The aim of the study is to determine the relationship between level of kidney function and the prevalence of CAC. Autopsy subjects known to have coronary artery disease and a wide range of kidney function were studied. Patients without CKD were classified into five groups depending on estimated GFR (eGFR) and proteinuria: eGFR > or =60 ml/min/1.73 m(2) without proteinuria; CKD1/2: eGFR > or =60 ml/min/1.73 m(2) with proteinuria; CKD3: 60 ml/min/1.73 m(2) >eGFR > or =30 ml/min/1.73 m(2); CKD4/5: eGFR <30 ml/min/1.73 m(2); and CKD5D: on hemodialysis. Intimal and medial calcification of the coronary arteries was evaluated. Risk factors for CVD and uremia were identified as relevant to CAC using logistic regression analysis. Intimal calcification of plaques was present in all groups, but was most frequent and severe in the CKD5D group and less so in the CKD4/5 and CKD3 groups. Risk factors included luminal stenosis, age, smoking, diabetes, calcium-phosphorus product, inflammation, and kidney function. Medial calcification was seen in a small number of CKD4/5 and CKD5D groups. Risk factors were use of calcium-containing phosphate binders, hemodialysis treatment, and duration. It was concluded that CAC was present in the intimal plaque of both nonrenal and renal patients. Renal function and traditional risks were linked to initimal calcification. Medial calcification occurred only in CKD patients.
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            Prevalence of atrial fibrillation and its predictors in nondialysis patients with chronic kidney disease.

            E Lerma, E Guglielmi, Sirikarn Napan … (2010)
            Chronic kidney disease (CKD) increases systemic inflammation, which is implicated in development and maintenance of atrial fibrillation (AF); therefore, we hypothesized that the prevalence of AF would be increased among nondialysis patients with CKD. This study also reports independent predictors of the presence of AF in this population. A retrospective, cross-sectional analysis of 1010 consecutive nondialysis patients with CKD from two community-based hospitals was conducted. Estimated GFRs (eGFRs) were calculated using the Modification of Diet in Renal Disease (MDRD) equation. Multivariate logistic regression was used to determine independent predictors. Of 1010 nondialysis patients with CKD, 214 (21.2%) had AF. Patients with AF were older than patients without AF (76 +/- 11 versus 63 +/- 15 yr). The prevalence of AF among white patients (42.7%) was higher than among black patients (12.7%) or other races (5.7%). In multivariate analyses, age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure were identified as independent predictors of the presence of AF. Although serum high-sensitivity C-reactive protein levels were elevated in our population (5.2 +/- 7.4 mg/L), levels did not correlate with the presence of AF or with eGFR. Finally, eGFR did not correlate with the presence of AF in our population. The prevalence of AF was increased in our population, and independent predictors were age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure.
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              Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation.

              Austin Schwartz, T. Desai, Bruce Gewertz … (2004)
              We undertook this study to quantitate differences in the degree of calcification between symptomatic and asymptomatic plaques removed at carotid endarterectomy (CEA) and to determine associated extent of plaque macrophage infiltration, a histopathologic feature of plaque instability. CEA plaques (n = 48) were imaged at 1.25-mm intervals with spiral computed tomography (CT; 10-15 images per plaque). Indications for CEA were transient ischemic attack (n = 16), stroke (n = 5), amaurosis (n = 4), and critical asymptomatic stenosis (n = 23). The percent area calcification for each plaque was determined in spiral CT serial sections and averaged for each plaque. In 31 of 48 plaques macrophage infiltration was quantitated in corresponding histologic sections with immunohistochemical techniques. The mean (+/- SD) age of patients with symptomatic and asymptomatic plaques was 66 +/- 7 years vs 71 +/- 7 years, respectively, and degree of stenosis was 76% versus 82%, respectively (P =.05). Atherosclerosis risk factors were similar between groups. Percent plaque area calcification was twofold greater in asymptomatic versus symptomatic plaques (48% +/- 19% vs 24% +/- 20%, respectively; P <.05). At receiver operating characteristic curve analysis, 80% of symptomatic plaques were below and 87% of asymptomatic plaques were above a cutoff point of 30% plaque area calcification. Macrophage burden was greater in the symptomatic plaques than in the asymptomatic plaques (52% vs 23%; P <.03). A strong inverse relationship between the degree of plaque calcification and macrophage infiltration was found in critical carotid stenoses (r = -0.87; P <.001). Symptomatic plaques are less calcified and more inflamed than asymptomatic plaques. Regardless of clinical outcome, a strong inverse correlation was found between the extent of carotid plaque calcification and the intensity of plaque fibrous cap inflammation as determined by the degree of macrophage infiltration. Carotid plaque calcification is associated with plaque stability, and is a potential spiral CT in vivo quantitative marker for cerebrovascular ischemic event risk.
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                Author and article information

                Journal
                Title: Nature Reviews Nephrology
                Abbreviated Title: Nat Rev Nephrol
                Publisher: Springer Nature
                ISSN (Print): 1759-5061
                ISSN (Electronic): 1759-507X
                Publication date Created: May 8 2017
                Publication date (Print): May 8 2017
                Volume:
                Issue:
                Article
                DOI: 10.1038/nrneph.2017.61
                PubMed ID: 28480902
                SO-VID: 6b5e346f-0523-43a1-9f60-2e66a9d02c8e
                Copyright © © 2017
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