CKD Progression Linked to CAC

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CKD patients with coronary artery calcification (CAC) are at increased risk for renal function decline, according to investigators at Queen's University in Kingston, Ont.

The findings are based on a study of 126 patients with stage 3-5 CKD and who had CAC at baseline. Their mean estimated glomerular filtration rate (eGFR) declined from 27.4 mL/min/1.73 m2 at baseline to 25.2 over one year.

Researchers found that 66% of subjects with CAC scores of 10 or higher (mild to severe CAC) had a 5% or greater decline in eGFR at one year compared with 43% of patients with a CAC score less than 10 (minimal CAC), researchers reported at the Canadian Society of Nephrology annual meeting in Edmonton, Alberta.

After adjusting for confounders, a CAC score of 10 or higher was associated with a 4.7 times increased risk of progressive kidney disease compared with subjects with lower CAC scores. In addition, patients with diabetes had a twofold increased risk.

“Our findings may suggest that having low GFR along with CAC may signal more significant ‘global' vascular disease, and thus may identify patients more likely to have progressive CKD,” said principal investigator Jocelyn S. Garland, MD, an Assistant Professor in the Division of Nephrology.

“These patients warrant longer term follow-up by nephrologists. Also, these patients may need to be treated more aggressively in terms of managing all the potential factors involved in the etiology of CAC, in order to preserve vascular health.” She cautioned, however, that the study is limited by its observational design and small sample size.

In a previous study of pre-dialysis CKD patients (Am J Kidney Dis. 2008;52:849-858), she and her collaborators demonstrated that traditional risk factors were important in the development of CAC.
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