Coronary Artery Calcification Risk Factors in CKD Identified

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Abnormal calcium-phosphate metabolism appears to be an important pathogenic factor in the development of vascular calcification in patients with chronic kidney disease.
Abnormal calcium-phosphate metabolism appears to be an important pathogenic factor in the development of vascular calcification in patients with chronic kidney disease.

Researchers have identified novel risk factors associated with coronary artery calcification (CAC) in patients with chronic kidney disease (CKD).

To understand why CAC is more common and severe in CKD patients, Jiang He, MD, PhD, of Tulane University School of Public Health and Tropical Medicine in New Orleans, and colleagues assessed CAC progression by computed tomography and Agatston measurements in 1123 racially and ethnically diverse patients (aged 21–74 years) with stage 2 to 4 CKD from the Chronic Renal Insufficiency Cohort (CRIC) study.

Over a mean 3.3 years of follow-up, CAC developed in one quarter of participants free of CAC at baseline, and 18% with pre-existing CAC experienced an increase of 100 Agatston units or more annually. After adjustment for established cardiovascular disease (CVD) risk factors, such as total cholesterol, systolic blood pressure, and diabetes, as well as medication use, several novel risk factors emerged.

Individuals with higher square root transformed CAC scores tended to have elevated levels of 24-hour urine albumin, cystatin C, serum phosphate, fibroblast growth factor-23, total parathyroid hormone, interleukin-6, and tumor necrosis factor-α. Those with lower CAC scores, however, had higher estimated glomerular filtration rate and serum calcium values.

“Our study indicates that reduced kidney function, calcium and phosphate metabolism disorders, and inflammation, independent of established CVD risk factors, might play a role in CAC progression among CKD patients,” Dr He and his colleagues concluded in Atherosclerosis. “Further studies are warranted to confirm these findings and to develop novel treatments to slow the progression of CAC among patients with CKD.”

Reference

Bundy JD, Chen J, Yang W, et al. Risk factors for progression of coronary artery calcification in patients with chronic kidney disease: The CRIC study. Athero. DOI:10.1016/j.atherosclerosis.2018.02.009

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