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Clinical ResearchChronic Kidney Disease
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Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease

Hae-Ryong Yun, Young Su Joo, Hyung Woo Kim, Jung Tak Park, Tae Ik Chang, Nak-Hoon Son, Tae-Hyun Yoo, Shin-Wook Kang, Suah Sung, Kyu-Beck Lee, Joongyub Lee, Kook-Hwan Oh and Seung Hyeok Han; on behalf of the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) investigators
JASN August 2022, 33 (8) 1590-1601; DOI: https://doi.org/10.1681/ASN.2022010080
Hae-Ryong Yun
1Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Young Su Joo
1Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Hyung Woo Kim
2Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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Jung Tak Park
2Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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Tae Ik Chang
3Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
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Nak-Hoon Son
4Department of Statistics, Keimyung University, Daegu, South Korea
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Tae-Hyun Yoo
2Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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Shin-Wook Kang
2Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
5Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Republic of Korea
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Suah Sung
6Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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Kyu-Beck Lee
7Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
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Joongyub Lee
8Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Republic of Korea
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Kook-Hwan Oh
9Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
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Seung Hyeok Han
2Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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Significant Statement

Coronary artery calcification (CAC) is an independent risk factor of cardiovascular disease (CVD) regardless of CKD status, and the CAC score (CACS) may have clinical implications beyond an increased CVD risk. In a prospective cohort study from 1936 patients with CKD in South Korea, higher CACS (1–100 AU and >100 AU) was associated with an increased risk of CKD progression (1.29-fold and 1.42-fold, respectively) compared with a CACS of 0. This association was consistent even after adjustment of nonfatal cardiovascular events being treated as a time-varying covariate. Moreover, the slope of eGFR decline was significantly greater in patients with higher CACS. These findings suggest that CACS may represent potential risk of CKD progression and high odds for adverse CVD.

Abstract

Background An elevated coronary artery calcification score (CACS) is associated with increased cardiovascular disease risk in patients with CKD. However, the relationship between CACS and CKD progression has not been elucidated.

Methods We studied 1936 participants with CKD (stages G1–G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1–100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy.

Results During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1–100 AU (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1–100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate.

Conclusion Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.

  • coronary calcification
  • coronary artery disease
  • chronic renal disease
  • clinical nephrology
  • vascular calcification
  • Copyright © 2022 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 33 (8)
Journal of the American Society of Nephrology
Vol. 33, Issue 8
August 2022
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Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease
Hae-Ryong Yun, Young Su Joo, Hyung Woo Kim, Jung Tak Park, Tae Ik Chang, Nak-Hoon Son, Tae-Hyun Yoo, Shin-Wook Kang, Suah Sung, Kyu-Beck Lee, Joongyub Lee, Kook-Hwan Oh, Seung Hyeok Han
JASN Aug 2022, 33 (8) 1590-1601; DOI: 10.1681/ASN.2022010080

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Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease
Hae-Ryong Yun, Young Su Joo, Hyung Woo Kim, Jung Tak Park, Tae Ik Chang, Nak-Hoon Son, Tae-Hyun Yoo, Shin-Wook Kang, Suah Sung, Kyu-Beck Lee, Joongyub Lee, Kook-Hwan Oh, Seung Hyeok Han
JASN Aug 2022, 33 (8) 1590-1601; DOI: 10.1681/ASN.2022010080
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Keywords

  • coronary calcification
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