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

doi:10.1681/ASN.2022010080

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Visual Abstract

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.

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