Coronary artery calcification in CKD spells increased atherosclerotic CVD, mortality risk

Adults with chronic kidney disease (CKD) are at heightened risk of atherosclerotic cardiovascular disease (CVD) and all-cause mortality in the presence of coronary artery calcification (CAC), as shown in a study.

The study included 1,310 adults (mean age at first CT scan 56.5 years, 47.8 percent women, 39.6 percent had diabetes, mean eGFR 46.3 mL/min per 1.73 m²) who participated in the Chronic Renal Insufficiency Cohort (CRIC) Study who had at least one CAC scan and no prior history of CVD. 

Observed or imputed CAC progression was defined as incident CAC among participants with zero CAC on the baseline scan, while progressive CAC was defined as an increase in CAC ≥50 Agatston units per year among those whose baseline scan demonstrated CAC. Outcomes of interest were atherosclerotic CVD (myocardial infarction or stroke), congestive heart failure, and all-cause mortality.

At baseline, CAC was present in 765 participants and absent in 545. Over a mean follow-up of 3.3 years, incident CAC was identified in 177 participants (32.5 percent) and progressive CAC in 270 (35.3 percent).

Multivariable cause-specific Cox proportional hazards regression analysis showed that participants with incident CAC had a more than twofold higher risk of atherosclerotic CVD (hazard ratio [HR], 2.42, 95 percent confidence interval [CI], 1.23–4.79) and 1.8-fold increased risk of all-cause mortality (HR, 1.82, 95 percent CI, 1.03–3.22) compared with those who remained CAC-free.

Likewise, participants with progressive CAC (≥50 units per year) were at higher risk of all-cause mortality (HR, 1.73, 95 percent CI, 1.31–2.28). No risk increase for atherosclerotic CVD was observed (HR, 1.42, 95 percent CI, 0.85–2.35).

The study was limited by residual confounding and limited statistical power for some outcomes.