Abstract 13839: Differences in Prevalence, Incidence, and Progression of Coronary Artery Calcium among Participants With Chronic Kidney Disease With and Without Diabetes Mellitus: Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Introduction: Chronic kidney disease (CKD) is associated with elevated coronary artery calcium (CAC) scores, presumed from altered calcium/phosphorus metabolism. However, differences in prevalence/progression of CAC in CKD with (CKD-DM) and without (CKD-non-DM) diabetes are not known. Methods: The MESA cohort (6780 individuals aged 45-84 yr, with no clinical cardiovascular disease enrolled 2000-02) were followed until 2010-12. Baseline CKD was identified (eGFR<60 ml/min/1.73 m 2 using CKD-EPI creatinine and cystatin C-based eGFR or spot urine albumin/creatinine ≥ 17 mg/g in men; 25 mg/g in women). Prevalent CAC was defined by baseline Agatston score >0, incident CAC by any follow-up Agatston score > 0 in those with baseline CAC=0, and CAC progression by any CAC score increase vs. baseline. CAC progression was adjusted for demographic, clinical and inflammatory biomarker variables using linear regression. Results: 1308 (19.3%) MESA participants had CKD, while 853 (12.5%) had DM. CAC > 0 at baseline was lowest (44.3%) in non-CKD, non-DM, intermediate in those with either condition, and highest (67.1%) in CKD-DM participants (table). CAC incidence (among those with CAC=0 at baseline) was highest in CKD-DM, lowest in non-CKD-non-DM (39.3% vs 18.3%, p<0.0001) & intermediate with either CKD or DM alone (27%). About 90% of those with CAC > 0 at baseline had an increase in Agatston score in follow-up; Agatston score increased 37.0/yr in non-CKD-non-DM, 57.6/yr in CKD-non-DM, 68.3/yr in non-CKD-DM, and 107.6/yr in CKD-DM (all pairwise p<0.001). Extensive adjustment (table) attenuated to similar increases between non-CKD-non-DM and CKD-non-DM (40.6 vs 47.2/yr, p=0.09). Greater increases remained in non-CKD-DM (65.7/yr) and in CKD-DM (95.8/yr, p<0.002). Conclusion: CKD-non-DM participants had slower CAC incidence/progression compared to CKD-DM participants. CAC differences among CKD participants may help identify subgroups at higher risk of future events.