Abstract 8939: Mild And Moderate Pre-dialysis Chronic Kidney Disease Is Associated With Increased Coronary Artery Calcium

Abstract

BACKGROUND It is increasingly evident that patients with chronic kidney disease (CKD) are more likely to die from heart disease than kidney failure. We evaluated whether pre-dialysis CKD is an independent risk factor for coronary artery calcium (CAC) in patients undergoing multi-detector computed tomography (MDCT) for CAC scoring. METHODS We analyzed 544 consecutive patients who underwent MDCT at our center. Eleven patients requiring regular hemodialysis were excluded. Patients were divided into three groups: normal GFR (GFR>90 ml/min/1.73 m 2 ), mild CKD (90≥GFR>60 ml/min/1.73m 2 ) and moderate CKD (60≥GFR>30 ml/min/1.73m 2 ). Continuous and categorical variables were compared using ANOVA and the χ 2 statistic. A multiple logistic regression model was used for detecting the association between total CAC score and GFR. An unadjusted model was used, followed by a second model adjusted for covariates known to be related to CAC. Another multivariable binary logistic model predicting presence of CAC (>10) was performed and odds of incidence of CAC (>10) were calculated among the three GFR sub-groups respectively. RESULTS In the unadjusted analysis, patients with mild CKD had mean CAC scores 174 points higher than those with the referent normal GFR (p=0.03), while patients with moderate CKD had mean CAC scores 575 points higher than the referent (p<0.001). After adjustment for the proper covariates, patients with mild CKD had mean CAC scores 175 points higher than those with normal GFR (p=0.048), while those with moderate CKD had mean CAC scores 693 points higher than the referent (p<0.001). Without adjustment, in the full population, patients with mild CKD were 1.9 times more likely to have incident CAC (defined as CAC score>10) (95p%CI 1.3-2.9, p=0.002), while patients with moderate CKD were 4.1 times more likely to have incident CAC when compared to the group with normal GFR (95p% CI 2.3-7.8, p<0.001). After adjustment for covariates, patients with mild CKD were found to be 2.2 times more likely (95p%CI 1.3-3.7, p=0.004) and patients with moderate CKD were 6.4 times more likely (95p% CI 2.9-14.3, p<0.001) to have incident CAC compared to the referent group. CONCLUSION Mild and moderate pre-dialysis CKD are independent risk factors for increased mean and incident CAC.