Abstract P063: Serum Calcification Propensity and Cardiovascular Disease Events Among Patients With Chronic Kidney Disease: the CRIC Study

Abstract

Introduction: Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease (CVD) events and vascular calcification is one pathway by which risk is increased. Hypothesis: We assessed the hypothesis that a novel measure of serum calcification propensity is associated with CVD events among patients with CKD stages 2-4. Methods: Among 3397 participants from the prospective longitudinal Chronic Renal Insufficiency Cohort (CRIC) Study, calcification propensity was quantified at baseline as the transformation time (T 50 ) from primary to secondary calciprotein particles, with lower T 50 corresponding to higher calcification propensity. CVD events are reported every six months and confirmed by medical record adjudication. Multivariable-adjusted Cox proportional hazards regression models, stratified by study site, were used to assess the associations of T 50 with risks of atherosclerotic CVD events (myocardial infarction, stroke, and peripheral artery disease) and congestive heart failure (CHF) events. Results: Over an average 7.1-year follow-up, we observed 571 atherosclerotic CVD events (312 myocardial infarction, 120 stroke, and 139 peripheral artery disease events) and 633 CHF events. The mean (standard deviation) T 50 was 313.4 (79.1) minutes. After adjustment for traditional CVD risk factors, lower T 50 was significantly associated with higher risk of atherosclerotic CVD, but not with risk of CHF. The addition of T 50 modestly improved atherosclerotic CVD event discrimination beyond ACC/AHA atherosclerotic CVD risk score variables (c-statistic 0.713 vs. 0.710; p<0.001). Adjustment for kidney function attenuated the association between T 50 and CVD events (Table). Conclusions: Among patients with CKD stages 2-4, higher serum calcification propensity is significantly associated with atherosclerotic CVD events, but not with CHF events. Future studies should evaluate whether T 50 and its determinants represent novel therapeutic targets.