Abstract P174: Kidney Function and Progression of Coronary Artery Calcification in Community-Dwelling Older Adults: The Rancho Bernardo Study

Abstract

Background: Despite growing evidence for the separate and joint contributions of declining estimated glomerular filtration rate (eGFR) and presence of albuminuria to cardiovascular death, longitudinal studies of the association of these risk factors with coronary artery calcification, a marker of subclinical cardiovascular disease (CVD), are contradictory. Methods: We evaluated 421 community-dwelling men and women (mean age 67 years) without known heart disease who had eGFR estimated by the Modification of Diet in Renal Disease equation and albuminuria assessed by urine albumin/creatinine ratio (ACR) between 1997-99. Coronary artery calcium (CAC) was measured by electron beam computed tomography between 2001-02; 338 participants returned for a repeat scan between 2005-06, a mean of 4.5 (0.5) years later. CAC progression was defined as a difference between the follow-up square-root transformed CAC volume score and the baseline square-root transformed score > 2.5 mm 3 . Results: At baseline, mean eGFR was 78 mL/min/1.73m 2 , median ACR was 10 mg/g. Median total Agatston CAC score was 77 at the baseline scan and 112 at follow-up; 45% (191 of 421) of participants had CAC>100 at baseline and 46% (157 of 338) showed CAC progression. Logistic regression analyses showed no separate or joint association between eGFR or ACR with baseline CAC or with CAC progression. Table 1 shows the odds ratio (95% CI) for CAC progression for each 1 SD decrease in eGFR or increase in ACR. Conclusions: In a cohort of community-dwelling older adults, we found no longitudinal association between eGFR or ACR with CAC progression. This information may enhance our understanding of CAC progression across the spectrum of kidney function in community-dwelling adults without prevalent CVD or kidney disease. 4 Year CAC Progression per 1 SD Decrease in eGFR or Increase in ACR 1997-99 Estimated Glomerular Filtration Rate Urine Albumin/Creatinine Ratio (n=338) (n=292) Covariates Odds Ratio (95% CI) p value Odds Ratio (95% CI) p value Model 1 1.07 (0.86, 1.33) 0.54 0.99 (0.78, 1.26) 0.93 Model 2 1.04 (0.84, 1.30) 0.69 0.97 (0.77, 1.24) 0.82 Model 3 1.06 (0.85, 1.33) 0.57 1.06 (0.82, 1.37) 0.67 Model 4 1.07 (0.85, 1.33) 0.57 1.05 (0.81, 1.36) 0.69 Model 5 1.05 (0.82, 1.36) 0.68 1.06 (0.82, 1.38) 0.66 Model 6 1.10 (0.83, 1.43) 0.53 0.99 (0.75, 1.30) 0.94 Model 1: Unadj; Model 2: Age, time lapse adj; Model 3: Age, time lapse, sex adj; Model 4: Age, timelapse, sex, BMI adj; Model 5: Age, time lapse, sex, BMI and (eGFR or ACR) adj; Model 6: Age, time lapse, sex, BMI, SBP, FPG, HDL and (eGFR or ACR) adj