Chronic kidney disease and coronary artery calcification in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Abstract

Chronic kidney disease is a worldwide public health concern due to the increased prevalence the high fatalities related to heart disease in this population. Among novel cardiovascular risk markers, the coronary artery calcification score (CAC) emerged as an independent predictor of cardiovascular events. We aimed to test if glomerular filtration rate or albuminuria are independently associated with coronary calcification. The Brazilian Longitudinal Study of Adult Health is a cohort of men and women aged 35 to 74 years old addressing cardiovascular diseases. We analyzed the association of CAC, estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR) according to stages of eGFR (1 = ≥90; 2 = 60-89; 3 = <60 mL/min/1.73 m2 ), and ACR (<30; 30 to 300; >300 mg/g). These associations were estimated by logistic regression with a model including age, sex, race, income, and cardiovascular risk factors. Among 4189 persons (median age = 51 years, 54% women), 1183 had CAC. The odds ratio (OR) and the 95% confidence interval (95% CI) in the multivariate model was 0.86 (0.58-1.29) for the category of eGFR <60 mL/min/1.73 m2 compared to people with eGFR >90 mL/min/1.73m2 . On the other hand, the OR (95% CI) for individuals with ACR >300 mg/g was 4.31 (1.27-14.64) compared to people with ACR <30 mg/g. A discrete interaction factor for the association with CAC between eGFR and ACR were analyzed as continuous variable. Albuminuria was independently associated with coronary calcification, but the reduction of the glomerular filtration rate was not associated with CAC score in this sample of apparently healthy adults.