Factors Associated with Coronary Artery Calcification and Cardiovascular Outcome Among Pre-Dialysis Chronic Kidney Disease Patients in Phramongkutklao hospital

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Calcified coronary artery is highly prevalent and more severe among these group. Coronary calcium score was used as a risk predictor for coronary heart disease in general population but data among CKD patients were less known. Objective To evaluate factors associated with coronary calcium score in pre-dialysis CKD patients. Methods Prospective cohort study was conducted in CKD patients who have intermediate risk for coronary heart disease between February 2021 and December 2021. Patients who had received dialysis or coronary revascularization were excluded. GFR was categorized into 4 groups including Group 1: GFR ≥ 60 ml/min/1.73m2, Group 2: GFR 45-59 ml/min/1.73m2, Group 3: GFR 30-44 ml/min/1.73m2 and Group 4: GFR < 30 ml/min/1.73m2. Baseline geographical data and prespecified factors that might be correlated with coronary calcium score were collected and Agaston coronary calcium score was performed by 640-slice CT scanner with standard protocol. Primary outcome was evaluation of factors associated with coronary calcium score. Secondary outcome was incidence of composited cardiovascular events which defined as death, MI or heart failure within 6 months after enrollment. Results Total 53 males and 35 females were enrolled. Patients in Group 1, 2, 3 and 4 were 22, 24, 21 and 21 patients, respectively. Mean age, underlying hypertension, T2DM with target organ damage, PTH, ESR, Osteocalcin and coronary calcium score were significantly different between each group of GFR. Coronary calcium score showed inversely correlation with GFR level, p-value < 0.001. Factors that significantly correlated with coronary calcium score were mean age (r=0.548, p-value <0.001), underlying hypertension (r=0.466, p-value <0.001), CAVI (r=0.436, p-value <0.001) and Osteocalcin (r=0.83, p <0.001). In multivariate analysis, Osteocalcin was significantly correlated with coronary calcium score, p-value < 0.001. Increasing Osteocalcin 1 ng/ml correlated with increasing coronary calcium score 52, p-value < 0.001. Composited cardiovascular events were found in 11 patients, 6 patients in Group 3, and was not demonstrated correlation with coronary calcium score. Conclusions Coronary calcium score showed inversely correlation with GFR level. Increasing Osteocalcin was significantly correlated with increasing coronary calcium score in pre-dialysis CKD patients.