Abstract
BackgroundAlthough a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages.MethodsWe performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement.ResultsVascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%.ConclusionThe addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population.
Highlights
Cardiovascular disease (CVD) has become a major cause of morbidity and a leading contributor to mortality [1]
Most CVD is caused by traditional risk factors (TRFs) that can be controlled, treated or modified
Previous studies have evaluated the prognostic value of the intima media thickness (IMT) in chronic kidney disease (CKD) patients and hemodialysis patients [7,8,9,10,11]
Summary
Cardiovascular disease (CVD) has become a major cause of morbidity and a leading contributor to mortality [1]. The presence of vascular calcification has been associated with a several-fold increase in the risk of morbidity and mortality in CKD stage 5D patients [17, 18]. The objective of the present study was to determine whether the addition of non-invasive indices (such as IMT, PWV, ABI, and vascular calcification) to TRFs can improve risk prediction in well characterized, closely monitored patients at different CKD stages. A variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. We looked at whether the addition of noninvasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages
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