Abstract 13845: Added Value of Coronary Calcification in Prediction of Long-term Cardiovascular Events in Chronic Kidney Disease With and Without Diabetes Mellitus: Multi-Ethnic Study of Atherosclerosis (MESA)
Introduction: Cardiovascular disease (CVD) is a major cause of morbidity/mortality in chronic kidney disease (CKD). Coronary calcification (CAC) is infrequently used by clinicians for risk prediction in CKD because high values are not felt to be predictive. We analyzed whether CAC can discriminate long-term outcomes in CKD with (CKD-DM) and without (CKD-non-DM) diabetes mellitus.
Methods: We analyzed 6780 MESA participants (age 45-84 yrs, 19.3% CKD) without clinical CVD enrolled at 6 clinical sites, followed for adjudicated CVD (coronary heart disease, stroke, heart failure, peripheral arterial disease) for 12.1 years. CKD was defined as eGFR<60 ml/min/1.73 m2 estimated using creatinine & cystatin C (CKD-EPI equation) or spot urine albumin/creatinine ≥ 17 mg/g in men; 25 mg/g in women. Baseline CAC was assessed by computed tomography. Poisson regression analysis was performed to adjust CVD events for demographic, clinical & inflammatory biomarker variables.
Results: CAC increased across CKD and DM categories (neither condition: 56% had no CAC while 9% had >300 Agatston score; CKD only: 33% had no CAC while 21% had score >300; DM only: 42% had no CAC while 17% had score >300; CKD-DM: 31% had no CAC while 26% had score >300. CVD incidence density per 12.1 years varied greatly across CKD and DM categories (Figure). CVD incidence density per 1000 person-years across CAC categories ranged from 5-21 in non-CKD, non-DM; 7-20 in CKD-non-DM; 9-21 in non-CKD-DM; and 16-29 in CKD-DM. With adjustment for demographics and many risk covariates, baseline CAC added to prediction within each CKD and DM category.
Conclusion: CKD-DM had the highest incident CVD events and those with CKD or DM alone had intermediate rates compared to those with neither condition. Contribution to risk prediction was as large from CAC category as from CKD or DM category. Despite the common knowledge that CAC increases in both CKD and DM, assessment of CAC would be helpful in risk stratification in all CKD and DM categories.
Author Disclosures: G.R. Shroff: None. O.A. Sanchez: None. M.D. Miedema: None. H. Kramer: None. J.H. Ix: None. D.A. Duprez: None. D.R. Jacobs, Jr.: None.
- © 2016 by American Heart Association, Inc.