Factors Affecting Coronary Arterial Calcification in Patients with Chronic Kidney Disease Who Did Not Undergo Treatment with Dialysis

Kunsu Kim; Goeun Kim; Yongkyun Kim; So Yeon Ki; Eun Hui Bae; Soo Wan Kim; Yun-Hyeon Kim

doi:10.3348/jksr.2018.78.2.88

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Kim, Kim, Kim, Ki, Bae, Kim, and Kim: Factors Affecting Coronary Arterial Calcification in Patients with Chronic Kidney Disease Who Did Not Undergo Treatment with Dialysis

Original Article

J Korean Soc Radiol 2018;78(2):88-94.

Published online: 20 January 2018

DOI: https://doi.org/10.3348/jksr.2018.78.2.88

Factors Affecting Coronary Arterial Calcification in Patients with Chronic Kidney Disease Who Did Not Undergo Treatment with Dialysis

Kunsu Kim, MD¹, Goeun Kim, MD¹, Yongkyun Kim, MD¹, So Yeon Ki, MD¹, Eun Hui Bae, MD², Soo Wan Kim, MD², Yun-Hyeon Kim, MD^1,^∗

¹Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea

²Department of Nephrology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea

^∗Corresponding author: Yun-Hyeon Kim, MD Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. Tel. 82-62-220-5747 Fax. 82-62-226-4380 E-mail: yhkim001@jnu.ac.kr

Received 10 November 2017 Revised 26 December 2017 Accepted 3 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate risk factors of coronary arterial calcification in chronic kidney disease (CKD) patients who did not undergo hemodialysis or peritoneal dialysis.

Materials and Methods

We enrolled 83 patients of normal renal function (Group I) and 112 patients of CKD [Group II (CKD stage 1–2) and Group III (CKD stage 3–5)], who were assessed coronary artery calcium score (CACS) with cardiac CT. CACS between the groups were compared. Risk factors for coronary artery calcification in patients with CKD including diabetes, hypertension, and smoking were identified as relevant to CACS using logistic regression analysis. Serologic data of electrolytes were analyzed to evaluate effect for coronary calcification in patients with CKD.

Results

Group III showed significant increment of CACS compared to Group I at the CACS level over 400 [odds ratio (OR) = 7.581, p = 0.01]. The OR were decreased in non-diabetic patients group, increased in non-hypertensive patients group, no significant differences in non-current smoker group. Serum phosphorous level was the only factor which showed significant effect for increased CACS (OR of 2.649, p = 0.02).

Conclusion

In CKD patients, higher stage of CKD was associated with increased CACS. Diabetes mellitus and increased serum phosphorous level would be considered as factors influencing coronary arterial calcification in CKD patients.

Keywords: Index terms Chronic Kidney Failure Coronary Artery Disease Computed X-ray Tomography

References

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Fig. 1.

Measurement of Agatston coronary calcium score. Coronary arterial calcifications with attenuation above 130 Hounsfield unit is selected automatically on electrocardiography gated axial CT images (A-C), and Agatston coronary calcium score is calculated (D). Simultaneously patient's calcium score is rated on age-calcium score graphs (E).

Table 1.

Characteristics of Study Populations by Presence of CKD

Characteristic	CKD (+) (n = 112)	CKD (−) (n = 83)	p-Value
Age (year)	58.09 ± 10.97	62.13 ± 9.40	0.007
Male sex (%)	73 (65.2)	53 (63.9)	0.848
Hypertension (%)	65 (58.0)	28 (33.7)	< 0.001
Diabetes mellitus (%)	44 (39.3)	13 (15.7)	< 0.001
Dyslipidemia (%)	45 (40.2)	23 (27.7)	0.071
Current smoker (%)	14 (12.5)	21 (25.3)	0.021
Serum creatinine (mg/dL)	1.73 ± 0.91	0.72 ± 0.16	< 0.001
GFR (mL/min/1.73 m²)	47.6 ± 22.41	104.7 ± 20.66	< 0.001
Uric acid (mg/dL)	7.2 ± 5.64	5.0 ± 1.40	< 0.001
Total cholesterol (mg/dL)	175.4 ± 44.87	187.7 ± 38.05	0.040
LDL cholesterol (mg/dL)	105.0 ± 35.20	121.0 ± 34.22	0.002
Triglyceride (mg/dL)	179.2 ± 138.44	133.5 ± 70.20	0.003
Coronary artery calcium	255.4 ± 636.24	106.3 ± 278.38	0.028
score
Coronary arterial	75 (67.0)	45 (54.2)	0.070
calcification (%)
LM (%)	21 (18.8)	10 (12.0)	0.206
LAD (%)	63 (56.3)	39 (47.0)	0.200
LCX (%)	32 (28.6)	19 (22.9)	0.372
RCA (%)	53 (47.3)	29 (34.9)	0.083

CKD = chronic kidney disease, GFR = glomerular filtration rate, LAD = left anterior descending artery, LCX = left circumflex artery, LM = left main coronary artery, RCA = right coronary artery

Table 2.

Characteristics of CKD Populations Categorized by Stage of CKD

Characteristic	CKD 1–2 (n = 39)	CKD 3–5 (n = 73)	p-Value
Age (year)	58.36 ± 11.12	57.95 ± 10.96	0.850
Male sex (%)	27 (69.2)	46 (63.0)	0.433
Hypertension (%)	21 (53.8)	44 (60.3)	0.511
Diabetes mellitus (%)	10 (25.6)	34 (46.6)	0.031
Dyslipidemia (%)	11 (28.2)	34 (46.6)	0.059
Current smoker (%)	7 (17.9)	7 (9.6)	0.203
Serum creatinine (mg/dL)	0.99 ± 0.15	2.13 ± 0.89	< 0.001
GFR (mL/min/1.73 m²)	73.8 ± 8.8	33.6 ± 12.78	< 0.001
Uric acid (mg/dL)	6.2 ± 1.26	7.7 ± 6.88	0.187
Total cholesterol (mg/dL)	183.5 ± 44.90	171.0 ± 44.55	0.162
LDL cholesterol (mg/dL)	109.2 ± 38.52	102.8 ± 33.37	0.368
Triglyceride (mg/dL)	174.2 ± 141.70	181.8 ± 137.61	0.785
Total calcium (mg/dL)	9.1 ± 0.63	8.8 ± 0.69	0.042
Phosphorus (mg/dL)	3.5 ± 0.55	3.7 ± 0.66	0.091
Coronary artery calcium	154.5 ± 314.55	309.3 ± 750.59	9 0.222
score
Coronary arterial	24 (61.5)	51 (69.9)	0.372
calcification (%)
LM (%)	6 (15.4)	15 (20.5)	0.505
LAD (%)	21 (53.8)	42 (57.5)	0.708
LCX (%)	6 (15.4)	26 (35.6)	0.024
RCA (%)	14 (35.9)	39 (53.4)	0.077

CKD = chronic kidney disease, GFR = glomerular filtration rate, LAD = left anterior descending artery, LCX = left circumflex artery, LM = left main coronary artery, RCA = right coronary artery

Table 3.

Odd Ratios for Coronary Arterial Calcification by Presence of CKD in Total and Non-Diabetic and Non-Hypertensive, Non-Current Smoking Study Populations

	CKD Stage 1–2/Non-CKD	p-Value	CKD Stage 3–5/Non-CKD	p-Value
Total (n)	39/83		73/83
CACS > 10 vs. CACS ≤ 10	0.922 (0.335–2.537)	0.874	1.641 (0.696–3.871)	0.258
CACS > 100 vs. CACS ≤ 10	1.625 (0.470–5.621)	0.443	2.376 (0.825–6.844)	0.109
CACS > 400 vs. CACS ≤ 10	1.949 (0.216–17.550)	0.514	7.581 (1.634–35.161)	0.010
Non-diabetic patients (n)	29/70		39/70
CACS > 10 vs. CACS ≤ 10	0.369 (0.097–1.393)	0.141	0.834 (0.259–2.691)	0.762
CACS > 100 vs. CACS ≤ 10	0.941 (0.158–5.621)	0.947	1.864 (0.376–9.253)	0.446
CACS > 400 vs. CACS ≤ 10	1.139 (0.036–36.289)	0.941	3.209 (0.302–34.094)	0.347
Non-hypertensive patients (n)	18/55		29/55
CACS > 10 vs. CACS ≤ 10	0.914 (0.175–4.770)	0.915	1.599 (0.451–5.667)	0.467
CACS > 100 vs. CACS ≤ 10	3.345 (0.316–35.361)	0.316	5.724 (0.949–34.541)	0.057
CACS > 400 vs. CACS ≤ 10			10.673 (0.563–202.427)	0.115
Non-current smoking patients (n)	32/62		66/62
CACS > 10 vs. CACS ≤ 10	0.831 (0.260–2.661)	0.756	2.205 (0.805–6.041)	0.124
CACS > 100 vs. CACS ≤ 10	0.996 (0.216–4.587)	0.996	2.676 (0.787–9.095)	0.115
CACS > 400 vs. CACS ≤ 10	1.060 (0.071–15.850)	0.967	7.335 (1.283–41.927)	0.025

CACS = coronary artery calcium score, CKD = chronic kidney disease

Table 4.

Laboratory Findings that Showed Associations with Increased Coronary Calcium Score of Chronic Kidney Disease Patients in Multivariate Logistic Regression Analysis

Laboratory Findings	OR (95% CI)	p-Value
CACS > 10
Uric acid	1.148 (0.931–1.415)	0.197
Phosphorus	1.599 (0.851–3.006)	0.145
Total calcium		0.623
Total cholesterol		0.259
LDL-cholesterol		0.323
Triglyceride		0.251
CACS > 100
Uric acid	1.200 (0.960–1.499)	0.109
Phosphorus		0.319
Total calcium		0.331
Total cholesterol		0.200
LDL-cholesterol		0.538
Triglyceride	1.002 (0.999–1.006)	0.172
CACS > 400
Uric acid		0.579
Phosphorus	2.649 (1.166–6.017)	0.020
Total calcium		0.800
Total cholesterol		0.922
LDL-cholesterol	0.987 (0.971–1.002)	0.097
Triglyceride		0.555

CACS = coronary artery calcium score, CI = confidence interval, OR = odds ratio

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