Objectives: To report the association between kidney dysfunction and coronary artery calcification (CAC) score (CACS) among patients with clinically suspected coronary artery disease (CAD). Methods: We prospectively included 1,572 consecutive patients with clinically suspected CAD who underwent ECG-gated cardiac CT scans using 64-multidetector row computed tomography. CACS was quantified using a previously described method. Renal function was assessed by the estimated glomerular filtration rate (eGFR). Ordinal logistic regression and Pearson correlation were used to analyze the association between eGFR and CACS. Results: Patients with higher CACS were older, more had a history of hypertension, diabetes and tobacco use, and they were more likely to have an atherogenic lipid profile, higher systolic blood pressure, diastolic blood pressure, hemoglobin A1c, body mass index and C-reactive protein (CRP) and lower eGFR when compared with those patients without CAC or with lower CACS. The unadjusted correlation coefficient of eGFR and CACS was –0.259 (p < 0.001). This remained significant after adjustment for age, gender, hypertension, diabetes, hyperlipidemia, tobacco use and CRP (R = –0.156, p < 0.001). Ordinal logistic regression analysis showed that age, hypertension, diabetes, CRP and eGFR exerted independent influences on CACS. Conclusions: Kidney dysfunction was an independent predictor of CACS in patients with clinically suspected CAD. Further prospective multicenter studies are needed to confirm this finding.

1.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
2.
Shlipak MG, Katz R, Sarnak MJ, et al: Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly people without chronic kidney disease. Ann Intern Med 2006;145:237–246.
3.
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH: Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004;164:659–663.
4.
Budoff MJ, Shaw LJ, Liu ST, et al: Long-term prognosis associated with coronary calcification observations from a registry of 25,253 patients. J Am Coll Cardiol 2007;49:1860–1870.
5.
Detrano R, Guerci AD, Carr JJ, et al: Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336–1345.
6.
Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG: Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol 2005;46:807–814.
7.
Greenland P, Alpert JS, Beller GA, et al: 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010;122:2748–2764.
8.
Goodman WG, Goldin J, Kuizon BD, et al: Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000;342:1478–1483.
9.
Yokoyama K: Evaluation of coronary artery calcification in ESRD patients. Clin Calcium 2004;14:109–115.
10.
Fox CS, Larson MG, Keyes MJ, Levy D, Clouse ME, Culleton B, O’Donnell CJ: Kidney function is inversely associated with coronary artery calcification in men and women free of cardiovascular disease: the Framingham Heart Study. Kidney Int 2004;66:2017–2021.
11.
Kramer H, Toto R, Peshock R, Cooper R, Victor R: Association between chronic kidney disease and coronary artery calcification: the Dallas Heart Study. J Am Soc Nephrol 2005;16:507–513.
12.
Ix JH, Katz R, Kestenbaum B, Fried LF, Kramer H, Stehman-Breen C, Shlipak MG: Association of mild to moderate kidney dysfunction and coronary calcification. J Am Soc Nephrol 2008;19:579–585.
13.
El Barzouhi A, Elias-Smale S, Dehghan A, Vliegenthart-Proença R, Oudkerk M, Hofman A, Witteman JC: Renal function is related to severity of coronary artery calcification in elderly persons: the Rotterdam Study. PLoS One 2011;6:e16738.
14.
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827–832.
15.
Weiner DE, Tighiouart H, Amin MG, et al: Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004;15:1307–1315.
16.
Foley RN, Parfrey PS, Sarnak MJ: Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32(5 suppl 3):S112–S119.
17.
Joki N, Hase H, Nakamura R, et al: Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease. Nephrol Dial Transplant 1997;12:718–723.
18.
Levin A, Singer J, Thompson CR, et al: Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996;27:347–354.
19.
Beattie JN, Soman SS, Sandberg KR, et al: Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction. Am J Kidney Dis 2001;37:1191–1200.
20.
Walsh CR, O’Donnell CJ, Camargo CA Jr, et al: Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction. Am Heart J 2002;144:1003–1011.
21.
McCullough PA, Soman SS, Shah SS, et al: Risks associated with renal dysfunction in patients in the coronary care unit. J Am Coll Cardiol 2000;36:679–684.
22.
Wison S, Foo K, Cunningham J, et al: Renal function and risk stratification in acute coronary syndromes. Am J Cardiol 2003;91:1051–1054.
23.
Best PJ, Lennon R, Ting HH, et al: The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 2002;39:1113–1119.
24.
Reis SE, Olson MB, Fried L, et al: Mild renal insufficiency is associated with angiographic coronary artery disease in women. Circulation 2002;105:2826–2829.
25.
Szczech LA, Best PJ, Crowley E, et al: Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. Circulation 2002;105:2253–2258.
26.
Patti G, Colonna G, Pasceri V, et al: Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study. Circulation 2005;111:2099–2106.
27.
Zhang ZJ, Marroquin OC, Weissfeld JL, et al: Beneficial effects of statins after percutaneous coronary intervention. Eur J Cardiovasc Prev Rehabil 2009;16:445–450.
28.
Lemos PA, Arampatzis CA, Hoye A, et al: Impact of baseline renal function on mortality after percutaneous coronary intervention with sirolimus-eluting stents or bare metal stents. Am J Cardiol 2005;95:167–172.
29.
Na KY, Kim CW, Song YR, et al: The association between kidney function, coronary artery disease, and clinical outcome in patients undergoing coronary angiography. J Korean Med Sci 2009;24(suppl):S87–S94.
30.
Reddan DN, Szczech LA, Tuttle RH, et al: Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol 2003;14:2373–2380.
31.
Budoff MJ, Rader DJ, Reilly MP, et al: Relationship of estimated GFR and coronary artery calcification in the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 2011;58:519–526.
32.
Knez A, Becker C, Becker A, et al: Determination of coronary calcium with multislice spiral computed tomography: a comparative study with electron-beam CT. Int J Cardiovasc Imaging 2002;18:295–303.
33.
Horiguchi J, Yamamoto H, Akiyama Y, et al: Coronary artery calcium scoring using 16-MDCT and a retrospective ECG-gating reconstruction algorithm. Am J Roentgenol 2004;183:103–108.
34.
Stanford W, Thompson BH, Burns TL, et al: Coronary artery calcium quantification at multidetector row helical CT versus electron beam CT. Radiology 2004;230:397–402.
35.
Mao SS, Pal RS, McKay CR, Gao YG, Gopal A, Ahmadi N, Child J, Carson S, Takasu J, Sarlak B, Bechmann D, Budoff MJ: Comparison of coronary artery calcium scores between electron beam computed tomography and 64-multidetector computed tomographic scanner. J Comput Assist Tomogr 2009;33:175–178.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.