Clinical Nephrology – Epidemiology – Clinical Trials

Kidney International (2005) 68, 1258–1266; doi:10.1111/j.1523-1755.2005.00522.x

Progression of coronary artery calcification in diabetics with and without chronic kidney disease

RAJNISH MEHROTRA, MATTHEW BUDOFF, JOHN E HOKANSON, ELI IPP, JUNICHIRO TAKASU and SHARON ADLER

Division of Nephrology and Hypertension; Division of Endocrinology; and Division of Cardiology, Harbor-UCLA Medical Center; Los Angeles Biomedical Research Center; David Geffen School of Medicine at UCLA, Torrance, California; and Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado

Correspondence: Rajnish Mehrotra, M.D, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502 E-mail: rmehrotra@labiomed.org

Received 9 February 2005; Revised 25 March 2005; Accepted 20 April 2005.

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Abstract

Progression of coronary artery calcification in diabetics with and without chronic kidney disease.

Background

 

Rapid progression of coronary artery calcification (CAC) has been reported among individuals with end-stage renal disease (ESRD). There is limited information on the progression of CAC during earlier stages of diabetic chronic kidney disease (CKD).

Methods

 

In a prospective, cohort study of type 2 diabetic individuals (N = 90; normoalbuminuric diabetic controls, 30; diabetic nephropathy, DN, 60), electron-beam computed tomography (EBCT) was repeated at an average interval of 19 months. All scan images were acquired at end-systole to minimize interscan variability. In order to eliminate the dependence of the residual error from interscan variability on baseline CAC scores, square root transformed CAC scores were used for analyses of progression of coronary calcification.

Results

 

Repeat EBCT scans were completed in 68 subjects (diabetic controls: 23; DN: 45). There was a highly significant relationship between the proportion of subjects with progressive CAC and renal disease—DN who progressed to ESRD, 80%; DN who did not progress to ESRD, 30%; and diabetic controls, 13% (P < 0.001). Similarly, the magnitude of change was significantly related to renal disease (DN who progressed to ESRD > DN who did not progress to ESRD > diabetic controls, P < 0.001). Using logistic regression and controlling for non-dialyzed DN, ESRD and inter-scan interval, advanced age was the only significant variable associated with progression of CAC. Finally, serum creatinine and baseline CAC score emerged as independent predictors for the magnitude of increase in CAC.

Conclusion

 

Progression of CAC is apparent among individuals with DN both before and after ESRD. However, the risk factors associated with progression of CAC may differ at different stages of CKD.

Keywords:

coronary artery calcification, progression, diabetic nephropathy, cardiovascular disease, chronic kidney disease, mineral metabolism

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