血清钙化倾向与慢性肾脏病患者的冠状动脉钙化：CRIC（慢性肾功能不全队列）研究。
Serum Calcification Propensity and Coronary Artery Calcification Among Patients With CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study.
机构信息
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
Am J Kidney Dis. 2019 Jun;73(6):806-814. doi: 10.1053/j.ajkd.2019.01.024. Epub 2019 Mar 29.
RATIONALE & OBJECTIVE: Coronary artery calcification (CAC) is prevalent among patients with chronic kidney disease (CKD) and increases risks for cardiovascular disease events and mortality. We hypothesized that a novel serum measure of calcification propensity is associated with CAC among patients with CKD stages 2 to 4.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: Participants from the Chronic Renal Insufficiency Cohort (CRIC) Study with baseline (n=1,274) and follow-up (n=780) CAC measurements.
PREDICTORS
Calcification propensity, quantified as transformation time (T) from primary to secondary calciprotein particles, with lower T corresponding to higher calcification propensity. Covariates included age, sex, race/ethnicity, clinical site, estimated glomerular filtration rate, proteinuria, diabetes, systolic blood pressure, number of antihypertensive medications, current smoking, history of cardiovascular disease, total cholesterol level, and use of statin medications.
OUTCOMES
CAC prevalence, severity, incidence, and progression.
ANALYTICAL APPROACH
Multivariable-adjusted generalized linear models.
RESULTS
At baseline, 824 (65%) participants had prevalent CAC. After multivariable adjustment, T was not associated with CAC prevalence but was significantly associated with greater CAC severity among participants with prevalent CAC: 1-SD lower T was associated with 21% (95% CI, 6%-38%) greater CAC severity. Among 780 participants followed up an average of 3 years later, 65 (20%) without baseline CAC developed incident CAC, while 89 (19%) with baseline CAC had progression, defined as annual increase≥100 Agatston units. After multivariable adjustment, T was not associated with incident CAC but was significantly associated with CAC progression: 1-SD lower T was associated with 28% (95% CI, 7%-53%) higher risk for CAC progression.
LIMITATIONS
Potential selection bias in follow-up analyses; inability to distinguish intimal from medial calcification.
CONCLUSIONS
Among patients with CKD stages 2 to 4, higher serum calcification propensity is associated with more severe CAC and CAC progression.
背景与目的
冠状动脉钙化（CAC）在慢性肾脏病（CKD）患者中较为常见，会增加心血管疾病事件和死亡的风险。我们假设一种新型的血清钙化倾向指标与 CKD 2 至 4 期患者的 CAC 相关。
研究设计
前瞻性队列研究。
研究场所和参与者
基线（n=1274）和随访（n=780）时均有 CAC 测量值的慢性肾脏不全队列研究（CRIC）参与者。
预测因素
钙化成核时间（T），从初级到次级钙结合蛋白颗粒的转化时间，T 值越低，钙化倾向越高。协变量包括年龄、性别、种族/民族、临床地点、估计肾小球滤过率、蛋白尿、糖尿病、收缩压、降压药物数量、当前吸烟、心血管疾病史、总胆固醇水平和他汀类药物的使用。
结局
CAC 的患病率、严重程度、发生率和进展。
分析方法
多变量调整的广义线性模型。
结果
基线时，824 名（65%）参与者存在 CAC 患病率。经过多变量调整后，T 与 CAC 的患病率无关，但与 CAC 患病率患者中 CAC 严重程度呈显著相关：T 降低 1 个标准差与 CAC 严重程度增加 21%（95%CI，6%-38%）相关。在 780 名平均随访 3 年后的参与者中，65 名（20%）无基线 CAC 者发生 CAC 发生率，而 89 名（19%）有基线 CAC 者 CAC 进展，定义为每年增加≥100 个 Agatston 单位。经过多变量调整后，T 与 CAC 发生率无关，但与 CAC 进展显著相关：T 降低 1 个标准差与 CAC 进展的风险增加 28%（95%CI，7%-53%）相关。
局限性
随访分析中存在潜在的选择偏倚；无法区分内膜和中膜钙化。
结论
在 CKD 2 至 4 期患者中，较高的血清钙化倾向与 CAC 严重程度和 CAC 进展相关。
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