Association of coronary artery calcium with adverse cardiovascular outcomes and death in patients with chronic kidney disease: results from the KNOW-CKD

Author:

Jung Chan-Young1,Yun Hae-Ryong2,Park Jung Tak1ORCID,Joo Young Su2ORCID,Kim Hyung Woo1ORCID,Yoo Tae-Hyun1,Kang Shin-Wook1,Lee Joongyub3,Chae Dong-Wan4,Chung Wookyung5,Kim Yong-Soo6,Oh Kook-Hwan7,Han Seung Hyeok1ORCID

Affiliation:

1. Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research , Seoul , Republic of Korea

2. Department of Internal Medicine, Yonsei University College of Medicine, Yongin Severance Hospital , Yongin , Republic of Korea

3. Department of Preventive Medicine, Seoul National University College of Medicine , Seoul , Republic of Korea

4. Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam , Republic of Korea

5. Department of Internal Medicine, Gachon University Gil Medical Center , Incheon , Republic of Korea

6. Department of Internal Medicine, Catholic University of Korea, College of Medicine , Seoul , Republic of Korea

7. Department of Internal Medicine, Seoul National University, College of Medicine , Seoul , Republic of Korea

Abstract

ABSTRACT Background In East Asian countries, patients with chronic kidney disease (CKD) have lower cardiovascular risk profiles and experience fewer cardiovascular events (CVEs) than those in Western countries. Thus the clinical predictive performance of well-known risk factors warrants further testing in this population. Methods The KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) is a multicenter, prospective observational study. We included 1579 participants with CKD G1–G5 without kidney replacement therapy between 2011 and 2016. The main predictor was the coronary artery calcium score (CACS). The primary outcome was a composite of nonfatal CVEs or all-cause mortality. Secondary outcomes included 3-point major adverse cardiovascular events (MACEs; the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke), all CVEs and all-cause mortality. Results During a median follow-up of 5.1 years, a total of 123 primary outcome events occurred (incidence rate 1.6/100 person-years). In the multivariable Cox model, a 1-standard deviation log increase in the CACS was associated with a 1.67-fold [95% confidence interval (CI), 1.37–2.04] higher risk of the primary outcome. Compared with a CACS of 0, the hazard ratio associated with a CACS >400 was 4.89 (95% CI 2.68–8.93) for the primary outcome. This association was consistent for secondary outcomes. Moreover, inclusion of the CACS led to modest improvements in prediction indices of the primary outcome compared with well-known conventional risk factors. Conclusions In Korean patients with CKD, the CACS was independently associated with adverse cardiovascular outcomes and all-cause death. The CACS also showed modest improvements in prediction performance over conventional cardiovascular risk factors.

Funder

Korea Centers for Disease Control and Prevention

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

Reference36 articles.

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