Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
Am J Kidney Dis. 2011 Oct;58(4):519-26. doi: 10.1053/j.ajkd.2011.04.024. Epub 2011 Jul 23.
Coronary artery calcification (CAC) is associated with increased mortality risk in the general population. Although individuals with chronic kidney disease (CKD) are at markedly increased mortality risk, the incidence, prevalence, and prognosis of CAC in CKD are not well understood.
Cross-sectional observational study.
SETTING & PARTICIPANTS: Analysis of 1,908 participants who underwent coronary calcium scanning as part of the multiethnic CRIC (Chronic Renal Insufficiency Cohort) Study.
Estimated glomerular filtration rate (eGFR) computed using the Modification of Diet in Renal Disease (MDRD) Study equation, stratified by race, sex, and diabetic status. eGFR was treated as a continuous and a categorical variable compared with the reference value of >60 mL/min/1.73 m(2).
CAC detected using computed tomography (CT) using either an Imatron C-300 electron beam computed tomography (CT) scanner or multidetector CT scanner. CAC was computed using Agatston score as a categorical variable. Analyses were performed using ordinal logistic regression.
We found a strong and graded relationship between lower eGFR and increasing CAC. In unadjusted models, ORs increased from 1.68 (95% CI, 1.23-2.31) for eGFR of 50-59 mL/min/1.73 m(2) to 2.82 (95% CI, 2.06-3.85) for eGFR <30 mL/min/1.73 m(2). Multivariable adjustment only partially attenuated the results (OR, 1.53; 95% CI, 1.07-2.20) for eGFR <30 mL/min/1.73 m(2).
Use of eGFR rather than measured GFR.
We showed a graded relationship between severity of CKD and CAC independent of traditional risk factors. These findings support recent guidelines that state that if vascular calcification is present, it should be considered as a complementary component to be included in the decision making required for individualizing CKD treatment.
冠状动脉钙化（CAC）与普通人群的死亡率风险增加有关。尽管患有慢性肾脏病（CKD）的个体具有明显更高的死亡率风险，但 CKD 患者 CAC 的发生率、患病率和预后尚不清楚。
横断面观察性研究。
分析了作为多民族 CRIC（慢性肾功能不全队列）研究的一部分接受冠状动脉钙扫描的 1908 名参与者。
使用肾脏病饮食改良公式（MDRD）计算的估计肾小球滤过率（eGFR），按种族、性别和糖尿病状态分层。与>60mL/min/1.73m2 的参考值相比，eGFR 被视为连续和分类变量。
使用计算机断层扫描（CT）检测 CAC，使用 Imatron C-300 电子束 CT（CT）扫描仪或多排 CT 扫描仪。使用 Agatston 评分作为分类变量计算 CAC。使用有序逻辑回归进行分析。
我们发现 eGFR 降低与 CAC 增加之间存在强烈的分级关系。在未调整的模型中，OR 从 eGFR 为 50-59mL/min/1.73m2 的 1.68（95%CI，1.23-2.31）增加到 eGFR <30mL/min/1.73m2 的 2.82（95%CI，2.06-3.85）。多变量调整仅部分减弱了结果（OR，1.53；95%CI，1.07-2.20）对于 eGFR <30mL/min/1.73m2。
使用 eGFR 而不是测量的 GFR。
我们显示了 CKD 严重程度与 CAC 之间的分级关系，独立于传统危险因素。这些发现支持最近的指南，即如果存在血管钙化，应将其视为补充成分，纳入个体化 CKD 治疗所需的决策制定中。
