Guerraty Marie A, Chai Boyang, Hsu Jesse Y, Ojo Akinlolu O, Gao Yanlin, Yang Wei, Keane Martin G, Budoff Matthew J, Mohler Emile R
Cardiovascular Medicine Division, Department of Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biostatistics and Epidemiology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Cardiol. 2015 May 1;115(9):1281-6. doi: 10.1016/j.amjcard.2015.02.011. Epub 2015 Feb 12.
Although subjects with chronic kidney disease (CKD) are at markedly increased risk for cardiovascular mortality, the relation between CKD and aortic valve calcification has not been fully elucidated. Also, few data are available on the relation of aortic valve calcification and earlier stages of CKD. We sought to assess the relation of aortic valve calcium (AVC) with estimated glomerular filtration rate (eGFR), traditional and novel cardiovascular risk factors, and markers of bone metabolism in the Chronic Renal Insufficiency Cohort (CRIC) Study. All patients who underwent aortic valve scanning in the CRIC study were included. The relation between AVC and eGFR, traditional and novel cardiovascular risk factors, and markers of calcium metabolism were analyzed using both unadjusted and adjusted regression models. A total of 1,964 CRIC participants underwent computed tomography for AVC quantification. Decreased renal function was independently associated with increased levels of AVC (eGFR 47.11, 44.17, and 39 ml/min/1.73 m2, respectively, p<0.001). This association persisted after adjusting for traditional, but not novel, AVC risk factors. Adjusted regression models identified several traditional and novel risk factors for AVC in patients with CKD. There was a difference in AVC risk factors between black and nonblack patients. In conclusion, our study shows that eGFR is associated in a dose-dependent manner with AVC in patients with CKD, and this association is independent of traditional cardiovascular risk factors.
尽管慢性肾脏病(CKD)患者心血管死亡风险显著增加,但CKD与主动脉瓣钙化之间的关系尚未完全阐明。此外,关于主动脉瓣钙化与CKD早期阶段的关系的数据也很少。我们试图在慢性肾功能不全队列(CRIC)研究中评估主动脉瓣钙(AVC)与估计肾小球滤过率(eGFR)、传统和新型心血管危险因素以及骨代谢标志物之间的关系。纳入CRIC研究中所有接受主动脉瓣扫描的患者。使用未调整和调整后的回归模型分析AVC与eGFR、传统和新型心血管危险因素以及钙代谢标志物之间的关系。共有1964名CRIC参与者接受了计算机断层扫描以进行AVC定量。肾功能下降与AVC水平升高独立相关(eGFR分别为47.11、44.17和39 ml/min/1.73 m2,p<0.001)。在调整传统而非新型AVC危险因素后,这种关联仍然存在。调整后的回归模型确定了CKD患者AVC的几个传统和新型危险因素。黑人和非黑人患者的AVC危险因素存在差异。总之,我们的研究表明,在CKD患者中,eGFR与AVC呈剂量依赖性相关,且这种关联独立于传统心血管危险因素。