Van Berkel Brecht, Van Ongeval Chantal, Van Craenenbroeck Amaryllis H, Pottel Hans, De Vusser Katrien, Evenepoel Pieter
Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium.
Clin Kidney J. 2021 Oct 5;15(2):295-302. doi: 10.1093/ckj/sfab178. eCollection 2022 Feb.
Breast arterial calcification (BAC) is increasingly recognized as a specific marker of medial calcification. The present retrospective observational cohort study aimed to define the prevalence, progression rate, risk factors and clinical implications of BAC in chronic kidney disease (CKD) patients across stages of disease. The presence and extent of BAC were determined on mammograms in 310 females (58.7 ± 10.8 years, Caucasian) with CKD across various stages of disease [CKD G2-5D = 132; transplant (Tx) recipients = 178]. In a subset of 88 patients, repeat mammography was performed, allowing us to calculate the annualized BAC rate. Overall, BAC was observed in 34.7% of the patients. BAC prevalence (P = 0.02) and BAC score (P = 0.05) increased along the progression of CKD. In the overall cohort, patients with BAC were characterized by older age, more cardiovascular disease, more inflammation, higher pulse pressure and borderline higher prevalence of diabetes and were more often treated with a vitamin K antagonist (VKA). The BAC progression rate was significantly lower in Tx patients as compared with CKD G5D. Progressors were characterized by more inflammation, worse kidney function, higher BAC score and higher serum phosphate level (Tx only) at baseline and were more often treated with a VKA. Major adverse cardiovascular event-free survival was significantly worse in Tx patients with BAC. In conclusion, BAC is common among CKD patients, progresses at a slower pace in Tx patients as compared with CKD 5D and associates with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and VKA usage seem to be important determinants of progression.
乳腺动脉钙化（BAC）日益被认为是中层钙化的一种特异性标志物。本回顾性观察性队列研究旨在明确BAC在不同疾病阶段的慢性肾脏病（CKD）患者中的患病率、进展率、危险因素及临床意义。对310例处于不同疾病阶段的CKD女性患者（58.7±10.8岁，白种人）进行乳房X线检查，以确定BAC的存在及程度[CKD G2 - 5D = 132例；移植（Tx）受者 = 178例]。在88例患者的亚组中进行了重复乳房X线检查，从而使我们能够计算BAC的年化率。总体而言，34.7%的患者观察到BAC。随着CKD的进展，BAC患病率（P = 0.02）和BAC评分（P = 0.05）升高。在整个队列中，患有BAC的患者具有年龄较大、心血管疾病更多、炎症更重、脉压更高以及糖尿病患病率略高的特点，并且更常接受维生素K拮抗剂（VKA）治疗。与CKD G5D患者相比，Tx患者的BAC进展率显著更低。进展者的特点是在基线时炎症更重、肾功能更差、BAC评分更高以及血清磷酸盐水平更高（仅Tx患者），并且更常接受VKA治疗。患有BAC的Tx患者无重大不良心血管事件生存率显著更差。总之，BAC在CKD患者中很常见，与CKD 5D患者相比，Tx患者进展较慢，并且与不良心血管结局相关。BAC评分、肾功能、基线血清磷酸盐水平及VKA使用似乎是进展的重要决定因素。
