Lee Bo-Ching, Tsai Hsin-Hsi, Huang Jia-Zheng, Chen Ya-Fang, Tsai Li-Kai, Lai Tai-Shuan
Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Kidney Dis (Basel). 2025 Jun 10;11(1):508-517. doi: 10.1159/000546853. eCollection 2025 Jan-Dec.
Vascular calcification, linked to atherosclerosis, is a significant cardiovascular risk factor in chronic kidney disease (CKD). While different intracranial carotid arteriosclerosis subtypes affect stroke risk in the general population, their prevalence, causes, and impact on CKD patients remain unclear.
This cohort study used data from the National Taiwan University Hospital's pre-end-stage renal disease care database, including 2,622 CKD patients with brain CT scans from 2006 to 2020. Intracranial carotid artery calcifications were categorized as intimal or internal elastic lamina (IEL) subtypes. Multivariable Cox regression assessed the associations between each calcification subtype and incident stroke or vascular mortality.
Among 2,622 patients, 2,470 (94.2%) had calcifications classifiable as intimal ( = 719, 27.4%), IEL ( = 1,642, 62.6%), or mixed ( = 109, 4.2%) subtypes. Multivariable analysis revealed that IEL subtype was associated with older age, diabetes, prior vascular diseases, and impaired renal function ( < 0.05). Over a median follow-up of 3.9 years, IEL subtype exhibited a higher risk of any stroke (adjusted hazard ratio [HR] [95% CI]: 2.0 [1.2-3.2], = 0.007) and vascular death (adjusted HR [95% CI]: 2.0 [1.4-3.0], < 0.001), compared to those without calcification. Furthermore, the IEL subtype displayed a higher risk of any stroke (adjusted HR [95% CI]: 1.6 [1.1-2.3], = 0.017) and vascular death (adjusted HR [95% CI]: 1.6 [1.3-2.1], < 0.001) compared to the intimal subtype.
IEL calcification is prevalent in CKD patients and associated with aging, diabetes, and impaired renal function. It poses a higher risk of cerebrovascular events compared to those without calcification or with intimal calcification.
血管钙化与动脉粥样硬化相关，是慢性肾脏病（CKD）中一项重要的心血管危险因素。虽然不同类型的颅内颈动脉粥样硬化对普通人群的中风风险有影响，但其在CKD患者中的患病率、病因及影响仍不明确。
这项队列研究使用了台湾大学附属医院终末期肾病前期护理数据库中的数据，包括2006年至2020年期间2622例接受脑部CT扫描的CKD患者。颅内颈动脉钙化被分为内膜型或内弹力层（IEL）型。多变量Cox回归分析评估了每种钙化类型与中风或血管性死亡事件之间的关联。
在2622例患者中，2470例（94.2%）的钙化可分类为内膜型（n = 719，27.4%）、IEL型（n = 1642，62.6%）或混合型（n = 109，4.2%）。多变量分析显示，IEL型与年龄较大、糖尿病、既往血管疾病及肾功能受损相关（P < 0.05）。在中位随访3.9年期间，与无钙化者相比，IEL型发生任何中风的风险更高（调整后风险比[HR][95%置信区间]：2.0[1.2 - 3.2]，P = 0.007），血管性死亡风险也更高（调整后HR[95%置信区间]：2.0[1.4 - 3.0]，P < 0.001）。此外，与内膜型相比，IEL型发生任何中风的风险更高（调整后HR[95%置信区间]：1.6[1.1 - 2.3]，P = 0.017），血管性死亡风险也更高（调整后HR[95%置信区间]：1.6[1.3 - 2.1]，P < 0.001）。
IEL钙化在CKD患者中普遍存在，与衰老、糖尿病及肾功能受损相关。与无钙化或内膜钙化患者相比，其发生脑血管事件的风险更高。
