Evolution of coronary artery calcification in patients with chronic kidney disease Stages 3 and 4, with and without diabetes

被引:26
作者
Stavroulopoulos, Aristeidis [1 ]
Porter, Christine J. [1 ]
Pointon, Kate [2 ]
Monaghan, John M. [3 ]
Roe, Simon D. [1 ]
Cassidy, Michael J. D. [1 ]
机构
[1] Nottingham Univ Hosp NHS Trust, Nottingham Renal & Transplant Unit, Nottingham NG5 1PB, England
[2] Nottingham Univ Hosp NHS Trust, Dept Radiol, Nottingham NG5 1PB, England
[3] Royal Derby Hosp, Dept Chem Pathol, Derby DE22 3NE, England
关键词
bone mineral density; fetuin-a; osteoprotegerin; phosphate; progression; vascular calcification; VASCULAR CALCIFICATION; COMPUTED-TOMOGRAPHY; SERUM PHOSPHORUS; NATURAL-HISTORY; SEX-DIFFERENCES; HEART-DISEASE; CALCIUM; PROGRESSION; DIALYSIS; ASSOCIATION;
D O I
10.1093/ndt/gfq751
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. The purpose of this study was to report the evolution of coronary artery calcification (CAC) in subjects with chronic kidney disease Stages 3 and 4 comparing those with and without diabetes. We previously reported prevalence in the same population. Methods. CAC was measured using multi-slice computer tomography. We prospectively followed up 103 patients for 2 years, 49 with diabetes and 54 without diabetes. Demographic, routine biochemistry, calcification inhibitors and bone mineral density data were collected and analysed. Evolution of CAC was defined as those with a difference of >= 2.5 U between baseline and final square root CAC scores. Results. There were more progressors in the group with diabetes, 24 compared to 12 in the group without diabetes (P = 0.004). When diabetes was present, CAC progressed equally in men and women. Risk factors for evolution of CAC included age, baseline CAC score and serum phosphate levels. Baseline CAC score, phosphate and body mass index were independent predictors for the increase of CAC score during the study period. Severity of CAC was greater in the diabetes group (median CAC score at baseline in the group with diabetes 154 increased to 258 2 years later, P < 0.001). Conclusions. Evolution of CAC is greater in older patients and those with diabetes, where the gender advantage of being female is lost. Serum phosphate level, despite being within the normal range and virtually no use of phosphate binders, was also a risk factor. Further studies are required to determine the levels of serum phosphate required to minimize cardiovascular risk.
引用
收藏
页码:2582 / 2589
页数:8
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