Valvular Heart Disease
Relation of Aortic Valve Calcium to Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort Study)

https://doi.org/10.1016/j.amjcard.2015.02.011Get rights and content

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.

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Methods

The CRIC study population is a racially and ethnically diverse cohort of men and women aged 21 to 74 years with mild-to-moderate renal disease, approximately half of which have diabetes. The CRIC participants were recruited from May 2003 to August 2008 from 7 clinical centers in the United States.2 The identification of subjects was facilitated through searches of laboratory databases, medical records, and referrals from health care providers. Subjects with cirrhosis, HIV infection, polycystic

Results

Table 1 summarizes demographics and baseline characteristics from the CRIC database participants who underwent baseline CT with calcium scoring of their aortic valves (n = 1,964). The participants were grouped based on the presence and severity of AVC. Increasing age, body mass index, waist circumference, blood pressure, cholesterol, hemoglobin A1c, and decreased physical activity and a history of diabetes, hypertension, or cardiovascular disease were all independently associated with increased

Discussion

To our knowledge, this study is the first to show a statistically significant correlation between non–end-stage CKD and AVC and to identify associations between traditional and novel cardiovascular risk factors and derangements in bone metabolisms and AVC in patients with early stages of CKD. In addition to confirming the relation between traditional cardiovascular risk factors and increased AVC in patients with CKD, the unadjusted analysis also identified decreased eGFR as independently

Disclosures

Funding for the CRIC Study was obtained under a co-operative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902, Bethesda, MD). In addition, this work was supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Sciences Award NIH NCATS UL1TR000003 (Philadelphia, PA), Johns Hopkins University UL1

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1

CRIC Study Investigators include Lawrence J. Appel, MD, MPH, Harold I. Feldman, MD, MSCE, Alan S. Go, MD, Jiang He, MD, PhD, John W. Kusek, PhD, James P. Lash, MD, Mahboob Rahman, MD, and Raymond R. Townsend, MD.

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