Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease

© 2022 American Society of Nephrology. All rights reserved.Background Elevated coronary artery calcification scores (CACS) are associated with increased cardiovascular disease risk in patients with chronic kidney disease (CKD). However, the relationship between CACS and CKD progression has not been elucidated. Methods We studied 1936 participants with CKD (stages G1–G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1–100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy. Results During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1–100 AU (hazard ratio [HR], 1.29; 95% confidence interval [95% CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1–100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate. Conclusion Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.N

Association between vitamin D deficiency and health-related quality of life in patients with chronic kidney disease from the KNOW-CKD study

<div><p>Vitamin D deficiency is a growing health problem in both the general population and in patients with chronic kidney disease (CKD). However, the relationship between serum 25-hydroxyvitamin D levels and health-related quality of life in CKD is not well established. This study examined the association between vitamin D deficiency and quality of life in pre-dialysis CKD patients. Serum 25-hydroxyvitamin D levels and the Korean version of the Kidney Disease Quality of Life short form were obtained for 1844 pre-dialysis CKD patients in the prospective KoreaN cohort Study for Outcomes in patients With Chronic Kidney Disease (KNOW-CKD). The baseline estimated glomerular filtration rate was 50.26 ± 0.71 mL/min/1.73 m². We identified 1294 (70.2%) patients with vitamin D deficiency, defined as a 25-hydroxyvitamin D level < 20 ng/ml. The scores of the kidney disease component summary, physical component summary, and mental component summary in the vitamin D deficiency group were significantly lower compared to the scores of those without vitamin D deficiency. The serum 25-hydroxyvitamin D level was independently associated with the kidney disease component summary and mental component summary scores (<i>β</i> = 0.147, <i>p</i> = 0.003 and <i>β</i> = 0.151, <i>p</i> = 0.047). In conclusion, there was a significant association between serum 25-hydroxyvitamin D levels and kidney disease component summary and mental component summary scores in pre-dialysis CKD patients.</p></div

Clinical Correlates of Mass Effect in Autosomal Dominant Polycystic Kidney Disease.

Mass effect from polycystic kidney and liver enlargement can result in significant clinical complications and symptoms in autosomal dominant polycystic kidney disease (ADPKD). In this single-center study, we examined the correlation of height-adjusted total liver volume (htTLV) and total kidney volume (htTKV) by CT imaging with hepatic complications (n = 461) and abdominal symptoms (n = 253) in patients with ADPKD. "Mass-effect" complications were assessed by review of medical records and abdominal symptoms, by a standardized research questionnaire. Overall, 91.8% of patients had 4 or more liver cysts on CT scans. Polycystic liver disease (PLD) was classified as none or mild (htTLV < 1,600 mL/m); moderate (1,600 ≤ htTLV <3,200 mL/m); and severe (htTLV ≥ 3,200 mL/m). The prevalence of moderate and severe PLD in our patient cohort was 11.7% (n = 54/461) and 4.8% (n = 22/461), respectively, with a female predominance in both the moderate (61.1%) and severe (95.5%) PLD groups. Pressure-related complications such as leg edema (20.4%), ascites (16.6%), and hernia (3.6%) were common, and patients with moderate to severe PLD exhibited a 6-fold increased risk (compared to no or mild PLD) for these complications in multivariate analysis. Similarly, abdominal symptoms including back pain (58.8%), flank pain (53.1%), abdominal fullness (46.5%), and dyspnea/chest-discomfort (44.3%) were very common, and patients with moderate to severe PLD exhibited a 5-fold increased risk for these symptoms. Moderate to severe PLD is a common and clinically important problem in ~16% of patients with ADPKD who may benefit from referral to specialized centers for further management

Prevalence of abdominal symptoms and hepatic complications.

<p>(A) The prevalence of hepatic complications of all subjects. (B) The prevalence of abdominal symptoms on a three-point scale. Back pain and flank pain were most prevalent. Abdominal fullness and early satiety were common among moderate to severe symptoms (point 2 or 3).</p

Likelihood (log odds) of having complications or two or more pressure-related symptoms according to htTLV and the correlation between htTLV and htTKV or htTLV + htTKV.

<p>(A) Positive likelihood of having pressure-related complications at htTLV ≥2,100 mL/m. (B) Positive likelihood of having two or more pressure–related symptoms at htTLV ≥ 1,600 mL/m. Note that htTLV≥3,200 mL/m was indicated as the threshold for severe polycystic liver disease. (C) The proportion of subjects and ratio of male to female according to htTLV of 1,600 mL/m and htTKV of 1,000 mL/m. (D) Correlation between htTLV and htTLV + htTKV.</p

Multivariate binominal logistic regression analysis of symptoms.

<p>Multivariate binominal logistic regression analysis of symptoms.</p

Distribution of height-adjusted total liver volume (htTLV) according to age and gender.

<p>(A) Box plot of median (and inter-quartile range) of htTLV by age decades. The median htTLV was higher in males of age <40 and females ≥70 years (*<i>P</i> < 0.05 for gender difference). The skewing of htTLV towards larger size is most noticeable in females across all strata above 40 years of age, (<i>P</i> value for Jonckheere–Terpstra test for trend <0.001). (B) A scatter plot of htTLV by age and gender. Moderate PLD is moderately enriched by females and severe PLD, extremely enriched by females.</p