Abstract：
OBJECTIVE: High coronary artery calcification (CAC) burden is a significant risk factor for adverse cardiovascular and kidney outcomes. However, it is unknown whether changes in the coronary atherosclerotic burden can accompany changes in kidney disease progression. Here, we evaluated the relationship between CAC progression and the risk of kidney failure with replacement therapy (KFRT).
METHODS: We analyzed 1173 participants with chronic kidney disease (CKD) G1 to G5 without kidney replacement therapy from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Participants were categorized into three groups according to the change in the CAC score between enrollment and year 4 (non-progressors, ≤0 AU; moderate progressors, 1-199 AU; and severe progressors, ≥200 AU). The primary outcome was the development of KFRT.
RESULTS: During a follow-up period of 4690 person-years (median, 4.2 years), the primary outcome occurred in 230 (19.6 %) participants. The incidence of KFRT was 37.6, 54.3, and 80.9 per 1000 person-years in the non-, moderate, and severe progressors, respectively. In the multivariable cause-specific hazard model, the hazard ratios (HRs) for the moderate and severe progressors were 1.71 (95 % confidence interval [CI], 1.02-2.87) and 2.55 (95 % CI, 1.07-6.06), respectively, compared with non-progressors. A different definition of CAC progression with a threshold of 100 AU yielded similar results in a sensitivity analysis.
CONCLUSIONS: CAC progression is associated with an increased risk of KFRT in patients with CKD. Our findings suggest that coronary atherosclerosis changes increase the risk of CKD progression.
METHODS: We analyzed 1173 participants with chronic kidney disease (CKD) G1 to G5 without kidney replacement therapy from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Participants were categorized into three groups according to the change in the CAC score between enrollment and year 4 (non-progressors, ≤0 AU; moderate progressors, 1-199 AU; and severe progressors, ≥200 AU). The primary outcome was the development of KFRT.
RESULTS: During a follow-up period of 4690 person-years (median, 4.2 years), the primary outcome occurred in 230 (19.6 %) participants. The incidence of KFRT was 37.6, 54.3, and 80.9 per 1000 person-years in the non-, moderate, and severe progressors, respectively. In the multivariable cause-specific hazard model, the hazard ratios (HRs) for the moderate and severe progressors were 1.71 (95 % confidence interval [CI], 1.02-2.87) and 2.55 (95 % CI, 1.07-6.06), respectively, compared with non-progressors. A different definition of CAC progression with a threshold of 100 AU yielded similar results in a sensitivity analysis.
CONCLUSIONS: CAC progression is associated with an increased risk of KFRT in patients with CKD. Our findings suggest that coronary atherosclerosis changes increase the risk of CKD progression.
摘要：
目的：高冠状动脉钙化（CAC）负担是心血管和肾脏不良结局的重要危险因素。然而,目前尚不清楚冠状动脉粥样硬化负荷的变化是否会伴随肾脏疾病进展的变化.这里,我们评估了CAC进展与替代治疗(KFRT)肾功能衰竭风险之间的关系.
方法：我们分析了来自KoreaN队列研究慢性肾脏病患者（KNOW-CKD）的1173例慢性肾脏病（CKD）G1至G5患者，但没有进行肾脏替代治疗。根据入学和第4年之间的CAC评分变化，参与者分为三组（非进展者，≤0AU；中等进步者，1-199AU；和严重的进步者，≥200AU)。主要结果是KFRT的发展。
结果：在4690人年的随访期间（中位数，4.2years),主要结局发生在230名(19.6%)参与者中.在非，中度,和严重的进步者，分别。在多变量特定原因的危险模型中，中度和重度进展者的风险比（HR）为1.71（95％置信区间[CI]，1.02-2.87)和2.55(95%CI，1.07-6.06)，分别,与非进步者相比。阈值为100AU的CAC进展的不同定义在敏感性分析中产生了相似的结果。
结论：CAC进展与CKD患者KFRT风险增加相关。我们的研究结果表明冠状动脉粥样硬化改变增加了CKD进展的风险。
方法：我们分析了来自KoreaN队列研究慢性肾脏病患者（KNOW-CKD）的1173例慢性肾脏病（CKD）G1至G5患者，但没有进行肾脏替代治疗。根据入学和第4年之间的CAC评分变化，参与者分为三组（非进展者，≤0AU；中等进步者，1-199AU；和严重的进步者，≥200AU)。主要结果是KFRT的发展。
结果：在4690人年的随访期间（中位数，4.2years),主要结局发生在230名(19.6%)参与者中.在非，中度,和严重的进步者，分别。在多变量特定原因的危险模型中，中度和重度进展者的风险比（HR）为1.71（95％置信区间[CI]，1.02-2.87)和2.55(95%CI，1.07-6.06)，分别,与非进步者相比。阈值为100AU的CAC进展的不同定义在敏感性分析中产生了相似的结果。
结论：CAC进展与CKD患者KFRT风险增加相关。我们的研究结果表明冠状动脉粥样硬化改变增加了CKD进展的风险。
