Coronary artery calcification does not predict stenosis for patients with kidney failure
Click Here to Manage Email Alerts
Differing from individuals without kidney disease, higher coronary artery calcification scores in patients on dialysis were not associated with an increased risk for coronary artery stenosis.
This finding led Thijs T. Jansz, MD, PhD, of Utrecht University in the Netherlands, and colleagues to conclude that calcification scores cannot be used as an accurate predictor of obstructive coronary artery disease in this patient population.
“The presence of calcified plaques in the coronary arteries is associated with cardiovascular mortality and is a hallmark of chronic kidney failure, but it is unclear whether this is associated with the same degree of coronary artery stenosis as in patients without kidney disease,” the researchers wrote. “We compared the relationship of coronary artery calcification and stenosis between dialysis patients and patients without chronic kidney disease (non-CKD).”
After undergoing a cardiac CT (consisting of non-contrast enhanced CT and CT angiography), 112 patients on dialysis were matched to 112 individuals without kidney disease. The non-CKD group consisted of participants who had cardiovascular risk factors (such as diabetes, hypertension, a positive family history or hypercholesterolemia) or a clinical manifestation of atherosclerosis (coronary artery disease, cerebrovascular disease, peripheral artery disease or abdominal aortic aneurysm).
Median CAC scores were estimated as 210 for dialysis group vs. 58 for the non-CKD group, with 35% of patients on dialysis and 36% of those without kidney disease having coronary artery stenosis of at least 50%.
The researchers observed that, for patients without kidney disease, a CAC score of more than 400 indicated a high probability of coronary artery stenosis. In contrast, findings suggested that a high CAC “can easily be found” without significant coronary artery stenosis in patients on dialysis; for these patients, each 100-units higher CAC score was associated with lower odds ratios for stenosis of at least 50% and at least 70% compared with those without kidney disease (ORs of 0.67 and 0.75, respectively).
“How do these findings translate to the interpretation of CAC scores in dialysis patients?” Jansz and colleagues wrote. “CAC scoring is generally used to rule out coronary artery stenosis, as CAC has a high sensitivity for coronary artery stenosis and patients without CAC are unlikely to have significant coronary artery stenosis. This is even more true in patients treated with dialysis: when a dialysis patient has a low CAC score, the probability for stenosis is lower than for a non-CKD patient. On the other hand, our data show that even with CAC scores [of greater than] 400, dialysis patients are unlikely to have coronary artery stenosis, whereas non-CKD patients with CAC scores [of greater than] 400 have a high risk of coronary artery stenosis. This means that CAC scores cannot readily be used to infer obstructive coronary artery disease risk in patients on dialysis.”
Collapse
Read more about
Click Here to Manage Email Alerts