Introduction:
As Chronic Kidney Disease (CKD) progresses, patients become more susceptible to Vascular Calcification (VC) which is associated with high cardiovascular risk and poorer survival rates. The complex interplay between VC and patient-reported outcomes, particularly in non-dialysis CKD population, remains under-explored. This study aims to study the link between vascular calcification (VC), frailty and Quality of Life (QoL) to identify potential interventions that may help improve outcomes in these patients.
Methods:
CKD stage 4 and 5 non-dialysis patients were enrolled over 1 year and their demographic details, history and laboratory investigations were recorded. Pregnant patients and renal transplant recipients were excluded. Frailty was assessed using Fried frailty phenotype including weight loss, hand grip strength, exhaustion, gait speed and physical activity components and QoL was assessed using KDQoL-36TM questionnaire which included physical, mental and kidney disease components. Patients were screened for VC using lateral abdominal X-ray and echocardiography. Those with evidence of calcification on screening underwent cardiac CT for presence and severity of coronary artery calcification. Association between VC, laboratory parameters and mineral bone disease markers and correlation between VC, QoL and frailty were studied.
Results:
A total of 202 patients were enrolled, of which, 26% patients had detectable VC. Older age, diabetes and smoking were associated with higher prevalence of VC. CKD stage or traditional mineral bone disease markers did not show any significant difference among patients with and without VC. Individuals with VC were significantly more likely to be frail than those without VC (57.4% vs 30.4%, p-value- 0.001). There was significant difference between all QoL scores including physical, mental and kidney disease related components between patients with and without VC (PCS - 45.84±18.98 vs 62.34±22.06; MCS - 51.18±20.17 vs 65.99±23.75; KDCS - 64.90±13.65 vs 74.28±16.32, p-value <0.001). The severity of abdominal aortic calcification showed weak negative correlation with QoL scores (r-value -0.202, p-value 0.004) whereas the severity of coronary artery calcification did not any show significant correlation with QoL (r-value 0.01, p-value 0.9).
Conclusions:
Patients with VC showed significantly higher prevalence of frailty, particularly affecting the grip strength, gait speed and physical activity components. VC also had a profound negative impact on all the domains of QoL. This highlights the broader clinical implications of VC and its potential role in functional decline in CKD patients beyond its cardiovascular consequences.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.