Serum Calcification Propensity (T50) Predicts Longitudinal Progression of Coronary Artery Calcification in CKD: THE CASCADE Study

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Serum Calcification Propensity (T50) Predicts Longitudinal Progression of Coronary Artery Calcification in CKD: THE CASCADE Study

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Co-author 1

Angela Yee-Moon Wang angela.wang@duke-nus.edu.sg Singapore General Hospital, Duke-NUS Renal Medicine Singapore Singapore * (past affiliation where the work was done), Department of medicine Queen Mary Hospital, The University of Hong Kong Hong Kong Hong Kong, China

Co-author 2

Chun Kwok Wong ck-wong@cuhk.edu.hk CHinese University of Hong Kong Department of Chemical Pathology Hong Kong Hong Kong, China -

Co-author 3

Yat-yin Yau yatyiny@gmail.com Biomedical Imaging Center Central Hong Kong Hong Kong, China -

Co-author 4

Andreas Pasch andreas.pasch@calciscon.com University Hospital Bern Department of Clinical Chemistry, Bern Switzerland -

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Introduction

Calcification propensity (T50) is a measure of extra-skeletal mineral stress and predicts mortality in chronic kidney disease (CKD). This study aims to determine if serum T50 predicts longitudinal progression of vascular calcification over a prospective follow-up period of at least 24 months in CKD and may thus explain its association with mortality.

Methods

Three hundred non-dialysis stages 3–5 CKD subjects (age: 60±10yrs, 56%men) underwent plain multi-slice computed tomography (MSCT) of coronary artery calcium scores (CACS) and fasting blood collection. MSCT was repeated after 2 years to determine changes in CACS. Those with changes in CACS over 2 years in the upper tertile (n=88) were defined as progressors while those in the middle and lower tertiles were defined as non-progressors.

Results

The mean T50 of all CKD subjects was 281 ± 59 mins. The progressors were older [P<0.001], had higher systolic blood pressure [P<0.001], serum phosphate [P<0.001] and intact parathyroid hormone [P=0.001], but lower serum albumin [p=0.014], T50 [268 ± 63 vs 289 ± 56mins; P=0.006], magnesium [P=0.047] and eGFR CKD-EPI [P<0.001]. In the stepwise multiple logistic regression adjusting for age, gender, background diabetes, atherosclerotic vascular disease, Framingham risk factors, baseline CACS, eGFR, high sensitivity C-reactive protein and intact parathyroid hormone, T50 significantly predicted CACS progression over 2 years [adjusted odds ratio [OR], 0.993, 95% confidence intervals (CI), 0.987 – 1.000, P=0.044]. Adjusting for the same covariates, phosphate, an important determinant of T50, marginally lost significance in predicting CACS progression [P=0.069].

Conclusion

These data for the first time showed that calcification propensity is related to progression of CACS in CKD 3-5, adding important evidence to support its usefulness in reflecting mineral stress in CKD.

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