Key result
A doubling of the albumin-to-creatinine ratio was associated with a 0.04 standardized log increase in coronary artery calcification volume after adjusting for cardiovascular risk factors.
Why the study?
The study was designed to investigate the association between kidney function and arterial calcification in major vascular beds, and to establish whether arterial calcification mediates the relation between kidney function and incident CVD.
Does impaired kidney function associate with arterial calcification, and does calcification mediate the relationship between kidney function and CVD incidence?
Cohort (n=2,241)
No
Does impaired kidney function associate with arterial calcification, and does calcification mediate the relationship between kidney function and CVD incidence?
The association between impaired kidney function and arterial calcification is largely explained by shared cardiovascular risk factors, and calcification does not mediate the link between kidney function and CVD incidence.
Suggests arterial calcification may mediate kidney-CVD links in older adults; hypothesis-generating and should not yet change practice.
Background The purpose of this study was to investigate the association between kidney function and arterial calcification in major vascular beds and to establish whether arterial calcification mediates the relation between kidney function measures and cardiovascular disease ( CVD ) incidence. Methods and Results In 2241 participants from the Rotterdam Study (mean age 69 years, 52% female), kidney function was assessed using the estimated glomerular filtration rate and urine albumin‐to‐creatinine ratio. All participants underwent noncontrast computed tomography to quantify the amount of arterial calcification in the coronary arteries, aortic arch, extracranial, and intracranial internal carotid arteries. We used linear regression models, adjusted for age, sex, and cardiovascular risk factors, to evaluate the association between kidney function and arterial calcification volume in the 4 vessel beds. Incidence rate of CVD was calculated in 3 groups of participants based on their kidney function and presence of arterial calcification. We conducted mediation analysis to evaluate whether arterial calcification mediates this association. We found that in age‐ and sex‐adjusted models, lower estimated glomerular filtration rate and higher albumin‐to‐creatinine ratio were associated with larger calcification volumes in all 4 vascular beds. Adjusting for cardiovascular risk factors attenuated the effect estimates. CVD incidence was higher in participants with estimated glomerular filtration rate <60 mL/min per 1.73 m 2 and presence of arterial calcification compared with individuals with estimated glomerular filtration rate >60 and no calcification. After adjusting for cardiovascular risk factors, arterial calcification did not mediate the association between kidney function measures and CVD incidence. Conclusions The association of impaired kidney function and larger volumes of arterial calcification is partly explained by cardiovascular risk factors. Arterial calcification does not mediate the association between kidney function and CVD beyond cardiovascular risk factors.
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Sedaghat et al. (2019) conducted a cohort in Impaired kidney function and arterial calcification (n=2,241). Higher albumin-to-creatinine ratio vs. Lower albumin-to-creatinine ratio was evaluated on Coronary artery calcification volume (standardized log increase per doubling of albumin-to-creatinine ratio, adjusted for cardiovascular risk factors) (MD 0.04, 95% CI 0.01-0.07, p=0.004). A doubling of the albumin-to-creatinine ratio was associated with a 0.04 standardized log increase in coronary artery calcification volume after adjusting for cardiovascular risk factors.
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