Key result
Coronary artery calcification in CKD is linked to ~89% higher all-cause mortality.
Why the study?
Patients with CKD face increased cardiovascular risk from accelerated coronary artery calcification (CAC), prompting this meta-analysis to determine the pooled risk of MACE and all-cause mortality associated with CAC.
Does the presence and severity of coronary artery calcification predict all-cause mortality and major adverse cardiovascular events in patients with chronic kidney disease?
Meta-Analysis (n=42,859)
Does the presence and severity of coronary artery calcification predict all-cause mortality and major adverse cardiovascular events in patients with chronic kidney disease?
Coronary artery calcification is a strong, linear predictor of both all-cause mortality and major adverse cardiovascular events in patients with chronic kidney disease.
Background Patients with chronic kidney disease (CKD) are at an increased risk for cardiovascular disease due to accelerated ectopic calcification, especially when involving the coronary arteries. Purpose This systematic review and meta-analysis aims to identify the pooled risk of major adverse cardiovascular events (MACE) and all-cause mortality in patients with CKD and CAC. Methods A systematic search using PubMed, Scopus, and Cochrane databases was conducted to identify studies reporting high and/or low CAC scores and their association with all-cause mortality and MACE in patients with CKD. Hazard ratios (HR) for each study were pooled using random-effects models and heterogeneity was assessed using the I² statistic. Subgroup analyses were performed according to CAC categories, and univariate and multivariate meta-regression analyses explored potential moderators including publication year, age, and male sex. Results A total of 21 studies, comprising of 42,859 patients, were included in the meta-analysis. CAC was identified as a significant prognostic factor for both all-cause mortality (HR: 1.89; 95%CI: 1.55 - 2.30; p < 0.001) and MACE (HR: 2.16; 95%CI: 1.61 – 2.88; p < 0.001). Test for subgroup differences revealed that higher CAC scores were associated with increased risk of all-cause mortality (CAC 1-100: HR: 1.39, 95%CI: 1.17 – 1.65, I2 = 0%; CAC 100-400: HR: 2.12, 95%CI: 1.68 – 2.68, I2 = 0%; CAC >400: HR: 2.63, 95%CI: 2.02 – 3.43, I2 = 0%; p<0.01). Regarding MACE, although the risk increased progressively with higher CAC scores (CAC 1-100: HR: 2.07, 95%CI: 1.33 – 3.22, I2 = 66.6%; CAC 100-400: HR: 2.91, 95%CI: 1.46 – 5.80, I2 = 78.2%; CAC >400: HR: 5.07, 95%CI: 1.96 – 13.13, I2 = 64.1%), the between-subgroup differences were not significant (p=0.22). Meta-regression demonstrated a significant moderating effect of publication year on all-cause mortality in both univariate and multivariate models. Conclusions This meta-analysis highlights that patients with CKD and CAC are at a significant risk for MACE and all-cause mortality, with this relationship being linear. These findings underscore the prognostic value of CAC, although prospective research is needed to evaluate these associations.
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Vythoulkas-Biotis et al. (2026) conducted a meta-analysis in Chronic kidney disease (n=42,859). Coronary artery calcification (CAC) vs. Low or absent coronary artery calcification was evaluated on All-cause mortality and major adverse cardiovascular events (MACE) (HR 1.89 (all-cause mortality); HR 2.16 (MACE), 95% CI 1.55-2.30 (all-cause mortality); 1.61-2.88 (MACE), p=<0.001). Coronary artery calcification in CKD patients significantly increased the risk of all-cause mortality (HR 1.89; 95% CI 1.55-2.30) and MACE (HR 2.16; 95% CI 1.61-2.88; both p<0.001).
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