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Association of Mild to Moderate Kidney Dysfunction and Coronary Calcification

Joachim H. Ix^*, Ronit Katz, Bryan Kestenbaum, Linda F. Fried^||, Holly Kramer^¶, Catherine Stehman-Breen^,** and Michael G. Shlipak

^* Department of Medicine, Division of Nephrology and Hypertension, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California; Collaborative Health Studies Coordinating Center, Department of Medicine and Division of Nephrology, and Department of Epidemiology, University of Washington, Seattle, Washington; ^|| Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; ^¶ Department of Medicine and Division of Nephrology, Loyola University, Maywood, Illinois; ^** Amgen, Thousand Oaks, California; and Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco and Veterans Affairs Medical Center, San Francisco, California

Correspondence: Dr. Joachim H. Ix, Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, and San Diego VA Healthcare System, 3350 La Jolla Village Drive, Mail code 111-H, San Diego, CA 92161. Phone: 858-552-8585, ext. 1657; Fax: 858-552-7549; E-mail: joeix{at}ucsd.edu

Received for publication July 13, 2007. Accepted for publication August 23, 2007.

Coronary artery calcification (CAC) is prevalent and predicts mortality among patients with ESRD, but whether less severe kidney dysfunction is associated with CAC is uncertain. To address this question, 6749 participants of the Multi-Ethnic Study of Atherosclerosis, who were middle-aged and without known cardiovascular disease, were evaluated. Renal function was categorized by cystatin C quartiles and estimated GFR (eGFR; < to >60 ml/min per 1.73 m²), and CAC was evaluated by computed tomography (CT). Fifty percent of participants had CAC, mean cystatin C was 0.90 mg/L, and 10% had eGFR <60 ml/min per 1.73 m². In unadjusted analysis, kidney dysfunction by either measure was strongly associated with CAC; however, the associations were lost after adjustment for age, gender, race, hypertension, and IL-6 (relative risk 1.04 [95% confidence interval 0.97 to 1.11] for the highest cystatin C quartile compared with the lowest, and relative risk 1.03 [95% confidence interval 0.98 to 1.08] for eGFR below compared with above 60 m/min per 1.73 m²). Similarly, neither higher cystatin C nor eGFR <60 was associated with severity of CAC. These results suggest that a higher burden of CAC is unlikely to explain the association between mild to moderate kidney dysfunction and cardiovascular mortality.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673