Abstract
Background: Coronary artery calcification (CAC) is common in patients with chronic kidney disease on hemodialysis (CKD-5D) and is an important predictor of mortality. However, cardiac functional links between CAC and mortality have not been well established. This study tested the hypothesis that CAC increases mortality by adversely affecting cardiac function. Methods: Patients were recruited from 37 regional dialysis centers. 2-D and Doppler echocardiographic analyses were performed, and CAC was measured using 64-slice computed tomography. Relationships between CAC and echocardiographic measures of left ventricular (LV) function were analyzed. Survival was assessed with median follow-up of 37 months. Results: There were 157 patients: 59% male, 46% Caucasian, 48% diabetic. Median age was 55 years, and median duration of CKD-5D was 45 months. Agatston CAC scores > 100 were found in 69% of patients, with 51% having a score > 400. CAC was associated with measures of LV systolic and diastolic function (global longitudinal strain (GLS; rho = 0.270, p = 0.004)), peak LV systolic velocity (rho = -0.259, p = 0.004), and estimate of LV filling pressure (E:E'; rho = 0.286, p = 0.001). Multivariate regression confirmed these relationships after adjustment for age, gender, LV ejection fraction, and coronary artery disease. Valvular calcification varied linearly with CAC (p < 0.05). Both LV diastolic and systolic functional measures were significant predictors of mortality, the strongest of which was LV diastolic dysfunction. Conclusions: These findings show a link between CAC, cardiac function, and mortality in CKD-5D. LV diastolic function (E:E'), peak LV systolic velocity, and GLS are independent predictors of mortality. Valvular calcification may be an important marker of CAC in CKD-5D. These effects on cardiac function likely explain the high mortality with CKD-5D and describe a potentially-valuable role for echocardiography in the routine management of these patients.
| Original language | English |
|---|---|
| Pages (from-to) | 291-302 |
| Number of pages | 12 |
| Journal | Clinical Nephrology |
| Volume | 86 |
| Issue number | 6 |
| DOIs | |
| State | Published - 2016 |
Bibliographical note
Publisher Copyright:© 2016 Dustri-Verlag Dr. K. Feistle.
Funding
Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number R01DK080770 and the Kentucky Nephrology Research Trust. The project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to acknowledge the contribution of the University of Kentucky echocardiography staff and most notably Paul A. League who served as principal sonographer on this study. We also recognize the research coordinators Kimberly McLaughlin, PA-C, and Nedda Hughes, PA-C, who enrolled the patients, recorded all data, and guided patients through all study activities.
| Funders | Funder number |
|---|---|
| Kentucky Nephrology Research Trust | |
| Nedda Hughes | |
| National Institutes of Health (NIH) | |
| National Institute of Diabetes and Digestive and Kidney Diseases | R01DK080770 |
| National Center for Research Resources | |
| National Center for Advancing Translational Sciences (NCATS) | UL1TR000117 |
Keywords
- Dialysis
- Echocardiography
- FGF-23
- Longitudinal strain
- cKD-5D
ASJC Scopus subject areas
- Nephrology
