Prevalence and prognostic significance of renal artery calcification in patients with diabetes and proteinuria.
OBJECTIVE
Vascular calcification is common and severe in chronic kidney disease. Because the consequences of calcification may differ by vascular beds, we sought to test the hypothesis that patients who have diabetes with proteinuria and have significant renal artery calcification (RAC) have a higher risk for progression to ESRD.


METHODS
Using electron-beam computed tomography, RAC was computed as the sum of Agatston scores at each of the two renal ostia and renal arteries. Time-to-event analysis was conducted to compare the risk in individuals with or without significant RAC (total score >10).


RESULTS
Of 172 patients with type 2 diabetes and overt proteinuria studied (estimated GFR 56 ± 25 ml/min per 1.73 m(2)), significant RAC was present in 31%. In 33 ± 21 months, 41 progressed to ESRD and 65 reached a composite outcome (ESRD or death). Serum phosphorus was a significant predictor of progression to ESRD but was replaced by the significant RAC in multivariate models that included the latter. Individuals with significant RAC had a higher risk for reaching the composite outcome. In contrast, there was no association between coronary artery calcification scores and progression to ESRD.


CONCLUSIONS
Significant RAC was an independent predictor of progression to ESRD as well as reaching the composite outcome. Understanding the pathogenesis of RAC would allow determination of whether this risk is potentially modifiable.
Chiu
Yi-Wen
YW
Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA.
Adler
Sharon
S
Budoff
Matthew
M
Takasu
Junichiro
J
Ashai
Jamila
J
Mehrotra
Rajnish
R
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003928:Diabetic Nephropathies / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012077:Renal Artery / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D010758:Phosphorus