title: Evolution of coronary artery calcification in patients with chronic kidney disease Stages 3 and 4, with and without diabetes.
abstract: BACKGROUND
  The purpose of this study was to report the evolution of coronary artery calcification (CAC) in subjects with chronic kidney disease Stages 3 and 4 comparing those with and without diabetes. We previously reported prevalence in the same population.
  
  
  METHODS
  CAC was measured using multi-slice computer tomography. We prospectively followed up 103 patients for 2 years, 49 with diabetes and 54 without diabetes. Demographic, routine biochemistry, calcification inhibitors and bone mineral density data were collected and analysed. Evolution of CAC was defined as those with a difference of ≥ 2.5 U between baseline and final square root CAC scores.
  
  
  RESULTS
  There were more progressors in the group with diabetes, 24 compared to 12 in the group without diabetes (P= 0.004). When diabetes was present, CAC progressed equally in men and women. Risk factors for evolution of CAC included age, baseline CAC score and serum phosphate levels. Baseline CAC score, phosphate and body mass index were independent predictors for the increase of CAC score during the study period. Severity of CAC was greater in the diabetes group (median CAC score at baseline in the group with diabetes 154 increased to 258 2 years later, P < 0.001).
  
  
  CONCLUSIONS
  Evolution of CAC is greater in older patients and those with diabetes, where the gender advantage of being female is lost. Serum phosphate level, despite being within the normal range and virtually no use of phosphate binders, was also a risk factor. Further studies are required to determine the levels of serum phosphate required to minimize cardiovascular risk.
authors.affiliation: Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK. stavroulopoulos@yahoo.co.uk
authors.forename: Aristeidis
authors.initials: A
authors.lastname: Stavroulopoulos
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Porter
authors.forename: Kate
authors.initials: K
authors.lastname: Pointon
authors.forename: John M
authors.initials: JM
authors.lastname: Monaghan
authors.forename: Simon D
authors.initials: SD
authors.lastname: Roe
authors.forename: Michael J D
authors.initials: MJ
authors.lastname: Cassidy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000209:etiology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology*; D048909:Diabetes Complications / Q000209:etiology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult