title: Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?
abstract: Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.
authors.affiliation: Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bashir
authors.affiliation: Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom; Clinical Cardiovascular Science, School of Clinical & Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: William E
authors.initials: WE
authors.lastname: Moody
authors.affiliation: Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom; Clinical Cardiovascular Science, School of Clinical & Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Nicola C
authors.initials: NC
authors.lastname: Edwards
authors.affiliation: Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ferro
authors.affiliation: Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Townend
authors.affiliation: Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. Electronic address: rick.steeds@uhb.nhs.uk.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Steeds
mesh_terms: D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018570:Risk Assessment; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy
keywords: Chronic kidney disease (CKD); cardiac computed tomography; cardiovascular; coronary artery calcification (CAC); prognosis; review