title: The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease.
abstract: BACKGROUND
  Although a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages.
  
  
  METHODS
  We performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement.
  
  
  RESULTS
  Vascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%.
  
  
  CONCLUSIONS
  The addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population.
authors.affiliation: INSERM U1088, Jules Verne University of Picardy Amiens, France; Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Liabeuf
authors.affiliation: INSERM U1088, Jules Verne University of Picardy Amiens, France; Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Desjardins
authors.affiliation: Department of Biostatistics, Amiens University Hospital, Amiens, France.
authors.forename: Momar
authors.initials: M
authors.lastname: Diouf
authors.affiliation: INSERM U1088, Jules Verne University of Picardy Amiens, France; Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Temmar
authors.affiliation: Division of Radiology, Amiens University Hospital, Amiens, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Renard
authors.affiliation: INSERM U1088, Jules Verne University of Picardy Amiens, France; Division of Nephrology, Amiens University Hospital, Amiens, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Choukroun
authors.affiliation: INSERM U1088, Jules Verne University of Picardy Amiens, France; Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000473:pathology*; D018570:Risk Assessment; D012307:Risk Factors; D061205:Vascular Calcification / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality