title: Systemic Inflammation Is Associated With Coronary Artery Calcification and All-Cause Mortality in Chronic Kidney Disease.
abstract: BACKGROUND
  Presence of systemic inflammation in chronic kidney disease (CKD) is associated with advanced coronary artery calcification (CAC). The prognostic significance of this association, however, is unknown. We evaluated the associations between CAC, estimated glomerular filtration rate (eGFR) and all-cause mortality, to determine whether the associations differ according to the presence of systemic inflammation.
  
  
  RESULTS
  We followed 30,703 consecutive individuals who underwent CAC measurement for a median of 79 months (IQR, 65-96 months). Patients were categorized according to baseline CAC score (0, 1-99, 100-399 and ≥400), eGFR (<45, 45-59, 60-74, 75-89, 90-104, and ≥105 ml/min/1.73 m(2)) and high-sensitivity C-reactive protein (hsCRP; <2.0, and ≥2.0 mg/L). Prevalence and extent of CAC were greater in those with lower eGFR and higher hsCRP accordingly, even after adjustment. Lower eGFR was strongly associated with higher CAC score (≥400), and the association was more significant in patients with higher hsCRP. The greater CAC burden was associated with worse outcome in the CKD patients (eGFR <60 ml/min/1.73 m(2)) only in those with higher hsCRP.
  
  
  CONCLUSIONS
  Patients with low eGFR and more extensive CAC had greater risk of mortality, and associations differed according to the presence of systemic inflammation. Among the CKD patients, coronary evaluation may be considered for those with elevated hsCRP. (Circ J 2016; 80: 1644-1652).
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine.
authors.forename: In-Chang
authors.initials: IC
authors.lastname: Hwang
authors.forename: Hyo Eun
authors.initials: HE
authors.lastname: Park
authors.forename: Hack-Lyoung
authors.initials: HL
authors.lastname: Kim
authors.forename: Hyue Mee
authors.initials: HM
authors.lastname: Kim
authors.forename: Jun-Bean
authors.initials: JB
authors.lastname: Park
authors.forename: Yeonyee E
authors.initials: YE
authors.lastname: Yoon
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.forename: Hyung-Kwan
authors.initials: HK
authors.lastname: Kim
authors.forename: Goo-Yeong
authors.initials: GY
authors.lastname: Cho
authors.forename: Dae-Won
authors.initials: DW
authors.lastname: Sohn
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003331:Coronary Vessels / Q000503:physiopathology*; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D061205:Vascular Calcification / Q000209:etiology / Q000401:mortality / Q000503:physiopathology