Association between Density of Coronary Artery Calcification and Serum Magnesium Levels among Patients with Chronic Kidney Disease.
BACKGROUND
The Agatston score, commonly used to quantify coronary artery calcification (CAC), is determined by the plaque area and density. Despite an excellent predictability of the Agatston score for cardiovascular events, the density of CAC has never been studied in patients with pre-dialysis chronic kidney disease (CKD). This study aimed to analyze the CAC density and its association with serum mineral levels in CKD.


METHODS
We enrolled patients with pre-dialysis CKD who had diabetes mellitus, prior cardiovascular disease history, elevated low-density lipoprotein cholesterol levels, or smoking history. The average CAC density was calculated by dividing the Agatston score by the total area of CAC.


RESULTS
The mean estimated glomerular filtration rate (eGFR) of 109 enrolled patients was 35.7 mL/min/1.73 m2. The correlation of the Agatston score with density was much weaker than that with the total area (R2 = 0.19, P < 0.001; and R2 = 0.99, P < 0.001, respectively). Multivariate analyses showed that serum magnesium level was inversely associated with the density, but not with the total area, after adjustment for demographics and clinical factors related to malnutrition-inflammation-atherosclerosis syndrome and mineral and bone disorders including fibroblast growth factor 23 (P = 0.006). This inverse association was pronounced among patients with higher serum phosphate levels (P for interaction = 0.02).


CONCLUSIONS
CAC density was inversely associated with serum magnesium levels, particularly in patients with higher serum phosphate levels.
Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Yusuke
Y
Sakaguchi
Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Takayuki
T
Hamano
Department of Internal Medicine, Kisei Hospital, 1-18-4 Nishi-mikuni, Yodogawa-ku, Osaka 532-0006, Japan.
Chikako
C
Nakano
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Yoshitsugu
Y
Obi
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Isao
I
Matsui
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Yasuo
Y
Kusunoki
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Daisuke
D
Mori
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Tatsufumi
T
Oka
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Nobuhiro
N
Hashimoto
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Yoshitsugu
Y
Takabatake
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Atsushi
A
Takahashi
Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, 2-2 J8 Yamada-oka, Suita 565-0871, Japan.
Jun-Ya
JY
Kaimori
Health Care Center, Osaka University, 1-17 Machikaneyama-cho, Toyonaka 560-0043, Japan.
Toshiki
T
Moriyama
Health Care Center, Osaka University, 1-17 Machikaneyama-cho, Toyonaka 560-0043, Japan.
Ryohei
R
Yamamoto
Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Masaru
M
Horio
Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Ken
K
Sugimoto
Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Koichi
K
Yamamoto
Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Hiromi
H
Rakugi
Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.
Yoshitaka
Y
Isaka
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