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Extracellular Fluid Excess Is Significantly Associated With Coronary Artery Calcification in Patients With Chronic Kidney Disease

 Seohyun Park  ;  Chan Joo Lee  ;  Jong Hyun Jhee  ;  Hae-Ryong Yun  ;  Hyoungnae Kim  ;  Su-Young Jung  ;  Youn Kyung Kee  ;  Chang-Yun Yoon  ;  Jung Tak Park  ;  Hyeon Chang Kim  ;  Seung Hyeok Han  ;  Shin-Wook Kang  ;  Sungha Park  ;  Tae-Hyun Yoo 
 Journal of the American Heart Association, Vol.7(13) : e008935, 2018 
Journal Title
 Journal of the American Heart Association 
Issue Date
chronic kidney disease ; coronary artery calcification ; edema ; fluid retention
BACKGROUND: Extracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD). METHODS AND RESULTS: A total of 1741 patients at all stages of pre-dialysis CKD from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water-to-total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW >/=0.390 or >/=0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of >/=400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079-1.264, P<0.001). The adjusted R(2) for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis. CONCLUSIONS: ECF status is independently associated with a high risk of CAC in patients with CKD. STUDY REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02003781.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yoon, Chang Yun(윤창연)
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Jung, Su Young(정수영)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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