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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. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실)
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
김현창(Kim, Hyeon Chang) ORCID logo https://orcid.org/0000-0001-7867-1240
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
유태현(Yoo, Tae Hyun) ORCID logo https://orcid.org/0000-0002-9183-4507
윤창연(Yoon, Chang Yun)
윤해룡(Yun, Hae Ryong) ORCID logo https://orcid.org/0000-0002-7038-0251
정수영(Jung, Su Young)
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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