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Subclinical fluid overload is significantly associated with coronary artery calcification in patients with chronic kidney disease

Other Titles
 초기 단계의 만성신부전 환자에게 나타나는 무증상 (subclinical)의 수분 과부하와 관상동맥 석회화 사이의 연관성 고찰 
Authors
 박서현 
College
 College of Medicine (의과대학) 
Department
 Dept. of Internal Medicine (내과학교실) 
Degree
석사
Issue Date
2017
Keywords
extracellular fluid excess ; coronary artery calcification ; chronic kidney disease
Abstract
Background: Cardiovascular (CV) disease is prevalent and most common cause of
mortality in dialysis patients. Extracellular fluid (ECF) excess is frequently
observed and an independent predictor of CV morbidity in patients with
advanced chronic kidney disease (CKD). However, there are few studies
about the relationship between fluid excess and CV risks even in patients with
early stage CKD. The aim of present study is to investigate the association
between extracellular fluid (ECF) status measured using bioelectrical
impedance analysis and coronary artery calcification score (CACS) as a
surrogate for CV disease in CKD patients with relatively preserved renal
function.
Method: Data were retrieved from the prospective observational cohort of
Cardiovascular and Metabolic Disease Etiology Research Center-High Risk
(NCT02003781). Extracellular water (ECW) and total body water (TBW)
were assessed by bioelectrical impedance analysis and CACS was measured
by multidetector computed tomography. After exclusion of patients with
significant volume overload (ECW/TBW >0.4) and substantially impaired
renal function (eGFR <45.0 mLmin-11.73 m-2), patients were divided into
four groups according to the quartiles of their ECW-to-TBW ratio
(ECW/TBW). Coronary artery calcification (CAC) was defined as CACS
more than 400 agatston units.
Result: A total of 1481 patients was analyzed and the mean was 59.8 ± 11.3
years; 759 (51.2%) were men; and the mean eGFR was 85.0 ± 16.9
mLmin-11.73 m-2. The patients in the increasing quartiles of the ECW/TBW
showed older, higher blood pressure, and much prevalent co-morbid
conditions such as diabetes compared to those in lower quartiles. CACS [1st to
4th quartile; 0.0 (0.0 – 73.9), 9.95 (0.0 – 133.3), 12.3 (0.0 – 144.6), vs. 59.6
(0.0 – 307.3), P for trend <0.001] and CAC [1st to 4th quartile; 23 (6.2%), 36
(9.7%), 44 (12.0%), vs. 76 (20.5%), P for trend <0.001] significantly
increased in accordance with increasing ECW/TBW quartiles. ECW/TBW
showed an independent association with CAC after adjustment for multiple
confounders (per 0.01 increase in ECW/TBW; odds ratio 2.890, 95%
confidence interval 1.787 – 4.674, P <0.001). In receiver operating
characteristic (ROC) analyses, the area under the ROC curve (AUC) for CAC
risk prediction was significantly increased by adding ECW/TBW to a model
consisting of traditional (AUC; 0.784 vs. 0.736, P = 0.013) or non-traditional
factors (AUC; 0.784 vs. 0.749, P = 0.038).
Conclusion: In conclusion, subclinical fluid excess in CKD patients with
preserved renal function was associated with the increasing risk of CAC. This
result suggests that the assessment of ECF can help to determine CV risk in
patients with early stage CKD.
Files in This Item:
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 2. Thesis
Yonsei Authors
Park, Seo Hyun(박서현)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/169765
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