Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?

Research output: Contribution to journalArticlepeer-review

Authors

  • Ahmed Bashir
  • William E Moody
  • Charles J Ferro
  • Jonathan N Townend
  • Richard P Steeds

Colleges, School and Institutes

Abstract

Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.

Details

Original languageEnglish
Pages (from-to)937-948
Number of pages12
JournalAmerican Journal of Kidney Diseases
Volume65
Issue number6
Early online date6 Mar 2015
Publication statusPublished - Jun 2015

Keywords

  • Asymptomatic Diseases, Cardiovascular Diseases, Coronary Angiography, Coronary Artery Disease, Diabetic Nephropathies, Humans, Kidney Failure, Chronic, Male, Middle Aged, Multidetector Computed Tomography, Risk Assessment, Vascular Calcification, Case Reports, Journal Article, Review, Chronic kidney disease (CKD), coronary artery calcification (CAC), cardiac computed tomography, cardiovascular, prognosis