Advertisement

Relation Between Calcified Atherosclerosis in the Renal Arteries and Kidney Function (from the Multi-Ethnic Study of Atherosclerosis)

      Renal artery calcium (RAC) has been shown to be associated with higher odds of hypertension (HTN). The purpose of this study was to determine if the presence and extent of RAC is associated with renal function. We analyzed cross-sectional data from the Multi-Ethnic Study of Atherosclerosis (MESA). A subsample of 1,226 participants underwent computed tomography of the abdomen and also had venous blood samples measured for kidney function. RAC was the primary predictor variable and the following measures of kidney function were the outcome variables: estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and chronic kidney disease (CKD) stage. The analyses were adjusted for age, gender, race, height, visceral fat, dyslipidemia, diabetes, cigarette smoking, hypertension, interleukin-6 and abdominal aortic calcium (AAC). The average age of this cohort was 66.1 years (SD 9.7), 44.8% (549 of 1,226) were men, and nearly 30% had RAC >0. Compared with those with no RAC, those with RAC >0 were significantly older but not different by gender or race. After adjustment for age, gender, and race, those with RAC >0 had significantly higher visceral fat, were more likely to have dyslipidemia, diabetes, and hypertension, had a higher interleukin-6, and a higher prevalence of AAC >0. The mean eGFR and UACR among those without RAC were 80 ml/min/1.73 m2 and 21 mg/g, whereas these values were 78 ml/min/1.73 m2 and 55 mg/g among those with RAC. In fully adjusted multivariable linear regression models, the presence of RAC was associated with a lower eGFR (β = −2.21, p = 0.06) but not with UACR (β = 0.02, p = 0.79). In fully adjusted ordinal logistic regression, RAC as a continuous variable was associated with increased odds of being in a worse CKD category (odds ratio 1.14, p = 0.05). When measured by eGFR and CKD stage, there is a modest relation between RAC and kidney function. Further studies might involve clinical trials to assess the role of intensive cardiovascular disease risk factor management in patients with subclinical RAC to determine if this may prevent or delay the development and progression of CKD.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abe K.
        • Abe M.
        • Ito S.
        Pathogenesis of hypertension.
        Nippon Rinsho. 1997; 55 (Available at): 1889-1894
        • Guyton A.C.
        Blood pressure control—special role of the kidneys and body fluids.
        Science. 1991; 252 (Available at): 1813-1816
        • Goldblatt H.
        The renal origin of hypertension.
        Physiol Rev. 1947; 27 (Available at): 120-165
        • Allison M.A.
        • Lillie E.O.
        • DiTomasso D.
        • Wright C.M.
        • Criqui M.H.
        Renal artery calcium is independently associated with hypertension.
        J Am Coll Cardiol. 2007; 50 (Available at): 1578-1583
        • Freedman B.I.
        • Hsu F.C.
        • Langefeld C.D.
        • Bowden D.W.
        • Moossavi S.
        • Dryman B.N.
        • Carr J.J.
        Renal artery calcified plaque associations with subclinical renal and cardiovascular disease.
        Kidney Int. 2004; 65: 2262-2267
        • Thomas I.C.
        • Ratigan A.R.
        • Rifkin D.E.
        • Ix J.H.
        • Criqui M.H.
        • Budoff M.J.
        • Allison M.A.
        The association of renal artery calcification with hypertension in community-living individuals: the multiethnic study of atherosclerosis.
        J Am Soc Hypertens. 2016; 10: 167-174
        • Tolkin L.
        • Bursztyn M.
        • Ben-Dov I.Z.
        • Simanovsky N.
        • Hiller N.
        Incidental renal artery calcifications: a study of 350 consecutive abdominal computed tomography scans.
        Nephrol Dial Transplant. 2009; 24: 2170-2175
        • Rifkin D.E.
        • Ix J.H.
        • Wassel C.L.
        • Criqui M.H.
        • Allison M.A.
        Renal artery calcification and mortality among clinically asymptomatic adults.
        J Am Coll Cardiol. 2012; 60 (Available at): 1079-1085
        • London G.M.
        • Guérin A.P.
        • Marchais S.J.
        • Métivier F.
        • Pannier B.
        • Adda H.
        Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality.
        Nephrol Dial Transplant. 2003; 18 (Available at): 1731-1740
        • Goodman W.G.
        • Goldin J.
        • Kuizon B.D.
        • Yoon C.
        • Gales B.
        • Sider D.
        • Wang Y.
        • Chung J.
        • Emerick A.
        • Greaser L.
        • Elashoff R.M.
        • Salusky I.B.
        Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis.
        N Engl J Med. 2000; 342: 1478-1483
        • Roseman D.A.
        • Hwang S.-J.
        • Manders E.S.
        • O'Donnell C.J.
        • Upadhyay A.
        • Hoffmann U.
        • Fox C.S.
        Renal artery calcium, cardiovascular risk factors, and indexes of renal function.
        Am J Cardiol. 2014; 113 (Available at): 156-161
        • Safar M.E.
        • London G.M.
        • Plante G.E.
        Arterial stiffness and kidney function.
        Hypertension. 2004; 43: 163-168
        • Ferrario C.M.
        • Strawn W.B.
        Role of the renin-angiotensin-aldosterone system and proinflammatory mediators in cardiovascular disease.
        Am J Cardiol. 2006; 98 (Available at): 121-128
        • Brewster U.C.
        • Perazella M.A.
        The renin-angiotensin-aldosterone system and the kidney: effects on kidney disease.
        Am J Med. 2004; 116 (Available at): 263-272
        • Chiu Y.-W.
        • Adler S.
        • Budoff M.
        • Takasu J.
        • Ashai J.
        • Mehrotra R.
        Prevalence and prognostic significance of renal artery calcification in patients with diabetes and proteinuria.
        Clin J Am Soc Nephrol. 2010; 5 (Available at): 2093-2100
        • Bild D.E.
        • Bluemke D.A.
        • Burke G.L.
        • Detrano R.
        • Diez Roux A.V.
        • Folsom A.R.
        • Greenland P.
        • Jacob D.R.
        • Kronmal R.
        • Liu K.
        • Nelson J.C.
        • O'Leary D.
        • Saad M.F.
        • Shea S.
        • Szklo M.
        • Tracy R.P.
        Multi-Ethnic Study of Atherosclerosis: objectives and design.
        Am J Epidemiol. 2002; 156 (Available at): 871-881
        • Criqui M.H.
        • Kamineni A.
        • Allison M.A.
        • Ix J.H.
        • Carr J.J.
        • Cushman M.
        • Detrano R.
        • Post W.
        • Wong N.D.
        Risk factor differences for aortic versus coronary calcified atherosclerosis: the multiethnic study of atherosclerosis.
        Arterioscler Thromb Vasc Biol. 2010; 30: 2289-2296
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Levey A.S.
        • Stevens L.A.
        Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions.
        Am J Kidney Dis. 2010; 55 (Available at): 622-627
        • Stevens L.A.
        • Schmid C.H.
        • Greene T.
        • Zhang Y.
        • Beck G.J.
        • Froissart M.
        • Hamm L.L.
        • Lewis J.B.
        • Mauer M.
        • Navis G.J.
        • Steffes M.W.
        • Eggers P.W.
        • Coresh J.
        • Levey A.S.
        Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73 m2.
        Am J Kidney Dis. 2010; 56: 486-495
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Hurwitz S.
        • Cohen R.J.
        • Williams G.H.
        Diurnal variation of aldosterone and plasma renin activity: timing relation to melatonin and cortisol and consistency after prolonged bed rest.
        J Appl Physiol. 2004; 96 (Available at): 1406-1414