NDT Advance Access published online on October 7, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn544
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Association of renal function with cardiac calcifications in older adults: the cardiovascular health study
1 Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 2 Departments of Medicine and Epidemiology, Harvard Medical School and Harvard School of Public Health, Boston, MA 3 Collaborative Health Studies, Coordinating Center 4 Division of Nephrology, University of Washington, Seattle, WA 5 Renal Section, Medical Service, VA Pittsburgh Healthcare System, Pittsburgh, PA 6 Division of Cardiology, University of Maryland Hospital, Baltimore, MD 7 General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA 8 Departments of medicine and Epidemiology, University of Washington, Seattle, WA, USA
Correspondence and offprint requests to: Folkert Asselbergs, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. Tel: +31-503612355; Fax: +31-503614391; E-mail: fwasselbergs{at}hotmail.com
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Abstract |
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Background. Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are highly prevalent in patients with end-stage renal disease. It is less well established whether milder kidney disease is associated with cardiac calcifications. We evaluated the relationships between renal function and MAC, aortic annular calcification (AAC) and AVS in the elderly.
Methods. From the Cardiovascular Health Study, a community-based cohort of ambulatory adults 
age 65, a total of 3929 individuals (mean ± SD age 74 ± 5 years, 60% women) were evaluated with two-dimensional echocardiography. Renal function was assessed by means of creatinine-based estimated glomerular filtration rate (eGFR) and cystatin C.
Results. The prevalences of MAC and AAC were significantly higher in individuals with an eGFR < 45 mL/ min/1.73 m2 (P < 0.01 for each), and cystatin C levels were significantly higher in individuals with MAC or AAC compared to individuals without these cardiac calcifications (P < 0.001 for each). After multivariate-adjustment, an eGFR <45 mL/min/1.73 m2 was significantly associated with MAC [odds ratio 1.54 (95% CI 1.16–2.06), P = 0.003] and not associated with AAC [1.30 (0.97–1.74), P = 0.085] and AVS [1.15 (0.86–1.53), P = 0.355]. In addition, cystatin C levels were independently associated with MAC [odds ratio per SD 1.12 (1.05–1.21), P = 0.001] and not associated with AAC [1.07 (1.00–1.15), P = 0.054] and AVS [0.99 (0.93–1.06), P = 0.82]. Furthermore, the prevalence of multiple cardiac calcifications was higher in subjects with an eGFR < 45 mL/ min/1.73 m2 and increased per quartile of cystatin C (P-values < 0.001). In addition, a significant trend was observed between an eGFR < 45 mL/min/1.73 m2, increasing levels of cystatin C and the number of cardiac calcifications (P < 0.05).
Conclusions. In a community-based cohort of the elderly, moderate kidney disease as defined by an eGFR <45 mL/min/1.73m2 and elevated levels of cystatin C was associated with prevalent MAC. In addition, a significant trend was observed between an eGFR <45 mL/min/1.73m2, increasing levels of cystatin C and the number of cardiac calcifications. No associations were found between renal function and AAC or AVS.
Keywords: chronic kidney disease; cohort; creatinine; cystatin C; elderly
Received for publication: 19. 3.08
Accepted in revised form: 4. 9.08