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Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis
BACKGROUND: Coronary calcification in patients with end-stage renal disease (ESRD) is associated with an increased risk of cardiovascular outcomes and death from all causes. Previous evidence has been limited by short follow-up periods and inclusion of a heterogeneous cluster of events in the primar...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534029/ https://www.ncbi.nlm.nih.gov/pubmed/26269747 http://dx.doi.org/10.1186/s40697-015-0065-6 |
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author | Wilkieson, Trevor J. Rahman, M. Omair Gangji, Azim S. Voss, Maurice Ingram, Alistair J. Ranganath, Nischal Goldsmith, Charlie H. Kotsamanes, Cathy Z. Crowther, Mark A. Rabbat, Christian G. Clase, Catherine M. |
author_facet | Wilkieson, Trevor J. Rahman, M. Omair Gangji, Azim S. Voss, Maurice Ingram, Alistair J. Ranganath, Nischal Goldsmith, Charlie H. Kotsamanes, Cathy Z. Crowther, Mark A. Rabbat, Christian G. Clase, Catherine M. |
author_sort | Wilkieson, Trevor J. |
collection | PubMed |
description | BACKGROUND: Coronary calcification in patients with end-stage renal disease (ESRD) is associated with an increased risk of cardiovascular outcomes and death from all causes. Previous evidence has been limited by short follow-up periods and inclusion of a heterogeneous cluster of events in the primary analyses. OBJECTIVE: To describe coronary calcification in patients incident to ESRD, and to identify whether calcification predicts vascular events or death. DESIGN: Prospective substudy of an inception cohort. SETTING: Tertiary care haemodialysis centre in Ontario (St Joseph’s Healthcare Hamilton). PARTICIPANTS: Patients starting haemodialysis who were new to ESRD. MEASUREMENTS: At baseline, clinical characterization and spiral computed tomography (CT) to score coronary calcification by the Agatston-Janowitz 130 scoring method. A primary outcome composite of adjudicated stroke, myocardial infarction, or death. METHODS: We followed patients prospectively to identify the relationship between cardiac calcification and subsequent stroke, myocardial infarction, or death, using Cox regression. RESULTS: We recruited 248 patients in 3 centres to our main study, which required only biochemical markers. Of these 164 were at St Joseph’s healthcare, and eligible to participate in the substudy; of these, 51 completed CT scanning (31 %). Median follow up was 26 months (Q(1), Q(3): 14, 34). The primary outcome occurred in 16 patients; 11 in the group above the median and 5 in the group below (p = 0.086). There were 26 primary outcomes in 16 patients; 20 (77 %) events in the group above the coronary calcification median and 6 (23 %) in the group below (p = 0.006). There were 10 deaths; 8 in the group above the median compared with 2 in the group below (p = 0.04). The hazard ratios for coronary calcification above, compared with below the median, for the primary outcome composite were 2.5 (95 % CI 0.87, 7.3; p = 0.09) and 1.7 (95 % CI 0.55, 5.4; p = 0.4), unadjusted and adjusted for age, respectively. For death, the hazard ratios were 4.6 (95 % CI 0.98, 21.96; p = 0.054) and 2.4 (95 % CI 0.45, 12.97; p = 0.3) respectively. LIMITATIONS: We were limited by a small sample size and a small number of events. CONCLUSIONS: Respondent burden is high for additional testing around the initiation of dialysis. High coronary calcification in patients new to ESRD has a tendency to predict cardiovascular outcomes and death, though effects are attenuated when adjusted for age. |
format | Online Article Text |
id | pubmed-4534029 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-45340292015-08-13 Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis Wilkieson, Trevor J. Rahman, M. Omair Gangji, Azim S. Voss, Maurice Ingram, Alistair J. Ranganath, Nischal Goldsmith, Charlie H. Kotsamanes, Cathy Z. Crowther, Mark A. Rabbat, Christian G. Clase, Catherine M. Can J Kidney Health Dis Original Research Article BACKGROUND: Coronary calcification in patients with end-stage renal disease (ESRD) is associated with an increased risk of cardiovascular outcomes and death from all causes. Previous evidence has been limited by short follow-up periods and inclusion of a heterogeneous cluster of events in the primary analyses. OBJECTIVE: To describe coronary calcification in patients incident to ESRD, and to identify whether calcification predicts vascular events or death. DESIGN: Prospective substudy of an inception cohort. SETTING: Tertiary care haemodialysis centre in Ontario (St Joseph’s Healthcare Hamilton). PARTICIPANTS: Patients starting haemodialysis who were new to ESRD. MEASUREMENTS: At baseline, clinical characterization and spiral computed tomography (CT) to score coronary calcification by the Agatston-Janowitz 130 scoring method. A primary outcome composite of adjudicated stroke, myocardial infarction, or death. METHODS: We followed patients prospectively to identify the relationship between cardiac calcification and subsequent stroke, myocardial infarction, or death, using Cox regression. RESULTS: We recruited 248 patients in 3 centres to our main study, which required only biochemical markers. Of these 164 were at St Joseph’s healthcare, and eligible to participate in the substudy; of these, 51 completed CT scanning (31 %). Median follow up was 26 months (Q(1), Q(3): 14, 34). The primary outcome occurred in 16 patients; 11 in the group above the median and 5 in the group below (p = 0.086). There were 26 primary outcomes in 16 patients; 20 (77 %) events in the group above the coronary calcification median and 6 (23 %) in the group below (p = 0.006). There were 10 deaths; 8 in the group above the median compared with 2 in the group below (p = 0.04). The hazard ratios for coronary calcification above, compared with below the median, for the primary outcome composite were 2.5 (95 % CI 0.87, 7.3; p = 0.09) and 1.7 (95 % CI 0.55, 5.4; p = 0.4), unadjusted and adjusted for age, respectively. For death, the hazard ratios were 4.6 (95 % CI 0.98, 21.96; p = 0.054) and 2.4 (95 % CI 0.45, 12.97; p = 0.3) respectively. LIMITATIONS: We were limited by a small sample size and a small number of events. CONCLUSIONS: Respondent burden is high for additional testing around the initiation of dialysis. High coronary calcification in patients new to ESRD has a tendency to predict cardiovascular outcomes and death, though effects are attenuated when adjusted for age. BioMed Central 2015-08-12 /pmc/articles/PMC4534029/ /pubmed/26269747 http://dx.doi.org/10.1186/s40697-015-0065-6 Text en © Wilkieson et al. 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Research Article Wilkieson, Trevor J. Rahman, M. Omair Gangji, Azim S. Voss, Maurice Ingram, Alistair J. Ranganath, Nischal Goldsmith, Charlie H. Kotsamanes, Cathy Z. Crowther, Mark A. Rabbat, Christian G. Clase, Catherine M. Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
title | Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
title_full | Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
title_fullStr | Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
title_full_unstemmed | Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
title_short | Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
title_sort | coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534029/ https://www.ncbi.nlm.nih.gov/pubmed/26269747 http://dx.doi.org/10.1186/s40697-015-0065-6 |
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