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

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Ahmed BashirRichard P Steeds

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.

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Citations

Aug 31, 2016·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Jordi BoverJosé Ballarín
Oct 7, 2016·Hemodialysis International·Eunjin BaeYon Su Kim
Sep 21, 2016·World Journal of Nephrology·Usama Abdel Azim Sharaf El DinDina Ossama Abdulazim
Mar 7, 2020·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Christian WenningMichael Schäfers
Jan 2, 2021·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Marta Cano MegíasDiego Rodríguez-Puyol
Jun 26, 2021·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Marta Cano MegíasDiego Rodríguez-Puyol

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