Coronary artery calcification (CC) is frequent in patients with CKD and even more in those with concomitant type 2 diabetes. Presence and progression of CC are both strong predictive factors of cardiovascular events (CVE) in on-dialysis patients. In contrast, the effects of CC on the rate of CVE has been seldom evaluated as predictors in pre-dialysis (NDD-CKD) diabetic patients. Main aim of the present study is the evaluation of the rate of CVE and inception to dialysis in NDD-CKD patients with CC. METHODS: Outpatients with stage 2 to 4 CKD were screened for presence of CC with CT scan. Inclusion criteria were: age > 18 years, CKD stage 2-4. Exclusion criteria were: symptoms of heart failure and/or coronary artery disease, previous history of myocardial infarction, coronary bypass surgery, angioplasty, stroke, arrhythmia. Routine blood chemistry was assessed at enrollment and every six months. Recorded events were: sudden death, fatal and not fatal myocardial infarction, other-cause mortality, and inception of dialysis. The scheduled followup for evaluation of events was 48-month long. Coronary Calcium Score (CAC-Score) was assessed by computed tomography at study entry, and on 48th month. RESULTS: Recruited patients (n.275) were divided in 4 groups according to presence of CC and diabetes. Patients without CC and without diabetes were n.126; those with CC but without diabetes were n.88; those with CC and diabetes were n.48; those without CC but with diabetes were n.13. Presence of CC was significantly (p<0.001) higher in diabetics (79% Vs 41%) as well as baseline CAC-score (489±571 Vs 335±666 SD; median: 250 Vs 132; Agatston Unit). At the end of follow-up progression was 76% higher in diabetics compared to non-diabetics. Descending artery was more frequently involved both in diabetics and not diabetics (80-91%); circumflex coronary artery was mostly involved (71% Vs 31%) in diabetics. Composite endpoint (CVE and inception of dialysis) was encountered in 42%, and in 69% of calcified NDDCKD patients without and with diabetes, respectively. In the whole population, patients with CC more frequently experienced CV events. Inception to dialysis was more frequent in non calcified patients because fatal CVE were less frequent than those occurring in calcified patients. CONCLUSIONS: Calcified NDD-CKD diabetic patients are more prone to composite end-point of CVE and inception to dialysis. Initiation of dialysis is more frequent in non calcified NDD-CKD patients. Because of the higher risk for cardiovascular events, NDD-CKD diabetic patients might benefit from risk stratification with CAC-score screening. This non invasive procedure may help physicians in choosing the better medical therapy for diabetics Saturday, May

CARDIOVASCULAR EVENTS AND INCEPTION OF DIALYSIS IN DIABETIC AND NON-DIABETIC CKD PATIENTS WITH CORONARY ARTERY CALCIFICATION. FOLLOW-UP STUDY / Elisa Buonanno, Stefania Brancaccio; Fimiani, Vanessa; Napolitano, Paola; Spadola, Rosanna; Luigi, Morrone; Biagio DI, Iorio; Russo, Domenico. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2012).

CARDIOVASCULAR EVENTS AND INCEPTION OF DIALYSIS IN DIABETIC AND NON-DIABETIC CKD PATIENTS WITH CORONARY ARTERY CALCIFICATION. FOLLOW-UP STUDY

FIMIANI, VANESSA;NAPOLITANO, PAOLA;SPADOLA, ROSANNA;RUSSO, DOMENICO
2012

Abstract

Coronary artery calcification (CC) is frequent in patients with CKD and even more in those with concomitant type 2 diabetes. Presence and progression of CC are both strong predictive factors of cardiovascular events (CVE) in on-dialysis patients. In contrast, the effects of CC on the rate of CVE has been seldom evaluated as predictors in pre-dialysis (NDD-CKD) diabetic patients. Main aim of the present study is the evaluation of the rate of CVE and inception to dialysis in NDD-CKD patients with CC. METHODS: Outpatients with stage 2 to 4 CKD were screened for presence of CC with CT scan. Inclusion criteria were: age > 18 years, CKD stage 2-4. Exclusion criteria were: symptoms of heart failure and/or coronary artery disease, previous history of myocardial infarction, coronary bypass surgery, angioplasty, stroke, arrhythmia. Routine blood chemistry was assessed at enrollment and every six months. Recorded events were: sudden death, fatal and not fatal myocardial infarction, other-cause mortality, and inception of dialysis. The scheduled followup for evaluation of events was 48-month long. Coronary Calcium Score (CAC-Score) was assessed by computed tomography at study entry, and on 48th month. RESULTS: Recruited patients (n.275) were divided in 4 groups according to presence of CC and diabetes. Patients without CC and without diabetes were n.126; those with CC but without diabetes were n.88; those with CC and diabetes were n.48; those without CC but with diabetes were n.13. Presence of CC was significantly (p<0.001) higher in diabetics (79% Vs 41%) as well as baseline CAC-score (489±571 Vs 335±666 SD; median: 250 Vs 132; Agatston Unit). At the end of follow-up progression was 76% higher in diabetics compared to non-diabetics. Descending artery was more frequently involved both in diabetics and not diabetics (80-91%); circumflex coronary artery was mostly involved (71% Vs 31%) in diabetics. Composite endpoint (CVE and inception of dialysis) was encountered in 42%, and in 69% of calcified NDDCKD patients without and with diabetes, respectively. In the whole population, patients with CC more frequently experienced CV events. Inception to dialysis was more frequent in non calcified patients because fatal CVE were less frequent than those occurring in calcified patients. CONCLUSIONS: Calcified NDD-CKD diabetic patients are more prone to composite end-point of CVE and inception to dialysis. Initiation of dialysis is more frequent in non calcified NDD-CKD patients. Because of the higher risk for cardiovascular events, NDD-CKD diabetic patients might benefit from risk stratification with CAC-score screening. This non invasive procedure may help physicians in choosing the better medical therapy for diabetics Saturday, May
2012
CARDIOVASCULAR EVENTS AND INCEPTION OF DIALYSIS IN DIABETIC AND NON-DIABETIC CKD PATIENTS WITH CORONARY ARTERY CALCIFICATION. FOLLOW-UP STUDY / Elisa Buonanno, Stefania Brancaccio; Fimiani, Vanessa; Napolitano, Paola; Spadola, Rosanna; Luigi, Morrone; Biagio DI, Iorio; Russo, Domenico. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2012).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/682527
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