Extracellular fluid excess is significantly associated with coronary artery calcification in patients with chronic kidney disease

Seohyun Park, Chan Joo Lee, Jong Hyun Jhee, Hae Ryong Yun, Hyoungnae Kim, Su Young Jung, Youn Kyung Kee, Chang Yun Yoon, Jung Tak Park, HyeonChang Kim, SeungHyeok Han, Shin-Wook Kang, Sungha Park, TaeHyun Yoo

Research output: Contribution to journalArticle

Abstract

Background—Extracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD). Methods and Results—A total of 1741 patients at all stages of pre-dialysis CKD from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water-to-total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis. Conclusions—ECF status is independently associated with a high risk of CAC in patients with CKD.

Original languageEnglish
Article numbere008935
JournalJournal of the American Heart Association
Volume7
Issue number13
DOIs
Publication statusPublished - 2018 Jul 1

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Extracellular Fluid
Chronic Renal Insufficiency
Coronary Vessels
Body Water
Water
Calcium
Dialysis
Cardiovascular Diseases
Metabolic Diseases
Renal Artery
Electric Impedance
Glomerular Filtration Rate
Epidemiology
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Morbidity

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, Seohyun ; Lee, Chan Joo ; Jhee, Jong Hyun ; Yun, Hae Ryong ; Kim, Hyoungnae ; Jung, Su Young ; Kee, Youn Kyung ; Yoon, Chang Yun ; Park, Jung Tak ; Kim, HyeonChang ; Han, SeungHyeok ; Kang, Shin-Wook ; Park, Sungha ; Yoo, TaeHyun. / Extracellular fluid excess is significantly associated with coronary artery calcification in patients with chronic kidney disease. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 13.
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title = "Extracellular fluid excess is significantly associated with coronary artery calcification in patients with chronic kidney disease",
abstract = "Background—Extracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD). Methods and Results—A total of 1741 patients at all stages of pre-dialysis CKD from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water-to-total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95{\%} confidence interval, 1.079–1.264, P<0.001). The adjusted R2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis. Conclusions—ECF status is independently associated with a high risk of CAC in patients with CKD.",
author = "Seohyun Park and Lee, {Chan Joo} and Jhee, {Jong Hyun} and Yun, {Hae Ryong} and Hyoungnae Kim and Jung, {Su Young} and Kee, {Youn Kyung} and Yoon, {Chang Yun} and Park, {Jung Tak} and HyeonChang Kim and SeungHyeok Han and Shin-Wook Kang and Sungha Park and TaeHyun Yoo",
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Extracellular fluid excess is significantly associated with coronary artery calcification in patients with chronic kidney disease. / Park, Seohyun; Lee, Chan Joo; Jhee, Jong Hyun; Yun, Hae Ryong; Kim, Hyoungnae; Jung, Su Young; Kee, Youn Kyung; Yoon, Chang Yun; Park, Jung Tak; Kim, HyeonChang; Han, SeungHyeok; Kang, Shin-Wook; Park, Sungha; Yoo, TaeHyun.

In: Journal of the American Heart Association, Vol. 7, No. 13, e008935, 01.07.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Extracellular fluid excess is significantly associated with coronary artery calcification in patients with chronic kidney disease

AU - Park, Seohyun

AU - Lee, Chan Joo

AU - Jhee, Jong Hyun

AU - Yun, Hae Ryong

AU - Kim, Hyoungnae

AU - Jung, Su Young

AU - Kee, Youn Kyung

AU - Yoon, Chang Yun

AU - Park, Jung Tak

AU - Kim, HyeonChang

AU - Han, SeungHyeok

AU - Kang, Shin-Wook

AU - Park, Sungha

AU - Yoo, TaeHyun

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background—Extracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD). Methods and Results—A total of 1741 patients at all stages of pre-dialysis CKD from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water-to-total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis. Conclusions—ECF status is independently associated with a high risk of CAC in patients with CKD.

AB - Background—Extracellular fluid (ECF) excess is an independent predictor of cardiovascular morbidity in patients undergoing dialysis. This study aimed to investigate the relationship between ECF status, which is affected by renal function, and coronary artery calcification (CAC), which is a marker of cardiovascular disease, in patients with chronic kidney disease (CKD). Methods and Results—A total of 1741 patients at all stages of pre-dialysis CKD from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk) were analyzed for the association between ECF status and CAC. ECF status was defined as extracellular water-to-total body water ratio (ECW/TBW) measured using bioelectrical impedance analysis. ECF excess was defined as ECW/TBW ≥0.390 or ≥0.400 depending on its severity. To define CAC, Agatston coronary artery calcium scores were measured. A total coronary artery calcium score of ≥400 was defined as CAC. The CKD stages were defined according to estimated glomerular filtration rate calculated using the CKD Epidemiology Collaboration equation. ECW/TBW and the proportion of ECF excess increased with progressing CKD stages. Multivariable logistic regression analyses showed that ECW/TBW was independently associated with CAC (per 0.01 increase of ECW/TBW, odds ratio 1.168, 95% confidence interval, 1.079–1.264, P<0.001). The adjusted R2 for predicting higher coronary artery calcium scores and CAC significantly improved after ECW/TBW was added to conventional factors. This association was further confirmed by net reclassification and integrated discriminant improvements, sensitivity analysis, and subgroup analysis. Conclusions—ECF status is independently associated with a high risk of CAC in patients with CKD.

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U2 - 10.1161/JAHA.118.008935

DO - 10.1161/JAHA.118.008935

M3 - Article

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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