#2380 CT coronary angiography to identify patients at increased risk of developing chronic kidney disease

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Abstract Background and Aims Chronic kidney disease (CKD) is common and cardiovascular disease is its commonest complication. Identifying patients at risk of developing CKD is an unmet clinical need. Computed tomography coronary angiography (CTCA) is used to diagnose patients with coronary artery disease but may also provide an opportunity to identify those at risk of developing future CKD. Method In a post-hoc analysis of a multicentre randomised controlled trial of CTCA in patients with suspected angina, we analysed routinely collected biochemistry data from time of enrolment. The primary outcome was development of CKD defined by estimated glomerular filtration rate (eGFR) criteria. Results Overall, 1,487 patients (58 ± 9 years; 58% male) were eligible for inclusion (baseline eGFR 94 ± 12 mL/min/1.73 m2): 809 patients were randomised to standard of care and 678 were randomised to CTCA plus standard of care. Over a median follow-up of 10.6 years, 247 patients (16.6%) developed CKD irrespective of trial allocation (17.9% versus 15.0%; P = 0.14). Compared to those who retained normal kidney function, those who developed CKD were older (63 ± 7 years versus 57 ± 9 years; P < 0.001), had a higher body mass index (BMI) (31.1 ± 5.9 kg/m2versus 29.3 ± 5.8 kg/m2; P < 0.001), and were more likely to have a history of coronary artery disease (16% versus 11%; P = 0.024), diabetes mellitus (18% versus 10%; P < 0.001), and hypertension (53% versus 33%; P < 0.001). Patients who underwent CTCA and developed CKD had a higher coronary artery calcium score (126 versus 34 AU; P < 0.001), were more likely to have obstructive coronary disease (52% versus 30%; P < 0.001) and aortic valve calcification (18% versus 8%; P = 0.002), and had greater coronary plaque burden (46.9% versus 41.6%; P = 0.002) than patients who underwent CTCA but did not develop CKD. After adjustment for known CKD risk factors (i.e., age, sex, baseline kidney function, BMI, diabetes mellitus, hypertension, smoking status), obstructive coronary artery disease independently associated with the development of CKD (adjusted hazard ratio [aHR], 2.66 [95% confidence interval (CI) 1.38–5.11]; P = 0.003). In addition, obstructive coronary artery disease was more strongly associated with the development of CKD than baseline eGFR (aHR per 2.5 mL/min/1.73 m2 lower eGFR: 1.24 [95% CI 1.19–1.30]; P < 0.001) or diabetes mellitus (aHR 2.06 [95% CI 1.23–3.45]; P = 0.006) (Fig. 1). Furthermore, total (aHR per doubling, 1.14 [95% CI 1.02–1.27]; P = 0.020) non-calcified (aHR per doubling, 1.14 [95% CI 1.02–1.27]; P = 0.020), and low-attenuation (aHR per doubling, 1.28 [95% CI 1.06–1.54]; P = 0.009) plaque burden independently associated with incident CKD. The inclusion of obstructive coronary artery disease improved the performance of a multivariable model incorporating known clinical risk factors (i.e., age, sex, diabetes mellitus, hypertension, baseline eGFR) to predict 5-year and 10-year risk of developing CKD. Conclusion The presence and extent of coronary artery disease on CTCA independently associates with the development of future CKD therefore potentially identifying those patients most likely to benefit from evidence-based renoprotective therapies.

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