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Abstract: FR-OR035

Prevalence, Progression, and Implications of Breast Artery Calcification in Patients with CKD

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Evenepoel, Pieter, University Hospitals Leuven, Leuven, Belgium
  • Van Berkel, Brecht, KU Leuven, Sint-Truiden, Belgium
  • Van ongeval, Chantal, UZ Leuven, Leuven, Belgium
  • Van Craenenbroeck, Amaryllis H., University Hospitals Leuven, Leuven, Belgium
  • Vusser, Katrien De, UZ Leuven, Leuven, Belgium
Background

Breast artery calcification (BAC) is increasingly recognized as a specific marker of medial calcification. In this retrospective observational cohort study, we aimed to define the prevalence and progression rate of BAC in CKD patients across disease stage, to identify clinical and biochemical correlates of BAC and to explore the association of BAC with incident cardiovascular morbidity and overall mortality.

Methods

Presence and extent (BAC score) were determined on mammograms in 311 females (58.7 ± 10.8 yrs, Caucasian) with CKD across disease stage (CKD 2-5D n=133; transplant recipients [Tx]: n=178). In a subset of 88 patients (CKD5D n=14, Tx n=74), a repeat mammography was performed after a mean interval of 3.5 ± 2.2 years, allowing to calculate the annualized BAC rate. Relevant clinical and laboratory parameters, including parameters of mineral metabolism and inflammation, and outcomes were extracted from electronic files. Survival analysis was performed in the TX group by Kaplan-Meijer analysis.

Results

BAC was observed in 34.7% of the patients. Prevalence and extent of BAC increased parallel to the decline of kidney function. In the overall cohort, patients with BAC were older, suffered more from CVD and inflammation, had higher pulse pressure, and borderline higher prevalence of diabetes . The BAC progression rate was significantly higher in patients with CKD5D as compared to Tx patients (2.2 ± 1.2 vs 1.0 ± 0.4 mm/yr, mean ± SE; p=0.02). Progressors were characterized by more inflammation, worse kidney function and higher BAC score at baseline. In the Tx subcohort, progressors moreover showed higher serum phosphate levels at baseline. Presence of BAC associated with poor overall (Log-Rank p=0.0007) and cardiovascular event free (Log-Rank p=0.007) survival in Tx.

Conclusion

BAC is common among CKD patients, progresses at a slower pace in Tx as compared to CKD5D, and associates with dismal (cardiovascular) outcomes. BAC score, kidney function and serum phosphate at baseline are important determinants of progression. Measurement of BAC may offer a personalized, non-invasive approach to risk-stratify CKD patients for cardiovascular disease at no additional cost or radiation since a majority of women over the age of 40 undergo regular breast cancer screening.