Frontiers in medicine · 2026
Progression of coronary artery calcification in chronic kidney disease: nonlinear associations with serum magnesium and parathyroid hormone.
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Chen Yutong, Qiu Wenhao, Shu Yinglan, Lu Lifeng, Luo Yindeng
Аннотация
INTRODUCTION: Coronary artery calcification (CAC) progresses rapidly in chronic kidney disease (CKD), but its trajectories across stages and nonlinear relationships with serum magnesium and parathyroid hormone (PTH) remain unclear.
METHODS: We evaluated 800 CKD patients stratified into four groups (stages 1-2, 3, 4-5, and dialysis) over a median follow-up of 20.5 months using serial chest CT scans. Linear mixed-effects models, restricted cubic splines, and LASSO regression were applied to analyze trajectories, nonlinear relationships, and construct a predictive model.
RESULTS: The annualized rate of CAC progression increased significantly with advancing CKD stages (8.5%, 13.2%, 22.8%, and 29.5%/year, respectively; P < 0.001). Serum magnesium exhibited an L-shaped nonlinear relationship with rapid CAC progression (inflection point: 0.82 mmol/L), while PTH showed a J-shaped relationship (inflection point: 120 pg/mL). Uric acid was linearly and positively correlated. A 7-factor LASSO-derived prognostic model demonstrated robust performance, yielding a C-statistic of 0.802 (95% CI: 0.772-0.832) and good calibration.
CONCLUSION: In conclusion, CAC progression accelerates as renal function declines, peaking in dialysis patients. Low magnesium (<0.82 mmol/L) and high PTH (120 pg/mL) are key nonlinear risk factors. The resulting predictive model provides clinical utility for stratified cardiovascular risk management.
METHODS: We evaluated 800 CKD patients stratified into four groups (stages 1-2, 3, 4-5, and dialysis) over a median follow-up of 20.5 months using serial chest CT scans. Linear mixed-effects models, restricted cubic splines, and LASSO regression were applied to analyze trajectories, nonlinear relationships, and construct a predictive model.
RESULTS: The annualized rate of CAC progression increased significantly with advancing CKD stages (8.5%, 13.2%, 22.8%, and 29.5%/year, respectively; P < 0.001). Serum magnesium exhibited an L-shaped nonlinear relationship with rapid CAC progression (inflection point: 0.82 mmol/L), while PTH showed a J-shaped relationship (inflection point: 120 pg/mL). Uric acid was linearly and positively correlated. A 7-factor LASSO-derived prognostic model demonstrated robust performance, yielding a C-statistic of 0.802 (95% CI: 0.772-0.832) and good calibration.
CONCLUSION: In conclusion, CAC progression accelerates as renal function declines, peaking in dialysis patients. Low magnesium (<0.82 mmol/L) and high PTH (120 pg/mL) are key nonlinear risk factors. The resulting predictive model provides clinical utility for stratified cardiovascular risk management.