A Nomogram for Identifying Subclinical Atherosclerosis in Chronic Kidney Disease

Figures & data

Table 1 Basic and Clinical Features of the Training and Validation Sets in CKD Patients

	Total (n = 1452)	Training Set (n =1022)	Validation Set (n = 430)	t/z/χ^Citation2	P-value
Age, n (%)	54.4±14.4	54.9±14.1	53.3±14.9	1.954	0.051
Male, n (%)	874(60.2%)	628(61.4%)	246(57.2%)	2.270	0.132
CKD stage, n (%)
stage 1–2	171(11.8%)	130(12.7%)	41(9.5%)	3.345	0.341
stage 3	261(18.0%)	183(17.9%)	78(18.1%)
stage 4	245(16.9%)	174(17.0%)	71(16.5%)
stage 5	775(53.4%)	535(52.3%)	240(55.8%)
Cardiovascular disease, n(%)	499(34.4%)	353(34.5%)	146(34.0%)	0.046	0.830
Diabetes, n (%)	380(26.2%)	257(25.1%)	123(28.6%)	1.873	0.171
Hypertension, n (%)	1102(75.9%)	769(75.2%)	333(77.4%)	0.799	0.371
Smoking, n (%)	447(30.8%)	327(32.0%)	120(27.9%)	2.375	0.123
Drinking, n (%)	366(25.2%)	258(25.2%)	108(25.1%)	0.003	0.959
Body mass index, kg/m^Citation2	23.6±3.7	23.6±3.7	23.5±3.7	0.623	0.534
Systolic blood pressure, mmHg	142.0±24.8	142.0±24.9	142.1±24.7	−0.078	0.938
Uric acid, μmol/L	426.6±131.3	426.5±131.0	427.7±130.7	−0.158	0.875
Serum hemoglobin, g/L	101.1±26.4	101.4±26.3	100.5±26.7	0.551	0.582
Albumin, g/L	37.8(32.6–41.8)	37.6(32.2–41.8)	38.1(33.8–41.8)	−1.398	0.162
Phosphorus, mmol/L	1.43±0.50	1.42±0.49	1.46±0.51	−1.291	0.197
Calcium, mmol/L	2.18(2.04–2.30)	2.18(2.03–2.29)	2.19(2.06–2.31)	−1.372	0.170
Intact parathyroid hormone, pg/mL	168.8(72.3–359.0)	171.8(68.2–362.7)	163.4(80.7–356.9)	−0.611	0.541
Platelet counts, 10^9/L	178.0(128.0–229.0)	179.0(129.0–229.0)	177.0(127.0–230.0)	−0.114	0.909
Blood glucose, mmol/L	4.69(4.21–5.47)	4.66(4.20–5.40)	4.78(4.25–5.65)	−1.721	0.085
Urine total protein, g/24h	1.94(0.67–4.06)	2.00(0.67–4.13)	1.85(0.68–3.89)	−0.621	0.535
C-reactive protein, mg/L	4.70(2.40–13.00)	4.70(2.40–12.70)	4.80(2.40–14.35)	−0.939	0.348
Total cholesterol, mmol/L	4.30(3.57–5.21)	4.35(3.58–5.29)	4.21(3.52–5.17)	−1.096	0.273
Triglyceride, mmol/L	1.51(1.08–2.14)	1.51(1.08–2.16)	1.52(1.07–2.09)	−0.114	0.909
High density lipoprotein, mmol/L	1.04(0.86–1.29)	1.04(0.86–1.28)	1.03(0.86–1.30)	−0.035	0.972
Low density lipoprotein, mmol/L	2.32(1.82–3.00)	2.32(1.82–3.00)	2.32(1.82–3.00)	−0.052	0.959

Notes: Uric acid: mg/dL=μmol/L×0.01681, Serum hemoglobin, g/dL=g/L×0.1, Albumin: g/dL=g/L×0.1, Phosphorus: mg/dL=mmol/L×3.097, Calcium: mg/dL=mmol/L×4.008, Intact parathyroid hormone: mg/dL=pg/mL, Platelet counts: mm³=10⁹/L×1000, Blood glucose: mg/dL =mmol/L×18.02, C-reactive protein: mg/dL=mg/L×0.1, Total cholesterol: mg/dL=mmol/L×38.67, Triglyceride: mg/dL=mmol/L×88.545, High density lipoprotein: mg/dL=mmol/L×38.61, Low density lipoprotein: mmol/L mg/dL=mmol/L×38.61.

Abbreviations: CKD, chronic kidney disease; AS, atherosclerosis.

Table 2 Comparisons of Basic and Clinical Features of Training and Validation Set According to Atherosclerosis

	Training Set (n =1022)			Validation Set (n = 430)
	No AS (n = 541)	AS (n = 481)	P-value	No AS (n = 242)	AS (n = 188)	P-value
Age, n (%)	48.6±13.1	62.0±11.7	<0.001	46.6±13.3	61.9±12.3	<0.001
Male, n (%)	286(52.9%)	342(71.1%)	<0.001	126(52.1%)	120(63.8%)	0.014
CKD stage, n (%)
Stage 1–2	84(15.5%)	46(9.6%)	0.029	28(11.6%)	13(6.9%)	0.237
Stage 3	90(16.6%)	93(19.3%)		40(16.5%)	38(20.2%)
Stage 4	94(17.4%)	80(16.6%)		36(14.9%)	35(18.6%)
Stage 5	273(50.5%)	262(54.5%)		138(57.0%)	102(54.3%)
Cardiovascular disease, n(%)	143(26.4%)	210(43.7%)	<0.001	62(25.6%)	84(44.7%)	<0.001
Diabetes, n (%)	85(15.7%)	172(35.8%)	<0.001	36(14.9%)	87(46.3%)	<0.001
Hypertension, n (%)	381(70.4%)	388(80.7%)	<0.001	172(71.1%)	161(85.6%)	<0.001
Smoking, n (%)	142(26.2%)	185(38.5%)	<0.001	59(24.4%)	61(32.4%)	0.064
Drinking, n (%)	119(22.0%)	139(28.9%)	0.011	54(22.3%)	54(28.7%)	0.128
Body mass index, kg/m^2	23.3±3.7	23.9±3.6	0.013	23.3±3.7	23.7±3.7	0.291
Systolic blood pressure, mmHg	140.8±24.0	143.3±25.8	0.098	140.6±24.9	144.0±24.2	0.163
Uric acid, μmol/L	426.6±130.3	426.3±131.8	0.975	434.2±135.1	419.2±124.7	0.241
Serum hemoglobin, g/L	102.4±26.8	100.2±25.8	0.202	99.9±25.6	101.3±27.0	0.607
Albumin, g/L	38.7(33.2–42.8)	36.0(30.8–40.3)	<0.001	38.5(33.1–41.9)	37.8(34.1–41.6)	0.718
Phosphorus, mmol/L	1.44±0.48	1.40±0.50	0.144	1.48±0.51	1.43±0.51	0.272
Calcium, mmol/L	2.20(2.05–2.30)	2.14(2.02–2.28)	0.018	2.20(2.06–2.32)	2.18(2.07–2.29)	0.486
Intact parathyroid hormone, pg/mL	161.5(62.2–363.4)	187.8(73.6–361.5)	0.336	163.2(82.6–360.8)	166.0(79.5–341.2)	0.986
Platelet counts, 10^9/L	182.5(129.3–234.0)	173.0(128.0–227.0)	0.185	184.0(137.5–241.5)	168.0(122.0–218.0)	0.014
Blood glucose, mmol/L	4.59(4.20–5.15)	4.75(4.18–5.96)	0.005	4.56(4.19–5.23)	5.08(4.41–6.38)	<0.001
Urine total protein, g/24h	1.86(0.63–3.52)	2.12(0.70–4.62)	0.034	1.73(0.61–4.23)	1.90(0.78–3.83)	0.632
C-reactive protein, mg/L	4.10(2.20–8.40)	5.00(2.50–15.00)	<0.001	4.50(2.30–12.30)	5.10(2.60–17.25)	0.108
Total cholesterol, mmol/L	4.38(3.56–5.23)	4.32(3.63–5.32)	0.919	4.21(3.52–5.15)	4.19(3.54–5.17)	0.978
Triglyceride, mmol/L	1.53(1.08–2.23)	1.48(1.09–2.11)	0.494	1.47(1.06–2.12)	1.56(1.11–2.08)	0.651
High density lipoprotein, mmol/L	1.04(0.87–1.29)	1.05(0.84–1.25)	0.356	1.03(0.84–1.31)	1.04(0.88–1.29)	0.905
Low density lipoprotein, mmol/L	2.29(1.82–2.98)	2.38(1.81–3.01)	0.453	2.34(1.86–2.95)	2.31(1.71–3.13)	0.786

Notes: Uric acid: mg/dL=μmol/L×0.01681, Serum hemoglobin, g/dL=g/L×0.1, Albumin: g/dL=g/L×0.1, Phosphorus: mg/dL=mmol/L×3.097, Calcium: mg/dL=mmol/L×4.008, Intact parathyroid hormone: mg/dL=pg/mL, Platelet counts: mm³=10⁹/L×1000, Blood glucose: mg/dL =mmol/L×18.02, C-reactive protein: mg/dL=mg/L×0.1, Total cholesterol: mg/dL=mmol/L×38.67, Triglyceride: mg/dL=mmol/L×88.545, High density lipoprotein: mg/dL=mmol/L×38.61, Low density lipoprotein: mmol/L mg/dL=mmol/L×38.61.

Abbreviations: CKD, chronic kidney disease; AS, atherosclerosis.

Figure 1 Prevalence of atherosclerosis by CKD stages.

Table 3 Risk Factors Associated with the Prevalence of Atherosclerosis in the Training Set

Characteristics	Model 1		Characteristics	Model 2
	P-value	OR (95% CI)		P-value	OR (95% CI)
Female (vs males)	<0.001	0.377(0.255–0.559)	Female (vs males)	<0.001	0.400(0.257–0.623)
Age, >65 years (vs ≤65 years)	<0.001	1.088(1.073–1.104)	Age, >65 years (vs ≤65 years)	<0.001	1.085(1.068–1.102)
CKD stage 3 (vs stage 1–2)	0.026	2.040(1.091–3.816)	CKD stage 3 (vs stage 1–2)	0.006	2.393(1.279–4.475)
CKD stage 4 (vs stage 1–2)	0.193	1.522(0.809–2.864)	CKD stage 4 (vs stage 1–2)	0.011	2.249(1.245–4.062)
CKD stage 5 (vs stage 1–2)	0.026	1.913(1.082–3.382)	CKD stage 5 (vs stage 1–2)	0.007	2.293(1.210–4.342)
Hypertension	0.034	1.547(1.034–2.315)	Hypertension	0.002	1.980(1.282–3.058)
Diabetes	0.002	1.798(1.242–2.602)	Diabetes	0.001	2.013(1.315–3.083)
			Albumin, g/L	0.001	0.963(0.941–0.986)
			Calcium, mmol/L	0.043	2.488(1.027–6.028)
			Platelet counts, 10^9/L	0.011	0.998(0.996–0.999)

Figure 2 The ROC curve of the two constructed models by logistic regression.

Figure 3 The DCA for 2 models to predict the occurrence of atherosclerosis in CKD patients.

Abbreviation: DCA, decision curve analysis.

Figure 4 The nomogram for prediction of the occurrence of atherosclerosis in terms of constructed model.

Figure 5 Prevalence of atherosclerosis by age and CKD stages in males and females. (A) stratified by age and CKD stages in male patients, (B) stratified by age and CKD stages in female patients, prevalence is colored in a 0–100% blue to red scale.

Figure 6 Adjusted odds ratio (OR) of CKD stages (adjusted by the status of hypertension and diabetes mellitus, smoke, alcohol, and body mass index, systolic blood pressure, platelet counts, albumin, calcium, blood glucose, and c-reactive protein) according to gender (A) and age (B).

Gajjala PR, Fliser D, Speer T, et al. Emerging role of post-translational modifications in chronic kidney disease and cardiovascular disease. Nephrol Dial Transplant. 2015;30:1814–1824.25862763

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