CKD, Plasma Lipids, and Common Carotid Intima-Media Thickness

Abstract

SummaryBackground and objectives Altered levels of atherogenic lipoproteins have been shown to be common in mild kidney dysfunction. This study sought to determine the associations between plasma lipids (including LDL particle distribution) and subclinical atherosclerosis measured by the common carotid intima-media thickness (IMT) across levels of estimated GFR (eGFR) and to assess whether inflammation modifies these associations. Results CKD, defined as eGFR ,60 ml/min per 1.73 m 2 , was present in 853 individuals (13.0%). Associations of total cholesterol and LDL cholesterol (LDL-C) with IMT were J shaped, particularly among participants with CKD (P value for interaction, P=0.01). HDL cholesterol (HDL-C) and small-dense LDL-C were consistently and linearly associated with IMT across levels of eGFR. The results showed differences in IMT of 221.41 (95% confidence interval, 241.00, 21.57) in eGFR $60 and 258.49 (2126.61, 9.63) in eGFR ,60 per unit difference in log-transformed HDL-C, and 4.83 (3.16, 6.50) in eGFR $60 and 7.48 (1.45, 13.50) in eGFR ,60 per 100 nmol/L difference in small-dense LDL. Among participants with CKD, inflammation significantly modified the associations of total cholesterol and LDL-C with IMT (P values for interaction, P,0.01 and P,0.001, respectively).Conclusions Compared with total cholesterol and LDL-C, abnormalities in HDL-C and small-dense LDL-C are more strongly and consistently associated with subclinical atherosclerosis in CKD. Inflammation modifies the association between total cholesterol and LDL-C with IMT.

Association between estimated glomerular filtration rate and peripheral arterial disease

“…This association could be explained in part by new biomarkers for premature atherosclerosis [42,43], as well as by traditional cardiovascular risk factors. In addition, progressive deterioration of renal function in CKD can be associated with the accumulation of uremic toxins, which stimulate oxidative stress and inflammation, and in turn contribute to endothelial dysfunction and the progression of atherosclerosis [44][45][46]. Further studies are needed to identify the mechanism and factors that affect the long-term prognosis of patients with PAD and CKD.…”

Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD

“…Classic risk prediction equations underestimate cardiovascular disease risk in adults with CKD (2,3), in which most events occur in patients with low-moderate risk (4,5). Therefore, new tools for risk prediction in renal patients are needed.…”

Residual Cardiovascular Risk in Chronic Kidney Disease: Role of High-density Lipoprotein

“…The multiethnic study of atherosclerosis (MESA) study did find that the association between lower HDL-C and carotid intima-media thickness (CIMT) become stronger with lower eGFR (48). HDL-C has also been reported to predict incident MI in hemodialysis patients without history of CVD (49) and was associated with enhanced mortality in short-term outcome in CKD patients with metabolic syndrome (50).…”