Clinical significance of subclinical carotid atherosclerosis and its relationship with echocardiographic parameters in non-diabetic chronic kidney disease patients

Abstract

BackgroundNon-diabetic chronic kidney disease (CKD) patients are a heterogeneous group with a variety of prognosis. We investigated the role of subclinical carotid atherosclerosis for the prediction of adverse cardiovascular (CV) outcomes in these patients, and tried to identify clinical and echocardiographic parameters associated with subclinical carotid atherosclerosis.MethodsAs a prospective design, 182 asymptomatic non-diabetic CKD patients underwent carotid ultrasonography and Doppler echocardiography. Carotid atherosclerosis was defined as a carotid intima-media thickness ≥1.0 mm and/or the presence of plaque.ResultsDuring the mean follow-up period of 28.8 ± 16.1 months, 23 adverse CV events occurred. Patients with carotid atherosclerosis (99, 54.4%) showed significantly higher rates of annual CV events than those without (8.6 vs. 1.5%, p <0.001). Particularly, the presence of carotid plaque was a powerful predictor of adverse CV outcomes (OR 7.80, 95% CI 1.45-45.97). Clinical parameters associated with the presence of subclinical carotid atherosclerosis were old age, previous history of hypertension, increased pulse pressure, and higher high-sensitivity C-reactive protein (hs-CRP) level. By echocardiography, early diastolic mitral annular velocity (E’) and the ratio of early peak transmitral inflow velocity (E) to E’ (E/E’) were closely related with the presence of carotid atherosclerosis. A multivariate analysis showed that age, hs-CRP, and E/E’ were significant determinants of carotid atherosclerosis.ConclusionsCarotid plaque, even subclinical, was closely associated with a poor prognosis in non-diabetic CKD patients. Increased age, hs-CRP level, and E/E’ ratio may be useful markers suggesting the presence of carotid atherosclerosis in these patients.

Utility of Traditional Circulating and Imaging-Based Cardiac Biomarkers in Patients with Predialysis CKD

“…In a longitudinal study of 3364 outpatients with and without CKD, lower creatinine clearance and higher cIMT were associated with fatal and nonfatal vascular events (74). However, in a study of nondiabetic outpatients with eGFR,60 ml/min per 1.73 m 2 , carotid plaque burden but not cIMT was associated with fatal or nonfatal acute coronary syndrome (ACS) or stroke (75). Similarly, Marcos et al did not show a significant association between the severity of cIMT and CV events or death (76).…”

Circulating angiotensin converting enzyme 2 activity as a biomarker of silent atherosclerosis in patients with chronic kidney disease

“…In CKD patients, carotid intima media thickness (IMT) has been demonstrated to be increased as compared to healthy patients 7,8 and to be an independent predictor of all-cause and cardiovascular mortality 9 . In addition, carotid plaque largely increases the risk of CV events 10 . Recent results from the multicenter prospective observational NEFRONA study 11 , that includes CKD patients and controls without previous cardiovascular events, have shown that the prevalence of atheromatous plaques is higher among CKD patients, correlating with the severity of CKD.…”

Cardiovascular risk in chronic kidney disease patients: intima-media thickness predicts the incidence and severity of histologically assessed medial calcification in radial arteries

“…Vascular calcification, common carotid intima media thickness (CCA-IMT) and the presence of carotid plaques are strongly associated with cardiovascular disease in chronic kidney disease (CKD) patients [ 1 , 2 ]. Arterial thickening contributes to elevated risk of cardiovascular episodes in patients on maintenance renal replacement therapy.…”