Is Mild Renal Dysfunction a Risk Factor for Carotid Atherosclerosis in Apparently Healthy Adults?

Abstract

Objective Renal dysfunction may be related to cerebrovascular disease. The aim of this study was to assess the relationship between mild renal dysfunction and carotid artery atherosclerosis detected by ultrasonography in apparently healthy subjects. Methods A total of 2,106 persons (1,368 men and 738 women, mean age+/-S.D.: 56 +/-10 years) with no history of stroke were enrolled. Kidney function was evaluated in terms of estimated glomerular filtration rate (eGFR), calculated by using the relationship 194Cr -1.094 ×Age -0.287 ×0.739 (if female), where Cr is serum creatinine concentration. Atherosclerosis on ultrasonography was defined as regional intimal thickening or nodular lesion. Results Atherosclerotic lesions were significantly more frequent in subjects with CKD stage 3 than in CKD stage 1 or 2 (p<0.001). Odds ratios for atherosclerotic lesions were significantly increased to 1.11 (95% confidence interval: 1.09-1.12, p<0.001) for increasing age, 1.66 (1.31-2.10, p<0.001) for male sex, 1.76 (1.43-2.16, p<0.001) for systolic blood pressure !130 mmHg and/or diastolic blood pressure !85 mmHg, 1.61 (1.28-2.01, p<0.001) for LDL-cholesterol !140 mg/dL, and 1.59 (1.23-2.05, p=0.003) for smoking habit versus no risk factor. The odds ratio of CKD stage 3 for !50% carotid artery stenosis was significantly increased to 3.47 (1.09-11.08, p=0.035), although CKD stage 2 and stage 3 were not significant (0.77, 95% CI: 0.59-1.01, p=0.068; 0.99, 95%CI: 0.67-1.46, p=0.981, respectively). Conclusion Renal dysfunction defined in terms of eGFR might be associated with early-stage carotid atherosclerosis, but traditional vascular risk factors, including increasing age or hypertension, appear to play a major role.

Age-related change in kidney function, its influencing factors, and association with asymptomatic carotid atherosclerosis in healthy individuals—A 5-year follow-up study

“…Atherosclerosis has been regarded as the very important risk factor for the occurrence and development of cardiovascular and cerebrovascular disease [21]. Recently, different clinical indicators were used to predict atherosclerosis in order to evaluate the association of atherosclerosis with GFR decline, but results are quite inconsistent [5][6][7][8].…”

“…However, in a comparative study, Takahashi et al [7] demonstrated that there was little association of renal dysfunction with early carotid atherosclerosis in apparently healthy adults, but that traditional vascular risk factors, such as aging and hypertension, appeared to play a major role. Similarly, a cross-sectional study conducted by Han et al [8] in 852 healthy individuals with age over than 30 years showed that aging was a major risk factor contributing to GFR reduction and that there was no independent correlation seen between the decline of GFR and atherosclerosis in a population with normal renal function.…”

“…It is important to clarify whether the factors causing the decline of GFR in the healthy population are the same as those in the cohort with chronic kidney disease (CKD). The correlation between age-related decline of GFR and atherosclerosis remains controversial [5][6][7][8]. Atherosclerosis is a generalized vascular disease, and ultrasonographic findings of visible carotid plaque can serve as a marker of atherosclerosis elsewhere in the circulation [9].…”

Smoking and the Renal Functional Status of Patients Should be Defined Clearly in Order to Assess Atherosclerosis and Metabolic Syndrome

“…Another study of apparently healthy Japan adult subjects showed that renal dysfunction is associated with early-stage carotid atherosclerosis (4). The participants of the present study were described as healthy individuals; however, the basal characteristics of the patients should be clearly defined, particularly with respect to the renal functional status.…”

Response Letter Regarding the Article "Significance of the Presence of Metabolic Syndrome in Patients with Asymptomatic Arteriosclerosis Affecting the Aorta and the Cerebral, Extra-cranial Carotid and Coronary Arteries"

“…In addition, chronic kidney disease (CKD) appears to be a predictor of asymptomatic cerebral infarction and/or large vessel disease, as previously described (4,5). In this study, we primarily intended to clarify the significance of the risk components for arteriosclerosis in various sites based on the National Cholesterol Education Program-Adult Treatment Panel III criteria.…”