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

Abstract

Background and objectives Ultrasonographic detection of subclinical atheromatosis is a noninvasive method predicting cardiovascular events. Risk factors predicting atheromatosis progression in CKD are unknown. Predictors of atheromatosis progression were evaluated in patients with CKD.Design, setting, participants, & measurements Our multicenter, prospective, observational study included 1553 patients with CKD (2009CKD ( -2011. Carotid and femoral ultrasounds were performed at baseline and after 24 months. A subgroup of 476 patients with CKD was also randomized to undergo ultrasound examination at 12 months. Progression of atheromatosis was defined as an increase in the number of plaque territories analyzed by multivariate logistic regression.Results Prevalence of atheromatosis was 68.7% and progressed in 59.8% of patients after 24 months. CKD progression was associated with atheromatosis progression, suggesting a close association between pathologies. Variables significantly predicting atheromatosis progression, independent from CKD stages, were diabetes and two interactions of age with ferritin and plaque at baseline. Given that multiple interactions were found between CKD stage and age, phosphate, smoking, dyslipidemia, body mass index, systolic BP (SBP), carotid intima-media thickness, plaque at baseline, uric acid, cholesterol, 25-hydroxy vitamin D (25OH vitamin D), and antiplatelet and phosphate binders use, the analysis was stratified by CKD stages. In stage 3, two interactions (age with phosphate and plaque at baseline) were found, and smoking, diabetes, SBP, low levels of 25OH vitamin D, and no treatment with phosphate binders were positively associated with atheromatosis progression. In stages 4 and 5, three interactions (age with ferritin and plaque and plaque with smoking) were found, and SBP was positively associated with atheromatosis progression. In dialysis, an interaction between body mass index and 25OH vitamin D was found, and age, dyslipidemia, carotid intima-media thickness, low cholesterol, ferritin, and uric acid were positively associated with atheromatosis progression.Conclusions Atheromatosis progression affects more than one half of patients with CKD, and predictive factors differ depending on CKD stage.

Low Serum Levels of Vitamin D are Associated with Progression of Subclinical Atherosclerotic Vascular Disease in Peritoneal Dialysis Patients: A Prospective, Multicenter Study

“…The proportion of patients suffering CV events (11.8%) or developing new carotid (47.9%) or femoral (52.1%) plaques during the 24-month follow-up was remarkable, considering that only patients without overt CV disease at baseline were included in the analysis. Similar findings have been reported for patients with CKD [20] and unselected populations on chronic dialysis [21] . These observations are worrisome, but not totally unexpected, given the high burden of traditional and non-traditional CV risk factors supported by these patients, resulting in elevated rates of CV mortality [1] .…”

“…On the other hand, baseline serum levels of 25OH vitamin D, but not 1,25OH vitamin D, kept an independent, significant association with the risk of progression of CV disease. The consistency of this association was remarkable and agrees with previous studies, showing that low serum vitamin D levels portend mortality, and more specifically CV outcomes, both in the general population [23,24] and in patients with different stages of CKD [7,20,[25][26][27][28] , including those treated with PD [29,30] . However, the significance of this association still needs some clarification.…”

The Modality of Dialysis Does Not Influence Atheromatous Vascular Disease Progression or Cardiovascular Outcomes in Dialysis Patients Without Previous Cardiovascular Disease

“…In agreement with the general results of the NEFRONA study [25], the baseline presence of any carotid plaque was a consistent predictor of progression of AD and CV events. Similar observations have been reported by some studies in HD patients [26][27][28].…”

Carotid intima‐media thickness predicts carotid plaque development: Meta‐analysis of seven studies involving 9341 participants

“…In a longitudinal study of 103 patients with end‐stage renal disease, baseline cIMT correlated positively with the formation rate of new atherosclerotic plaques on univariate analysis, but was not statistically significant in a multiple regression model for new plaque formation . In a subpopulation of the NEFRONA study involving 1553 participants with different stages of chronic kidney disease, cIMT was associated with new plaque progression in dialysis patients . In another subpopulation of the NEFRONA study including 237 patients undergoing peritoneal dialysis, individuals in the median and highest third of baseline cIMT had a higher risk for progression of atherosclerotic disease compared to individuals in the lowest third of baseline cIMT …”

“…44 In a subpopulation of the NEFRONA study involving 1553 participants with different stages of chronic kidney disease, cIMT was associated with new plaque progression in dialysis patients. 45 In another subpopulation of the NEFRONA study including 237 patients undergoing peritoneal dialysis, individuals in the median and highest third of baseline cIMT had a higher risk for progression of atherosclerotic disease compared to individuals in the lowest third of baseline cIMT. 46 In order to predict the genesis of carotid plaques, it is important to study initiation and progression of atherosclerosis.…”