Prevalence and progression of subclinical atherosclerosis in patients with chronic kidney disease and diabetes

Palanca, Ana; Castelblanco, Esmeralda; Perpiñán, Hèctor; Betriu, Àngels; Soldevila, Berta; Valdivielso, José M.; Bermúdez, Marcelino; Duran, Xavier; Fernàndez, Elvira; Puig-Domingo, Manel; Groop, Per‐Henrik; Alonso, Núria; Mauricio, Dı́dac

doi:10.1016/j.atherosclerosis.2018.07.018

Cited by 27 publications

(18 citation statements)

References 45 publications

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“…The criteria used to make the diagnosis of diabetes and, thus, to include a individual in the diabetes group have been reported previously [17]. The criteria used were as follows: a previous diagnosis of diabetes recorded in the individual’s medical history, a fasting plasma glucose ≥ 126 mg/dl or HbA1c ≥ 6.5% determined by laboratory testing or a current prescription of any anti-diabetic drug.…”

Section: Methodsmentioning

confidence: 99%

“…To date, there is limited evidence describing the specific prevalence of SA in individuals with both diabetes and CKD. Recently, our group reported that SA is more prevalent, carries a higher plaque burden and is more rapidly progressive in individuals with CKD and diabetes [17]. In addition, our group also reported that renal individuals show a higher prevalence of plaques [18, 19] and a higher incidence of future CVEs across all stages of CKD compared with controls [20].…”

Section: Introductionmentioning

confidence: 93%

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Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease

Palanca¹,

Castelblanco

Betriu

et al. 2019

Cardiovasc Diabetol

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Background Individuals with diabetes have remarkably high rates of cardiovascular morbidity and mortality. However, the incremental cardiovascular risk in diabetes is heterogeneous and has often been related to renal involvement. The purpose of this study was to analyse the prognostic value of subclinical atherosclerosis in determining the incidence of first cardiovascular events (CVEs) in individuals with diabetes and chronic kidney disease (CKD) compared to CKD individuals without diabetes. Methods We included data from individuals with CKD with and without diabetes, free from pre-existing cardiovascular disease, from the NEFRONA cohort. Participants underwent baseline carotid and femoral ultrasound and were followed up for 4 years. All CVEs during follow-up were registered. Bivariate analysis and Fine–Gray competing risk models were used to perform the statistical analysis. Results During the mean follow-up time of 48 months, a total of 203 CVE was registered. 107 CVE occurred among participants without diabetes (19.58 per 1000 person-years) and 96 CVE occurred among participants with diabetes (44.44 per 1000 person-years). Following the competing risk analysis, the variables predicting CVEs in CKD individuals without diabetes were the number of territories with plaque at baseline (HR 1.862, 95% CI [1.432;2.240]), age (HR 1.026, 95% CI [1.003;1.049]) and serum concentrations of 25-OH vitamin D (HR 0.963, 95% CI [0.933;0.094]). The only variable predicting CVEs among CKD participants with diabetes was the number of territories with plaque at baseline (HR 1.782, 95% CI [1.393, 2.278]). For both models, concordance (C) index yielded was over 0.7. Conclusions The burden of subclinical atherosclerosis is the strongest predictor of future CVEs in diabetic individuals with CKD. Early detection of subclinical atherosclerotic burden by multiterritorial vascular ultrasound could improve CVE prediction in this population. Electronic supplementary material The online version of this article (10.1186/s12933-019-0897-y) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease

Palanca¹,

Castelblanco

Betriu

et al. 2019

Cardiovasc Diabetol

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“…CKD patients have more severe atherosclerosis than age-and sex-matched controls from the general population [6]. The NEFRONA study has indicated that the incidence rates of carotid atherosclerosis are 50.8% in patients with CKD and 69% in diabetic patients with CKD [16]. Currently, antiplatelet drugs are widely used to prevent CVD, especially intravascular thrombosis.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Antiplatelet therapy for the prevention of atherosclerosis in chronic kidney disease (ALTAS-CKD) patients: study protocol for a randomized clinical trial

Xiong

et al. 2021

Trials

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Background Cardiovascular disease (CVD) is the most common complication and the leading cause of death in patients with chronic kidney disease (CKD). Accelerated atherosclerosis is a pathophysiological process that is vital to the occurrence of cardiovascular complications associated with CKD. Abnormal platelet activation is not only the leading cause of atherosclerosis but also plays a critical role in the occurrence of thrombotic events. Currently, antiplatelet drugs are commonly used as a secondary prevention strategy for high blood pressure, obesity, diabetes, and ischemic heart disease and can reduce the risk of CVD in the susceptible population. However, the benefits and evidence of using antiplatelet agents in patients with CKD remain controversial. This study aimed to determine whether antiplatelet therapy can safely prevent atherosclerosis in patients with CKD in the primary care setting. Methods/design The ALTAS-CKD study is a multicenter, prospective, randomized, double-blind, placebo-controlled trial of 554 adult patients with stage 3–5 non-dialysis-dependent CKD recruited from 10 territory medical centers in China. A secured web-based computer randomization system will be used to administer aspirin 100 mg once daily or a matching inactive placebo for 36 months. The primary endpoint will be the occurrence of atherosclerosis, as measured by carotid ultrasonography. The secondary endpoints will be combined cardiovascular events, all-cause mortality, and 50% decrease in the estimated glomerular filtration rate. Trial registration {2a} Current controlled trials number: ChiCTR1900021393. Registered on 18 February 2019.

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“…Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD) and atherosclerosis [1]. Atherosclerosis is more prevalent in CKD patients, and it also causes more comorbidities in CKD patients [2]. Studies have produced controversial results as to the independence of CKD indexes as risk factors for atherosclerosis among other atherosclerosis risk factors.…”

Section: Introductionmentioning

confidence: 99%

Association of Kidney Function Tests with a Cardio-Ankle Vascular Index in Community-Dwelling Individuals with a Normal or Mildly Decreased Estimated Glomerular Filtration Rate

et al. 2019

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Background and objectives: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). Previous studies reported controversial results about the independence of CKD as a risk factor for atherosclerosis. In this study, we tried to determine whether the estimated glomerular filtration rate (eGFR) and other renal function tests are independent factors associated with arterial stiffness in community-dwelling individuals with a normal (≥90) or slightly decreased eGFR (60-90). Materials and Methods: Data of 164 community individuals were analyzed, and demographic information, related disease history, atherosclerosis risk factors, certain laboratory tests, the estimated eGFR, and urine albumin creatinine ratio (UACR) were recorded for each individual. Results: The age, systolic blood pressure (SBP), hypertension (HTN), and cardio-ankle vascular index (CAVI) significantly differed between individuals with a normal and those with a slightly decreased eGFR. Blood urea nitrogen (BUN), glycated hemoglobin (HBA1c), and the eGFR significantly differed between the high- and low-CAVI groups and were also significantly correlated with the CAVI. The relationship between the eGFR and CAVI was shown to be independent of other atherosclerosis risk factors in a multiple linear regression model. Conclusions: We concluded that evaluations of the eGFR, HTN, body-mass index, and SBP can be used in a model for arterial stiffness risk assessments for community-dwelling individuals with a normal or slightly decreased eGFR.

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Prevalence and progression of subclinical atherosclerosis in patients with chronic kidney disease and diabetes

Abstract: Subclinical atherosclerosis is more prevalent, carries a higher plaque burden and is more rapidly progressive in renal patients with diabetes. In these patients, diabetes outweighs other described risk factors associated with the presence of subclinical atherosclerosis.

Cited by 27 publications

References 45 publications

Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease

Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease

Antiplatelet therapy for the prevention of atherosclerosis in chronic kidney disease (ALTAS-CKD) patients: study protocol for a randomized clinical trial

Association of Kidney Function Tests with a Cardio-Ankle Vascular Index in Community-Dwelling Individuals with a Normal or Mildly Decreased Estimated Glomerular Filtration Rate

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