Related Experiment Video
Updated: Aug 11, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Increased targeting of cardiovascular risk factors in patients with chronic kidney disease does not improve atheroma
Nicole M Isbel1, Brian Haluska, David W Johnson
1Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia. nikky_isbel@health.qld.gov.au
Insights
Multiple risk factor intervention (MRFI) in chronic kidney disease (CKD) improved risk factors but not vascular health. This study found no significant changes in atheroma burden or endothelial function despite intervention.
Area of Science:
- Nephrology
- Cardiology
- Vascular Biology
Background:
- Cardiovascular disease (CVD) poses a significant risk for patients with chronic kidney disease (CKD).
- Multiple risk factor intervention (MRFI) is recommended for CVD risk reduction in CKD, but its effectiveness is not well-established.
- This study investigated the efficacy of an MRFI program in patients with advanced CKD.
Purpose of the Study:
- To evaluate the impact of a physician-supervised, nurse-driven MRFI program on vascular structure and function in patients with stage 4 or 5 CKD.
- To assess changes in atheroma burden (carotid intima-media thickness) and endothelial function (brachial artery reactivity) following the MRFI program.
Main Methods:
- A randomized controlled study involving 200 patients with stage 4 or 5 CKD.
- Comparison between an MRFI clinic (targeting dyslipidemia, hyperhomocysteinemia, blood pressure, anemia, hyperphosphatemia) and conventional care.
- Follow-up for 2 years, measuring carotid intima-media thickness and brachial artery reactivity.
Main Results:
- The MRFI group demonstrated significant improvements in LDL cholesterol, homocysteine, systolic BP, and diastolic BP compared to the control group.
- No significant changes were observed in serum phosphate or hemoglobin levels.
- Despite risk factor improvements, no significant differences were found in carotid intima-media thickness or brachial artery reactivity between the groups. The composite endpoint of CVD events was similar between groups.
Conclusions:
- A MRFI program in patients with stage 4 or 5 CKD effectively improved modifiable risk factors.
- However, the MRFI program did not lead to significant improvements in vascular structure or endothelial function.
- The study suggests that current MRFI strategies may not be sufficient to alter vascular outcomes in this high-risk population.
Background:
Although multiple risk factor intervention (MRFI) is recommended to reduce the increased morbidity and mortality of cardiovascular disease (CVD) in chronic kidney disease (CKD), its efficacy is unknown. We studied the efficacy of a MRFI program in CKD.
Methods:
This randomized controlled study of 200 patients with stage 4 or 5 CKD compared a physician-supervised, nurse-driven MRFI clinic (focused on dyslipidemia, hyperhomocysteinemia, blood pressure [BP], anemia, and hyperphosphatemia) with conventional care in CKD. One hundred eleven subjects completed 2 years of follow-up (median follow-up 674 days [interquartile range {IQR} 348-719 days]). Outcome measures were atheroma burden (carotid intimamedia thickness [IMT]) and endothelial function (brachial artery reactivity [BAR]).
Results:
The MRFI group showed significant improvements, compared with usual care, in serum low-density lipoprotein cholesterol (-30.9 mg/dL vs -12.7 mg/dL, P = .001), homocysteine (-6.95 vs -0.67 micromol/L, P < .001), systolic BP (-6.9 vs -0.2 mm Hg, P = .049), and diastolic BP (-4.8 vs -1.0 mm of Hg, P = .043). No significant changes were seen in serum phosphate or hemoglobin level. Despite observed improvements in risk factors, no differences from baseline were demonstrated for IMT (-0.00 vs -0.01 mm, P = .533) or BAR (0.09% vs 0.22%, P = .834). Forty-two patients reached a composite end point of CVD death, acute coronary syndrome, revascularization, nonfatal stroke, and amputation and this was similar between groups (23 vs 19 events, P = .475).
Conclusions:
A MRFI program was not associated with improvement in vascular structure or function in stage 4 or 5 patients with CKD.
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management
01:26Atherosclerosis III: Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System