Atheroma progression in chronic kidney disease

Area of Science:

• Nephrology
• Cardiology
• Vascular Biology

Background:

• Cardiovascular disease (CVD) is significantly more prevalent in patients with chronic kidney disease (CKD).
• The relationship between the severity of CKD and the rate of atherosclerotic plaque progression remains unclear.

Purpose of the Study:

• To investigate whether atherosclerotic plaque growth is accelerated in patients with severe versus moderate chronic kidney disease.
• To test the hypothesis that lower renal function is associated with faster plaque progression.

Main Methods:

• Prospective cohort study of 318 prevalent CKD patients with creatinine clearance (CCr) between 20-50 ml/min/1.73 m(2).
• Bilateral carotid ultrasonography was used to measure plaque area every 6 months.
• Multiple linear regression analysis assessed the association between CCr quintiles and the rate of change in plaque area.

Main Results:

• The rate of atherosclerotic plaque progression was lower in patients with the lowest CCr (severe CKD).
• Median plaque growth was 0.4 mm(2)/yr in the lowest CCr quintile (< 23 ml/min/1.73 m(2)) compared to 5.0 mm(2)/yr in the highest quintile (> 43 ml/min/1.73 m(2)).
• This inverse association remained significant after adjusting for confounders.

Conclusions:

• Accelerated atherosclerotic plaque growth was not observed in patients with low renal function (severe CKD).
• The findings suggest that mechanisms beyond plaque growth contribute to the elevated cardiovascular disease burden in CKD patients.