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Maximum Carotid Intima-Media Thickness in Association with Renal Outcomes
Shun Manabe1, Hiroshi Kataoka1,2, Toshio Mochizuki1,2
1Department of Nephrology, Tokyo Women's Medical University.
Insights
Maximum intima-media thickness (Max IMT) is a significant predictor of kidney disease progression, particularly in younger chronic kidney disease (CKD) patients under 65. This finding highlights age as a crucial factor in renal prognosis.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Geriatrics
Background:
- Chronic kidney disease (CKD) poses a significant health burden.
- Carotid artery intima-media thickness (IMT) is a marker of subclinical atherosclerosis.
- The relationship between Max IMT and renal prognosis, especially considering age interactions, requires further investigation.
Purpose of the Study:
- To investigate the association between maximum intima-media thickness of the carotid artery (Max IMT) and renal prognosis in CKD patients.
- To explore the potential interaction between Max IMT and age in determining renal outcomes.
Main Methods:
- Survival analyses were conducted on 112 CKD patients.
- Renal prognosis was defined as a ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease.
- Multivariate Cox regression analysis was used to assess the association between Max IMT and renal outcomes, with interaction analysis for age categories (≥ 65 vs. <65 years).
Main Results:
- A Max IMT of ≥ 1.5 mm was significantly associated with poorer renal prognosis.
- Max IMT showed a significant interaction with age categories (P=0.0153).
- A 1-mm increase in Max IMT was associated with disease progression in patients <65 years (HR: 2.52), but not in those ≥ 65 years (HR: 0.95).
Conclusions:
- Elevated Max IMT is a significant factor for predicting renal prognosis in CKD patients younger than 65 years.
- Age is a critical modifier in the association between Max IMT and CKD progression.
- These findings may inform tailored treatment strategies for CKD management.
Aim:
We aimed to examine the association between the maximum intima-media thickness of the carotid artery (Max IMT) and renal prognosis, considering their potential interaction with age.
Methods:
Survival analyses were performed in 112 patients with chronic kidney disease (CKD), to assess renal prognosis, with the endpoint defined as a ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease.
Results:
During a median follow-up of 12.5 years, 44 participants reached the study endpoint. The major determinant of Max IMT was the maximum IMT of the internal carotid artery (Max ICA-IMT), which was the distribution ratio of 50.0% of Max IMT. Kaplan-Meier analyses showed that Max IMT ≥ 1.5 mm was significantly associated with renal prognosis when age and eGFR were matched. On multivariate Cox regression analysis, Max IMT was significantly associated with the renal outcomes and had a significant interaction with the age categories (≥ 65 years or ＜65 years) (P=0.0153 for interaction). A 1-mm increase in Max IMT was significantly associated with disease progression in the sub-cohort ＜65 years age-category, but not in the ≥ 65 years age-category; similarly the hazard ratio (HR) in the ＜65 years age-category was higher than in the ≥ 65 years age-category (HR: 2.52 vs. 0.95). Comparable results were obtained for Max ICA-IMT, Max bulb-IMT, but not for Max common carotid artery-IMT.
Conclusions:
A higher Max IMT was a significant renal prognosis factor in patients with CKD aged ＜65 years. Our results may provide new insights into treating CKD.
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