Related Experiment Video
Updated: Jun 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Carotid plaque thickness predicts cardiovascular events and death in patients with chronic kidney disease
Sasha S Bjergfelt1,2, Ida M H Sørensen1, Laerke Urbak3
1Department of Nephrology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, DK-2100, Denmark.
Insights
Maximal carotid plaque thickness (cPTmax) can predict major adverse cardiovascular events (MACE) in chronic kidney disease (CKD) patients. cPTmax demonstrated a similar predictive ability for MACE as coronary artery calcium score (CACS) in this population.
Area of Science:
- Cardiology
- Nephrology
- Vascular Imaging
Background:
- Classical cardiovascular risk scores underestimate risk in chronic kidney disease (CKD).
- Coronary artery calcium score (CACS) improves cardiovascular event prediction in CKD.
- Maximal carotid plaque thickness (cPTmax) shows predictive value similar to CACS in the general population.
Purpose of the Study:
- Investigate cPTmax's ability to predict cardiovascular events in CKD patients.
- Compare the predictive value of cPTmax and CACS in CKD.
Main Methods:
- Ultrasound assessment of cPTmax in 200 CKD stage 3 patients.
- Categorization of patients based on cPTmax: No plaques, 1.0-1.9 mm, and >1.9 mm.
- CACS measured in 175 patients via non-contrast CT scan.
- Follow-up for major adverse cardiovascular events or death (MACE).
Main Results:
- 45 patients (22.5%) experienced MACE over a median 5.4-year follow-up.
- Patients with cPTmax >1.9 mm had a significantly increased hazard ratio for MACE (HR 3.2).
- Models including cPTmax or CACS showed similar improvements in predicting MACE (C-statistics 0.247 vs. 0.243).
Conclusions:
- cPTmax is a potentially useful tool for predicting MACE in CKD.
- cPTmax and CACS exhibit comparable abilities in predicting MACE within the CKD population.
Background:
Classical risk scoring systems underestimate the risk of cardiovascular disease in chronic kidney disease (CKD). Coronary artery calcium score (CACS) has improved prediction of cardiovascular events in patients with CKD. The maximal carotid plaque thickness (cPTmax) measured in ultrasound scans of the carotid arteries has demonstrated similar predictive value as CACS in the general population. This is the first study to investigate whether cPTmax can predict cardiovascular events in CKD and to compare the predictive value of cPTmax and CACS in CKD.
Method:
Two hundred patients with CKD stage 3 from the Copenhagen CKD Cohort underwent ultrasound scanning of the carotid arteries. The assessment consisted of locating plaque and measuring the thickest part of the plaque, cPTmax. Based on the distribution of cPTmax, the participants were divided into 3 groups: No plaques, cPTmax 1.0-1.9 mm and cPTmax > 1.9 mm (median cPTmax = 1.9 mm among patients with plaques). To measure CACS, 175 of the patients underwent a non-contrast CT scan of the coronary arteries. The follow-up time spanned between the ultrasound scan and a predefined end-date or the time of first event, defined as a composite of major cardiovascular events or death of any cause (MACE).
Results:
The median follow-up time was 5.4 years during which 45 patients (22.5%) developed MACE. In a Cox-regression adjusted for classical cardiovascular risk factors, patients with cPTmax > 1.9 mm had a significantly increased hazard ratio of MACE (HR 3.2, CI: 1.1-9.3), p = 0.031) compared to patients without plaques. C-statistics was used to evaluate models for predicting MACE. The improvement in C-statistics was similar for the two models including classical cardiovascular risk factors plus cPTmax (0.247, CI: 0.181-0.312) and CACS (0.243, CI: 0.172-0.315), respectively, when compared to a model only controlled for time since baseline (a Cox model with no covariates).
Conclusion:
Our results indicate that cPTmax may be useful for predicting MACE in CKD. cPTmax and CACS showed similar ability to predict MACE.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...