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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Assessment of total carotid plaque area progression in patients with chronic kidney disease. Good practices for
Daniela J Porta1, Mariana N Carrillo1, Hernán A Pérez2,3
1Institute of Research in Health Sciences and National Research Council Scientific and Technical (INICSA-CONICET), Ciudad Universitaria, Córdoba, X5016, Argentina.
Insights
Declining kidney function (eGFR) is linked to increased carotid plaque area, indicating higher cardiovascular risk. This association persists even when traditional risk factors are well-managed, suggesting non-traditional mechanisms in chronic kidney disease (CKD) patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Atherosclerosis Research
Background:
- Chronic kidney disease (CKD) significantly elevates cardiovascular risk beyond traditional factors.
- Renal function decline is a potential driver of atherosclerosis progression.
- Understanding early CKD mechanisms is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To investigate the relationship between estimated glomerular filtration rate (eGFR) decline and carotid plaque progression in CKD stages 1-3.
- To identify risk factors associated with atherosclerosis progression before severe CKD onset.
- To validate findings in a cohort with optimal traditional cardiovascular risk factor management.
Main Methods:
- A longitudinal study of 328 CKD patients (stages 1-3) monitored for 16±5 months.
- Carotid total plaque area measured via ultrasound, with eGFR stages (G1, G2, G3) as a key variable.
- Multilevel mixed effects modeling used to analyze associations, controlling for traditional cardiovascular risk factors.
Main Results:
- An inverse correlation was found between eGFR decline and total plaque area progression (β=0.99).
- This association remained significant irrespective of age, lipids, blood pressure, smoking, diabetes, or hypertension.
- Total plaque area increased significantly in G2-G3 patients compared to G1, even with optimal risk factor management.
Conclusions:
- CKD, carotid plaque area, and eGFR are inversely correlated, independent of traditional risk factors.
- Non-traditional mechanisms likely contribute to resistant atherosclerosis in CKD.
- Combining eGFR and total plaque area may enhance identification of high-risk cardiovascular patients.
Background:
Chronic kidney disease (CKD) increases cardiovascular risk, however, traditional cardiovascular risk factors cannot entirely explain it. A real-world investigation examined the concept that renal function decline is linked to carotid total plaque area progression, which strongly confirms cardiovascular risk. We analyzed CKD patients in stages 1-3 to find risk factor relationships before the onset of severe CKD.
Methods:
We monitored 328 patients for 16 ± 5 months. Participants were classified at baseline by estimated glomerular filtration rate (eGFR) stage: G1 (≥ 90), G2 (60-89), and G3 (30-59 ml/min/1.73m2). Ultrasound-guided total plaque area tracked atherosclerosis. Age, sex, blood pressure, lipids, and HbA1c were covariates. Total plaque area and variables were measured on day 1 and at the conclusion of observation. We used a multilevel mixed effects model to assess biological and behavioral factors on total plaque area progression in the general population. For validation, this research was conducted on 73 CKD patients with optimal traditional cardiovascular risk factor management during 15 ± 5 months.
Results:
Multiple analyses showed an inverse relationship between eGFR decline and total plaque area progression [β-exponent = 0.99 (95% CI = 0.98-0.99)], regardless of age, lipid profile, blood pressure, smoking, diabetes, or hypertension. The correlation remained significant in the 73-patient sample with optimal traditional cardiovascular risk factor management (β-exponent = 0.99; 95% CI 0.97-0.99). Although traditional cardiovascular risk factor management was excellent, total plaque area increased considerably in G2-G3 patients compared to G1.
Conclusions:
CKD, total plaque area, and eGFR are inversely correlated, independent of traditional cardiovascular risk factors, suggesting that non-traditional mechanisms are responsible for resistant atherosclerosis. The combination of eGFR and total plaque area may be useful in identifying high-risk patients.
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