"Patients with decreased kidney function have faster progression of carotid intima-media thickness and increased risk of cardiovascular events, according to findings published in the April issue of the
American Journal of Kidney Diseases. Data on associations among different levels of kidney disease, carotid IMT progression, and cardiovascular outcomes are limited, note Dr. Michel Chonchol, of the University of Colorado Health Sciences Center, Denver, and colleagues.
They examined these associations in a community-based cohort study involving 3364 participants. Creatinine clearance (Ccr) was used to categorize the level of kidney function, and the team assessed the change in carotid IMT during two years. The clinical end point was a composite of myocardial infarction (MI), stroke, and vascular death.
Of the 3364 subjects, 551 (16.4 per cent) had chronic kidney disease at baseline. The mean carotid IMT at baseline was 0.79 mm. The mean change in carotid IMT was 0.02 mm/year.
The researchers observed an association between lower Ccr quartile at baseline and a greater change in adjusted mean IMT values.
Thirty-six patients experienced a fatal or non-fatal vascular event. The worst prognosis was observed in patients with baseline Ccr less than the median and carotid IMT progression greater than the median (p = 0.04).
"The potential implication (of this study) is mainly a confirmation that atherosclerosis burden is progressive as patients have deterioration of kidney function," Dr. Chonchol told Reuters Health. "Although the association between cardiovascular disease and kidney disease is well established, very few studies have shown some type of imaging documentation of cardiovascular disease progression."
The researcher said that the next step is to examine various therapeutic modalities that might have an effect on carotid atherosclerosis in patients with kidney disease.
Am J Kidney Dis 2008;51:584-593."
