Abstract 494: The Impact of Renal Insufficiency on Carotid Artery Disease Regression in an Academic Medical Center

Abstract

Introduction: In the United States, 3% of adults are affected by carotid artery disease, and the prevalence is higher in patients with concomitant renal insufficiency. Ischemic events are also more common in patients with renal insufficiency and significantly contribute to morbidity and mortality. Despite the prevalence of carotid artery disease in individuals with renal insufficiency, only a few studies have examined the rate of carotid disease progression in this high risk group, and the mechanisms underlying disease progression are largely unknown. Hypothesis: Patients with any stage of renal insufficiency will have an accelerated rate of carotid artery atherosclerotic progression compared to patients with normal renal function. Methods: Retrospective chart review was performed on 171 consecutive patients referred to Cooper University Hospital for non invasive evaluation of carotid artery disease. Severity of carotid artery disease was evaluated with carotid doppler, and each patient had at least two carotid doppler studies performed at least 6 months apart. The sample was divided into 2 groups - [Group 1] GFR > 60 and [Group 2] GFR <60. Demographics, comorbidities, medications, serum creatinine, MDRD GFR and ultrasound analysis (proximal peak systolic velocity (PSV), and proximal end diastolic velocity (EDV)) were recorded. The average change in the PSV between studies for the 2 groups were calculated and compared. None of the patients in the sample were on dialysis. Results: Preliminary results revealed carotid artery disease regression in both groups; however, patients with any stage of renal insufficiency had less carotid artery disease regression compared to patients with normal renal function. Conclusions: Renal insufficiency negatively impacts the rate of carotid artery disease regression in patients with carotid artery disease. These results suggest that patients with renal insufficiency may require more aggressive follow-up and/or earlier invasive interventions of carotid artery disease. Current monitoring and treatment standards should be improved to adequately address the needs of this high risk subgroup.