Association of Aortic Atherosclerosis and Renal Dysfunction

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Both aortic atherosclerosis (AA) and renal dysfunction are associated with increased morbidity and mortality. We sought to assess the association between AA and renal dysfunction. The study consisted of 200 consecutive patients (62% were male, mean age 69 +/- 11 years) who underwent transesophageal echocardiography. Demographic and clinical data were recorded. On transesophageal echocardiography, descending and aortic arch atherosclerosis were recorded (in millimeters) using off-line planimetry. The patients were graded with normal AA (group 1, n = 83), mild AA (< or =4 mm in thickness, group 2, n = 53), or severe AA (>4 mm in thickness or complex, group 3, n = 64). Glomerular filtration rate (GFR) (expressed as milliliters/minute/1.73 meters squared) was calculated as 186 x (serum creatinine(-1.154)) x (age(-0.203)) x 1.212 (if black) x 0.742 (if female). The mean GFR decreased significantly with increasing severity of AA (89 +/- 20 for group 1, 72 +/- 20 for group 2, and 49 +/- 23 for group 3, P < .001). Seventy-three percent of patients with severe atherosclerosis compared with 16% patients with no or mild AA had moderate-severe renal dysfunction (GFR < 60; P < .001). On multiple logistic regression, only the size of the AA and the presence of diabetes mellitus were associated with severe (GFR < 30) renal dysfunction (P < .001, odds ratio 65). On receiver operating curve analysis, the area under the curve for AA predicting severe renal dysfunction was 0.90 (P < .0001). There exists a strong association between AA and renal dysfunction.