Abstract
Patients with chronic kidney disease (CKD) have increased risk of cardiovascular events. However, the association of glomerular filtration rate (GFR) and carotid intima-media thickness (CIMT) in non-diabetic CKD patients is under-investigated. This prospective study was conducted at University Clinical Hospital Mostar over a 4-year period and enrolled a total of 100 patients with stage 2 and 4 CKD (50 patients per group). Stage 4 CKD group had significantly higher baseline CIMT values (1.13 ± 0.25 vs. 0.74 ± 0.03 mm, P < 0.001), and more atherosclerotic plaques at the study onset (13 (26%) vs. 0 (0%), P < 0.001) compared to stage 2 CKD. A statistically significant 4-year increase in GFR (coefficient of 2.51, 3.25, 2.71 and 1.50 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.05) with non-significant CIMT alterations has been observed in stage 2 CKD. Furthermore, linear mixed effects analysis revealed significant decrease in GFR (coefficient of −6.69, −5.12, −3.18 and −1.77 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.001) with increase in CIMT (coefficient of 0.20, 0.14, 0.07 and 0.03 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.001) in stage 4 CKD. GFR and CIMT showed significant negative correlation in both CKD groups during all follow-up phases (P < 0.001). Furthermore, multiple linear regression analysis revealed significant independent prediction of CIMT by baseline GFR (B = −0.85, P < 0.001), while there was no significant prediction of CIMT with other covariates. In conclusion, this study demonstrates significant association of GFR and CIMT in non-diabetic stage 2 and stage 4 CKD during the 4-year follow-up.
Highlights
Chronic kidney disease (CKD) is a progressive multifactorial disease characterized by permanent impairment of the renal function and/or structure [1]
There was no significant difference in demographic and anthropometric characteristics between studied groups, except in age, systolic blood pressure and BMI which were higher in stage 4 CKD group (60 (53, 63) vs. 48 (36, 54) years, P < 0.001; 149.30 ± 18.24 vs
During the follow-up, absolute estimate glomerular filtration rate (eGFR) values showed a gradual increase in stage 2 (73.78 ± 7.12 vs. 75.27 ± 7.23 vs. 76.49 ± 7.43 vs. 77.02 ± 8.05 vs. 76.28 ± 5.07 mL/min/1.73 m2 )
Summary
Chronic kidney disease (CKD) is a progressive multifactorial disease characterized by permanent impairment of the renal function and/or structure [1]. It represents an emerging health burden with substantial morbidity and mortality [2]. CKD initiates numerous pathophysiological processes that could represent a perpetual interaction of renal and cardiovascular diseases [6]. Entities such as cardiorenal syndrome highlight the aforementioned close bidirectional relationship of renal, cardiac and vascular homeostasis [7]. One of the most commonly used techniques to assess atherosclerosis and overall cardiovascular risk in CKD patients is carotid ultrasound [9]
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