Abstract
BackgroundNon-diabetic chronic kidney disease (CKD) patients are a heterogeneous group with a variety of prognosis. We investigated the role of subclinical carotid atherosclerosis for the prediction of adverse cardiovascular (CV) outcomes in these patients, and tried to identify clinical and echocardiographic parameters associated with subclinical carotid atherosclerosis.MethodsAs a prospective design, 182 asymptomatic non-diabetic CKD patients underwent carotid ultrasonography and Doppler echocardiography. Carotid atherosclerosis was defined as a carotid intima-media thickness ≥1.0 mm and/or the presence of plaque.ResultsDuring the mean follow-up period of 28.8 ± 16.1 months, 23 adverse CV events occurred. Patients with carotid atherosclerosis (99, 54.4%) showed significantly higher rates of annual CV events than those without (8.6 vs. 1.5%, p <0.001). Particularly, the presence of carotid plaque was a powerful predictor of adverse CV outcomes (OR 7.80, 95% CI 1.45-45.97). Clinical parameters associated with the presence of subclinical carotid atherosclerosis were old age, previous history of hypertension, increased pulse pressure, and higher high-sensitivity C-reactive protein (hs-CRP) level. By echocardiography, early diastolic mitral annular velocity (E’) and the ratio of early peak transmitral inflow velocity (E) to E’ (E/E’) were closely related with the presence of carotid atherosclerosis. A multivariate analysis showed that age, hs-CRP, and E/E’ were significant determinants of carotid atherosclerosis.ConclusionsCarotid plaque, even subclinical, was closely associated with a poor prognosis in non-diabetic CKD patients. Increased age, hs-CRP level, and E/E’ ratio may be useful markers suggesting the presence of carotid atherosclerosis in these patients.
Highlights
Non-diabetic chronic kidney disease (CKD) patients are a heterogeneous group with a variety of prognosis
We examined the impact of subclinical carotid atherosclerosis, as measured by carotid intimamedia thickness and carotid plaque, on longterm CV outcomes in asymptomatic non-diabetic CKD patients, and tried to identify clinical and echocardiographic parameters suggesting the presence of subclinical carotid atherosclerosis in these patients
Serum phosphorus level was significantly lower and low-density lipoprotein (LDL) cholesterol, triglyceride, and high-sensitivity C-reactive protein levels were higher in these patients
Summary
Non-diabetic chronic kidney disease (CKD) patients are a heterogeneous group with a variety of prognosis. We investigated the role of subclinical carotid atherosclerosis for the prediction of adverse cardiovascular (CV) outcomes in these patients, and tried to identify clinical and echocardiographic parameters associated with subclinical carotid atherosclerosis. Patients with chronic kidney disease (CKD) are often regarded as the highest risk population for cardiovascular (CV) disease. CKD patients are a heterogeneous group, and there are subgroups at lower risk for CV complications as well as subgroups with increased need of intensive medical care and close follow-up. According to the previous multi-ethnic observational study, subclinical carotid atherosclerosis was closely associated with significant alterations in myocardial strain parameters, reflecting incipient myocardial systolic and diastolic dysfunction [5]. No data regarding the relationship between echocardiographic parameters and carotid atherosclerosis have been reported in these patients
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