Abstract 2642: The Impact of Chronic Kidney Disease on Carotid Atherosclerosis in a General Japanese Urban Population: the Suita Study
Introduction: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease and stroke. However, few studies have examined the association between CKD and carotid atherosclerosis as a subclinical study in general populations. We hypothesized that CKD was a strong predictor for carotid atherosclerosis and the predictive power was more accentuated with higher blood pressure (BP).
Methods: Study participants (35 to 93 years of age; 1,844 women and 1,602 men) who gave written informed consent were randomly selected from a general urban population. Carotid atherosclerosis was evaluated by high-resolution ultrasonography (7.5MHz). Max-IMT was defined as the maximum IMT in the entire scanned area. Stenosis was defined as a condition in which a plaque occupied ≥25% of the lumen circumference of an artery on a cross-sectional scan. Glomerular filtration rate (GFR) [mL/min/1.73m2] was estimated using the Modification of Diet in Renal Disease study equation and subjects were divided into 4 categories according to GFR (≥90, 60 to 89, 50 to 59, and <50 mL/min/1.73m2). CKD was defined as an estimated GFR <60 mL/min/1.73m2. BP category (optimal, normal, and high-normal BP, and hypertension) was defined on the basis of the ESH-ESC 2007 criteria. The association of GFR category with the carotid atherosclerosis index and the impact of BP category on the index in the subjects with and without CKD were investigated by logistic regression analysis adjusting for confounding factors.
Results: CKD was identified in 13.2% (16.2% for men and 10.5% for women). Compared with the subjects for GFR ≥90, the Max-IMT was significantly greater and the prevalence of stenosis was significantly higher (OR 1.91, 95% CIs 1.16 to 3.14) in the subjects with GFR <50. As for the impact of BP category on carotid atherosclerosis, multivariable-adjusted Max-IMTs in subjects with hypertension were significantly greater than in those with optimal BP. This result was more evident in CKD subjects, especially in women. The impact of high-normal BP and hypertension on stenosis were more evident in subjects with CKD (ORs [95% CIs]: 1.58 [1.08 to 2.31] in non-CKD/high-normal BP, 2.74 [1.63 to 4.61] in CKD/high-normal BP, 1.94 [1.36 to 2.77] in non-CKD/hypertension, and 2.36 [1.49 to 3.73] in CKD/hypertension vs. non-CKD/optimal BP as a reference).
Conclusions:CKD was associated with an increased risk for carotid atherosclerosis in a general urban Japanese population. Furthermore, the association between BP and carotid atherosclerosis may be evident by CKD. To prevent the carotid atherosclerosis, it is necessary for subjects with CKD to control their BP by lifestyle modification and proper clinical treatment.
- © 2012 by American Heart Association, Inc.