Assessment of total carotid plaque area progression in patients with chronic kidney disease. Good practices for decision-making

Abstract

Background Chronic kidney disease (CKD) increases cardiovascular risk, however, traditional cardiovascular risk factors cannot entirely explain it. A real-world investigation examined the concept that renal function decline is linked to carotid total plaque area progression, which strongly confrms cardiovascular risk. We analyzed CKD patients in stages 1–3 to fnd risk factor relationships before the onset of severe CKD. Methods We monitored 328 patients for 16±5 months. Participants were classifed at baseline by estimated glomerular fltration rate (eGFR) stage: G1 (≥90), G2 (60–89), and G3 (30–59 ml/min/1.73m2 ). Ultrasound-guided total plaque area tracked atherosclerosis. Age, sex, blood pressure, lipids, and HbA1c were covariates. Total plaque area and variables were measured on day 1 and at the conclusion of observation. We used a multilevel mixed efects model to assess biological and behavioral factors on total plaque area progression in the general population. For validation, this research was conducted on 73 CKD patients with optimal traditional cardiovascular risk factor management during 15±5 months. Results Multiple analyses showed an inverse relationship between eGFR decline and total plaque area progression [β-exponent=0.99 (95% CI=0.98–0.99)], regardless of age, lipid profle, blood pressure, smoking, diabetes, or hypertension. The correlation remained signifcant in the 73-patient sample with optimal traditional cardiovascular risk factor management (β-exponent=0.99; 95% CI 0.97–0.99). Although traditional cardiovascular risk factor management was excellent, total plaque area increased considerably in G2–G3 patients compared to G1. Conclusions CKD, total plaque area, and eGFR are inversely correlated, independent of traditional cardiovascular risk factors, suggesting that non-traditional mechanisms are responsible for resistant atherosclerosis. The combination of eGFR and total plaque area may be useful in identifying high-risk patients.