Carotid atherosclerosis in chronic renal failure—the central role of increased plaque burden

Leskinen, Yrjö; Lehtimäki, Terho; Loimaala, Antti; Lautamatti, Visa; Kallio, Timo; Huhtala, Heini; Salenius, Juha; Saha, Heikki

doi:10.1016/j.atherosclerosis.2003.08.010

Cited by 69 publications

(58 citation statements)

References 26 publications

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“…Interstudy differences in populations, distribution of GFR, and medications could account for some of this variation. Cross-sectional analyses (15)(16)(17)(18)(19)(20), moreover, do not measure progression. The finding that IMT is higher at reduced GFR does not necessarily imply that IMT increases faster at lower GFR.…”

Section: Discussionmentioning

confidence: 99%

Atheroma Progression in Chronic Kidney Disease

Rigatto¹,

Levin²,

House³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Cardiovascular events are 10 to 100 times more frequent in chronic kidney disease (CKD). We tested the hypothesis that the rate of atherosclerotic plaque growth is faster in severe versus moderate CKD.Design, setting, participants, & measurements: We performed a prospective cohort study in 318 prevalent CKD patients with initial creatinine clearance (CCr) between 20 and 50 ml/min/1.73 m 2 . Baseline clinical and laboratory data were obtained on all patients. Plaque area was determined every 6 mo using bilateral carotid ultrasonography. Plaque area distribution was normalized using a cube root transformation. Unadjusted and adjusted associations between CCr quintiles and rate of change in the transformed plaque area were assessed using multiple linear regression.Results: The rate of plaque progression appeared lower in patients with the lowest CCr. Median rate of plaque growth was 0.4 mm 2 /yr in the lowest quintile of CCr (< 23 ml/min/1.73 m 2 ) versus 5.0 mm 2 /yr in the highest quintile (> 43 ml/min/1.73 m 2 ). This association remained significant after adjustment for potential confounders. A secondary analysis using quintiles of Modification of Diet in Renal Disease (MDRD) GFR confirmed the absence of increased plaque growth at low GFR, although a reduced rate of growth in the lowest quintile of MDRD GFR was not observed.Conclusion: We did not observe accelerated plaque growth at low levels of renal function. We suggest that mechanisms other than plaque growth are responsible for the observed excess of cardiovascular disease in CKD patients.

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Section: Discussionmentioning

confidence: 99%

Atheroma Progression in Chronic Kidney Disease

Rigatto¹,

Levin²,

House³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…We were particularly interested to establish whether AG or AIx correlates with IMT more closely than brachial artery blood pressure, and how these measures are related to other cardiovascular risk factors. As a secondary aim, we examined the association of local soft tissue and mineralised arterial wall changes with AG and AIx in a subgroup of 97 patients, since these structural changes may provide additional information about atherosclerosis beyond IMT [33,34].…”

Section: Introductionmentioning

confidence: 99%

Increased augmentation of central blood pressure is associated with increases in carotid intima–media thickness in type 2 diabetic patients

et al. 2005

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Aims/hypothesis: Type 2 diabetes is associated with a two-to seven-fold increase in cardiovascular morbidity and mortality. The aim of this study was to determine the relationships between intima-media thickness (IMT), an established marker of atherosclerosis, large artery function and other determinants of cardiovascular risk in type 2 diabetic patients. Methods: We studied 228 type 2 diabetic patients (75 women, aged 62±2 years [mean± SEM]). Carotid IMT was bilaterally measured using ultrasound technology. Applanation tonometry and pulse wave analysis were used to measure aortic systolic and diastolic blood pressures, central pressure augmentation (AG) and the augmentation index (AIx), a measure of systemic arterial stiffness. Conventional cardiovascular risk factors (lipids, HbA 1 c, smoking and diabetes duration) were also assessed. Results: Women had higher AG and AIx (p<0.0001), despite comparable systolic BP and heart rate in women and men. In women, AG (r=0.39, p<0.001), age (r=0.32, p<0.01), brachial systolic BP (r=0.34, p< 0.01) and aortic systolic BP (r=0.34, p<0.01) correlated with IMT. In men, age (r=0.41, p<0.001), diabetes duration (r=0.25, p<0.01), AG (r=0.22, p<0.01), aortic systolic BP (r=0.21, p<0.01), brachial systolic BP (r=0.21, p<0.01) and body weight (r=0.16, p<0.05) correlated with IMT. In multiple linear regression analyses, AG and aortic systolic BP, but not brachial systolic BP, were age-independent determinants of IMT in men and women. In all patients, increased AG (adjusted for sex, age and heart rate) correlated with longer duration of diabetes, urinary albumin excretion and IMT. Conclusions/interpretation: Measures of central systolic pressure correlate with carotid IMT, independently of age and other risk markers.

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“…Kabaya et al 33 were also unable to find any influence from the duration of dialysis on the incidence of vascular calcification in hemodialyzed patients. Leskinen et al 34 also found no significant difference in carotid calcification in CRF patients before or after dialysis. Although various authors contend that metabolic changes induced by dialysis might operate on the etiology and pathogeny of ectopic calcification in CRF patients, there is no consensus in the literature on this subject.…”

Section: Discussionmentioning

confidence: 87%

Miringosclerose em pacientes com insuficiência renal crônica: análise comparativa com um grupo controle

Neto¹,

Lessa²,

Alves³

et al. 2008

Rev. Bras. Otorrinolaringol.

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Myri ngosclerosis is a scar of the tympanic membrane lamina propria, resulting from trauma or inflammation, characterized by proliferation of collagen, hyalinization, calcium and phosphate deposits and cartilaginous or osseous metaplasia of the middle ear mucosa, a sequence that is similar to that taking place in other types of pathologic calcification, common in chronic renal failure (CRF). Aim: To verify the influence of chronic renal failure on the prevalence of myringosclerosis. Method: The otoscopic examination was done in 341 chronic renal failure patients and in 356 normal control individuals. The frequency of positive otoscopies was compared between the two groups, based on individual variables and those pertaining to CRF. Results: 11.7% of the patients had a positive otoscopy in the CRF group, compared to 5.1% in the control group. There was no statistical diference in the frequency of myringosclerosis acording to gender, ethnic group, time of dialysis or serum minerals. The groups had a wide age range. Conclusion: Although the findings of this study suggest a higher ocurrence of myringosclerosis in patients with renal disease, they do not provide a basis for stating that there is any relation between renal failure and tympanic alterations.

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Carotid atherosclerosis in chronic renal failure—the central role of increased plaque burden

Cited by 69 publications

References 26 publications

Atheroma Progression in Chronic Kidney Disease

Atheroma Progression in Chronic Kidney Disease

Increased augmentation of central blood pressure is associated with increases in carotid intima–media thickness in type 2 diabetic patients

Miringosclerose em pacientes com insuficiência renal crônica: análise comparativa com um grupo controle

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