Carotid Intima-Media Thickness and Incident ESRD: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background and objectives Carotid intima-media thickness has been reported to predict kidney function decline. However, whether carotid intima-media thickness is associated with a hard kidney end point, ESRD, has not been investigated.Design, setting, participants, & measurements We studied 13,197 Atherosclerosis Risk in Communities participants at visit 1 (1987)(1988)(1989) without history of cardiovascular disease, including coronary heart disease, stroke, and heart failure, at baseline and assessed whether carotid intima-media thickness measured by B-mode ultrasound is associated with ESRD risk using Cox proportional hazards models. Regarding carotid intimamedia thickness parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation, and internal carotid arteries) measurements.Results Mean age was 54.0 (SD=5.7) years old, and there were 3373 (25.6%) blacks and 7370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid intima-media thickness was significantly associated with ESRD risk (hazard ratio [HR] between quartiles 4 and 1, 1.46; 95% confidence interval [95% CI], 1.02 to 2.08 for overall mean intima-media thickness and HR between quartiles 4 and 1, 1.75; 95% CI, 1.24 to 2.48 for overall maximum intima-media thickness). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific intima-media thicknesses, the associations with ESRD were most robust for bifurcation carotid (e.g., adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.49; 95% CI, 1.04 to 2.13 for bifurcation; adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.36; 95% CI, 0.94 to 1.97 for common; and adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 0.93; 95% CI, 0.67 to 1.29 for internal).Conclusions Carotid intima-media thickness was independently associated with incident ESRD in the general population, suggesting the shared etiology of atherosclerosis and ESRD.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…Among 15 792 individuals aged 45 to 64 years (26% blacks, 56% females) followed up for a median of 22.7 years, mean carotid IMT in the fourth quartile (>0.81 mm) versus first quartile (<0.62) was significantly associated with ESRD. 54 Investigators from the FHS demonstrated that additional information obtained from carotid ultrasound regarding the degree of carotid stenotic burden was predictive of cerebral microbleeds detected on brain MRI, which are recognized as a marker of stroke and dementia, in 1243 participants (aged 56.9±8.8 years; 53% females). Carotid stenosis ≥25% was associated with a 2.2-fold (95% CI, 1.10–4.40) increased risk of cerebral microbleed, whereas no association was noted with carotid IMT.…”

Carotid Intima-Media Thickness and Visit-to-Visit HbA1c Variability Predict Progression of Chronic Kidney Disease in Type 2 Diabetic Patients with Preserved Kidney Function

“…Prospective studies have shown a positive correlation between increased carotid IMT and the risk for kidney function decline and incident CKD in the elderly and the general population [9–11]. Recently, carotid IMT has been reported to be associated with end-stage renal disease in the general population [23]. The current study is the first, to our knowledge, to report that subclinical carotid atherosclerosis is an independent predictor of future deterioration of CKD in type 2 diabetic patients with preserved kidney function.…”

Maximum Carotid Intima-Media Thickness in Association with Renal Outcomes

“…However, until recently, longitudinal studies evaluating carotid IMT as a predictor of kidney function decline in patients with CKD were lacking, and whether the carotid IMT is useful for predicting kidney disease progression remained unclarified 14) . More recently, a few studies reported that an increased carotid IMT is associated with CKD progression in diabetic patients 15,16) and end-stage renal disease (ESRD) in the general population 17) . However, these previous studies included patients without CKD; no study has exclusively focused on patients with CKD.…”

“…Furthermore, in these former studies, renal function was lower in the group with increased carotid IMT than in other groups. Considering the fact that age 16,17) and decreased renal function [16][17][18] , which are also risk factors of CKD progression, were associated with increased carotid IMT, a study that eliminates the effects of age and renal function is desired.…”