Increased arterial inflammation in individuals with stage 3 chronic kidney disease

Abstract

Purpose While it is well known that patients with CKD are at an increased risk for the development and progression of atherosclerosis it is not known whether arterial inflammation is increased in mild CKD. To compare arterial inflammation using 18-F-fluorodeoxyglucose positron emission tomography/computed tomography imaging (FDG-PET/CT) in patients with chronic kidney disease (CKD) with matched controls. Methods One hundred twenty-eight individuals undergoing FDG-PET/CT imaging for clinical indications were studied retrospectively: 64 patients with Stage 3 CKD and 64 control patients were matched by age, gender, and cancer history. CKD was defined per guidelines with a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake by PET. Background FDG uptake (venous, subcutaneous fat (SAT) and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. Thereafter, the impact of CKD on arterial inflammation and CAC was assessed. Results Arterial inflammation was higher in patients with CKD compared to matched controls (Standardized uptake value (SUV): 2.41±0.49 vs. 2.16±0.43; p=0.002). Arterial SUV correlated inversely with eGFR (r=−0.299, p=0.001). Venous SUV was also significantly elevated among CKD subjects, while SAT and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in CKD compared to controls after correcting for muscle or fat background, and further remained a significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). Conclusions Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is associated with higher CAC. Current risk stratification tools may underestimate presence of atherosclerosis in patients with CKD and thereby risk of cardiovascular events.

Diagnosis and management of atherosclerotic cardiovascular disease in chronic kidney disease: a review

“…72 In addition, calcium deposition is associated with vascular smooth muscle death in experimental models, which may result in impaired vascular reactivity or increased plaque rupture. 73 A clinical correlate was demonstrated by Takx et al, 74 who showed an increased uptake within the arterial system (i.e., ascending aorta) of 18 fludeoxyglucose during positron emission tomography CT, an indication of immune mediated inflammatory activity, in patients with CKD compared with matched controls without CKD. The increase in activity was independent of coronary artery calcium score.…”

Vascular calcification in chronic kidney disease: different bricks in the wall?

“…Very recently, Takx et al conducted a retrospective study that included 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history undergoing fluorodeoxyglucose positron emission tomography or CT imaging. 47 Arterial inflammation was measured in the ascending aorta as fluorodeoxyglucose uptake on positron emission tomography, while coronary artery calcification (CAC) was assessed using the CT images. Interestingly, the authors concluded that moderate CKD associated with arterial inflammation compared to controls with normal renal function, independently of subclinical atherosclerosis.…”

Aggravated Atherosclerosis and Vascular Inflammation With Reduced Kidney Function Depend on Interleukin-17 Receptor A and Are Normalized by Inhibition of Interleukin-17A

“…An autopsy study found more leukocytes in the arterial wall in patients with nondialysis-dependent CKD than in patients with normal kidney function (12) . Two recent studies found increased aortic wall glucose metabolism in human CKD stage III, indicating enhanced vascular wall inflammation also in patients without clinical atherosclerotic endpoints 13 , 14 .…”