Narrative Review of Carotid disease and the kidney

Abstract

Patients with chronic kidney disease (CKD) have an increased cardiovascular (CV) risk that is only in part explained by established risk factors. Carotid arteriosclerosis and atherosclerosis are increased in CKD, play a role in the causation of CV disease in these patients and can affect the progression of renal disease. The arterial stiffening process is evident even in CKD patients with a very mild reduction of glomerular filtration rate (GFR) whereas arterial thickening is evident in more advanced stages. Possible mechanisms include functional and structural alterations of the arterial wall. Arterial stiffness can mediate the effect of CKD on target organs (i.e., brain, kidney and heart). In this review we discuss the arterial phenotype of patients with CKD. This is characterized by increased common carotid artery stiffness and outward remodeling (enlargement and thickening of the arterial wall) and a normal/reduced stiffness paired with an inward remodeling (narrowing of the arterial wall) of muscular arteries. We also discuss the consequences of carotid dysfunction, including the involvement of large elastic arteries stiffness on ventricular-vascular coupling, the mechanisms linking carotid stiffening and increased cardio-and cerebrovascular risk in CKD patients, and the therapeutic options to improve carotid function.

Prevalence and Predictors of Renal Disease in a National Representative Sample of the Romanian Adult Population: Data from the SEPHAR IV Survey

“…In the univariate analysis, age > 50 years, female sex, SUR > 6.9 mg/dL, ACR > 30 mg/g, DM, HbA1c % > 7.5, LV mass > 140 g, presence of carotid plaques, obesity, AF, and HF were associated with the risk of developing CKD. There are contradictory details on these relationships, but growing evidence suggests that there are correlations that could be bidirectional between these biomarkers and the cardiovascular clinical and subclinical manifestations and renal damage [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. From the multivariate analysis, after adjusting for age, sex, and DM status, only SUR > 6.9 mg/dL (OR: 6.61; 95% CI: 2.063, 10.83; p = 0.004) and the presence of carotid plaques as a marker surrogate of atherosclerosis (OR: 2.09; 95% CI: 1.1, 2.31; p = 0.07) were independent risk factors of CKD.…”

“…If the clinical arguments are strong enough to recommend a ULD in symptomatic subjects (the goal would be to lower SUR < 6 mg/dL), for those who are asymptomatic, there is an unmet need to develop a carefully designed RCT to determine the role of uric acid in the progression of CKD [ 67 ]. The presence of carotid atherosclerotic plaques is well recognized as a marker of atherosclerosis, which in patients with CKD, plays a role in the development of CV disease and could enhance the progression of renal disease [ 51 ]. Even if the results in our study have only borderline statistical significance due to the limited sample size, we found more carotid plaques among subjects with CKD (refer to Table 1 ).…”

Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications

“…Atherosclerosis and carotid arteriosclerosis are more prevalent in CKD. Even in CKD patients with a relatively slight decline in glomerular filtration rate (GFR), the arterial stiffening is prominent, but arterial thickness is only noticeable in more advanced stages [ 28 ]. In another study, it was shown that a family history of stroke and coronary heart disease (CHD) were significantly associated with the presence of CS, independent of conventional risk factors.…”

The role of dyslipidemia in atherogenesis in peritoneal dialysis patients

“…The prevalence of CKD is increasing globally, ranging between 8% and 16%, and it is associated with atheromatous CVD owing to the deleterious effects of uremic toxins on the structure and function of arteries. [ 3 4 5 ] With a mortality rate that is 10–30 times greater than the general population, CVD are the major cause of death in patients with ESRD and CKD with dialysis treatment. [ 6 7 ]…”

“…[ 12 ] Changes in the vascular system in uremic patients are attributed to the synergistic action of numerous factors, such as prothrombotic factors, dyslipidemia, anemia, hypertension, increased oxidative stress, disruption of the synthesis of parathormone (PTH), homocysteine, and nitric oxide, abnormalities of endothelial function, which leads to remodeling of the vascular system. [ 4 5 13 14 ]…”