Observational multicenter study to evaluate the prevalence and prognosis of subclinical atheromatosis in a Spanish chronic kidney disease cohort: baseline data from the NEFRONA study

BMC Nephrology

Elvira Fernández¹  Jose Manuel Valdivielso¹  Teresa Vidal²  Montserrat Martinez-Alonso³  Angels Betriu¹  David Arroyo² 

[1] Spanish Renal Investigation Network – RedInRen, Instituto de Salud Carlos III, Madrid, Spain;Unit for Detection and Treatment of Atherotrombotic Disease (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova, Avda. Rovira Roure 80, 25198 Lleida, Spain;Statistics Department, IRB-Lleida, Hospital Universitari Arnau de Vilanova, Avda. Rovira Roure 80, 25198 Lleida, Spain

关键词: Ankle-brachial index;    Intima-media thickness;    Vascular calcification;    Atheromatosis;    Cardiovascular disease;    Chronic kidney disease;   

Others  :  1082592
DOI  :  10.1186/1471-2369-15-168

 received in 2014-06-02, accepted in 2014-10-02,  发布年份 2014

【 摘 要 】

Background

Cardiovascular events (CVE) are more prevalent in chronic kidney disease (CKD) than in general population, being the main cause of morbimortality. Specific risk factors related to CKD have been suggested, because traditional factors do not fully explain this increase in cardiovascular disease rates. However, the role of atheromatosis, its pathogenesis and evolution are still unclear. The potential use of diagnostic tests to detect subclinical atheromatosis has to be determined.

Methods

NEFRONA is a prospective multicenter cohort study. 2445 CKD subjects were enrolled from 81 Spanish hospitals and dialysis clinics, from 2010 to 2012. Eligibility criteria included: 18 to 74 years old, CKD stage 3 or higher, and no previous CVE. 559 non-CKD controls were also recruited. Demographical, clinical and analytical data were collected. Carotid and femoral ultrasounds were performed by a single trained team to measure carotid intima-media thickness (cIMT) and detect atheromatous plaques. Ankle-brachial index (ABI) was measured.

Results

Differences in age, sex and prevalence and control of cardiovascular risk factors were found between controls and CKD patients. These differences are similar to those described in epidemiological studies.

No difference was found regarding cIMT between controls and CKD (when subjects with plaques in common carotid arteries were omitted); earlier CKD stages had higher values. CKD patients had a higher rate of atheromatous plaques, with no difference between stages in the unadjusted analysis. A group of patients had plaques in femoral arteries but were plaque-free in carotid arteries, and would have gone underdiagnosed without the femoral study. The percentage of pathologic ABI was higher in CKD, with higher prevalence in more advanced stages, and a higher rate of ABI >1.4 than <0.9, suggesting more vascular calcification.

Conclusions

NEFRONA is the first large study describing the actual prevalence of subclinical atheromatosis across different CKD stages. There is a very high rate of atheromatous plaques and pathologic ABI in CKD. Prospective data will add important information to the pathogenesis and evolution of atheromatosis in CKD, compared to non-CKD subjects.

【 授权许可】

   
2014 Arroyo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 1.

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