Advanced CKD and Vascular Disease: Characterization of Cardiovascular Phenotype

Background: Cardiovascular disease is the leading cause of morbidity and mortality in patients with advanced chronic kidney disease (ACKD). In individuals with chronic kidney disease (CKD), the number of cardiovascular events and mortality increases as glomerular filtration decreases. Non-invasive techniques such as carotid intima-media thickness determination, could allow early detection of vascular damage. Objectives: Determine and compare phenotypes of vascular damage in patients with ACKD and undergoing renal replacement therapy (RRT) with dialysis techniques. Methods: Cross-sectional study of individuals with ACKD and those undergoing RRT. Patients were recruited from the ACKD outpatient clinic, as well as those undergoing hemodialysis and peritoneal dialysis. Carotid intima-media thickness (IMT) and the presence of atherosclerotic plaques were evaluated. Results: 37 individuals were evaluated with ultrasound, and 56.7% had carotid atherosclerotic plaques. Age greater or equal to 65 years and being a former smoker were associated (p <0.005) with the presence of atherosclerotic plaques. When compared with population studies of healthy individuals, our cohort had increased IMT in 45.9% or 37.8% of cases, according to Spanish and Argentinean studies, respectively. 75% showed some alteration, either increased IMT or atherosclerotic plaques. No significant differences were found between individuals with ACKD without RRT and those with ACKD on RRT. Conclusion: Most of patients with ACKD, regardless of the initiation of RRT, present objectively measurable vascular damage. Age equal to or greater than 65 and being a former smoker were associated with the presence of carotid atherosclerotic plaques. In a high percentage of patients, significant vascular damage precedes the initiation of RRT, which should reinforce the prevention of vascular damage in earlier stages of CKD. Funding: Government Support – Non-U.S.