New NEFRONA article

Date:Tuesday, 15 de December del 2015 Author:Aitor Moreno

Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD

Background and objectives Ultrasonographic detection of subclinical atheromatosis is a noninvasive method predicting cardiovascular events. Risk factors predicting atheromatosis progression in CKD are unknown. Predictors of atheromatosis progression were evaluated in patients with CKD. Design, setting, participants, & measurements Our multicenter, prospective, observational study included 1553 patients with CKD (2009–2011).  Carotid and femoral ultrasounds were performed at baseline and after 24 months. A subgroup of 476 patients with CKD was also randomized to undergo ultrasound examination at 12 months. Progression of atheromatosis was defined as an increase in the number of plaque territories analyzed by multivariate logistic regression.

Prevalence of atheromatosis was 68.7% and progressed in 59.8% of patients after 24 months. CKD progressionwas associatedwith atheromatosis progression, suggesting a close association between pathologies. Variables significantly predicting atheromatosis progression, independent from CKD stages, were diabetes and two interactions of age with ferritin and plaque at baseline. Given thatmultiple interactionswere found between CKDstage and age, phosphate, smoking, dyslipidemia, body mass index, systolic BP (SBP), carotid intima-media thickness, plaque at baseline, uric acid, cholesterol, 25-hydroxy vitaminD(25OHvitaminD), and antiplatelet and phosphate binders use, the analysiswas stratified by CKDstages. In stage 3, two interactions (age with phosphate and plaque at baseline)were found, and smoking, diabetes, SBP, low levels of 25OHvitamin D, and no treatment with phosphate binders were positively associated with atheromatosis progression. In stages 4 and 5, three interactions (age with ferritin and plaque and plaque with smoking) were found, and SBP was positively associated with atheromatosis progression. In dialysis, an interaction between body mass index and 25OH vitamin D was found, and age, dyslipidemia, carotid intima-media thickness, low cholesterol, ferritin, and uric acid were positively associated with atheromatosis progression.

Atheromatosis progression affects more than one half of patients with CKD, and predictive factors differ depending on CKD stage.