Study Of Carotid Intima Media Thickness In Patients Of Chronic Kidney Disease
Carotid Intima Media Thickness in CKD
Keywords:
Chronic kidney disease, Cardiovascular disease, End stage renal disease, carotid intima media thickness, atherosclerosis, Glomerular Filtration RateAbstract
Background: Patients with Chronic Kidney Disease (CKD) are at high risk for developing cardiovascular disease (CVD). Carotid intima media thickness (CIMT) has been found to correlate with coronary artery atherosclerosis. Methodology: This was a prospective study of carotid intima media thickness in patients of CKD, done in the Department of Medicine, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P.), India. A total of 70 patients of CKD and 35 age and sex matched controls were enrolled. Bilateral assessment of intima media thickness was done in common carotid artery and higher value of CIMT of any one carotid artery was recorded. Results: Out of total 70 patients of CKD, 42 were males. Clinical findings in CKD patients were anemia (92.5%), edema (71.4%), decreased urine output (41.42%), obesity (12.5%). Proteinuria (>300mg/24 hrs) was seen in 91.4% patients. CIMT in CKD patients was between 0.9-1.0mm whereas in controls was between 0.5-0.6mm. 62.5% of total patients (CIMT 0.91±0.24 to 1.15±0.24) were having mean BP between 90 to 130 mmHg, 12.7% of total patients (CIMT 1.00±0.26) were having mean BP>130 mmHg. CKD patients with dyslipidemia were having mean CIMT 1.08±0.19 in comparison to controls with dyslipidemia having mean CIMT 0.67±0.22. Conclusion: CIMT was increased in CKD patients with increased age, progression of stage of CKD and proteinuria. Mean CIMT was increased in all stages of CKD and there was no significant difference in CIMT in different stages of CKD. Patients having high mean blood pressure was having higher mean CIMT in comparison to patients having lower mean blood pressure, patient with dyslipidemia had high mean CIMT as compared to mean CIMT of controls having dyslipidemia. [Tiwari D NJIRM 2015; 6(6):11-14]
References
2. Enzo B, Giovanni T, Francesca S. Homeostasis Model Assessment closely mirrors the glucose clamp technique in the assessment of insulin resistant. Diabetes Care 2000; 23: 57-63.3. Barakat A A, Nasr F M, Metwaly A A, Ameen M A. Correlation between epicardial fat thickness and cardiovascular risk in hemodialysis patients. Am J of Internal Medicine 2015; 3(3): 86-94.
4. Agarwal SK, Dash SC. Spectrum of renal disease in Indian adults. J Assoc Physicians India 2000, 48(6): 594 -00.
5. Mohan MR, Eorge TJ, Ashok LK. What do we know about chronic kidney disease in India: first report of the Indian CKD registry. BMC Nephrology 2012, 13:10.
6. European society of hypertension-European society of cardiology guidelines for the management of arterial hypertension. J. Hypertens 2003; 21(6): 10011-53.
7. Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerosis progression. Circulation 1993; 87: II56-65.
8. Szeto CC, Chow KM, Woo KS, Chook P, Ching-Ha Kwan B, Leung CB, Kam-Tao Li P. Carotid intima media thickness predicts cardiovascular diseases in Chinese predialysis patients with chronic kidney disease. J Am Soc Nephrol. 2007 Jun; 18(6): 1966-72.
9. Macros AG, Watanabe R, Lemos MM, Canziani ME. Evaluation of intima-media thickness in patients with chronic kidney disease not on dialysis: a prospective study of 24 months. J Bras Nefrol 2014; 36(1): 35-41.
10. Tonelli M, Bohm C, Pandeya S, Gill J, Gill J, Levin A. Cardiac risk factors and use of cardioprotective medications in patients with chronic renal insufficiency. Am J Kidney Dis. 2001; 37: 484-89.
11. Paul J, Dasgupta S, Ghosh MK. Carotid Artery Intima Media Thickness as a Surrogate Marker of Atherosclerosis in Patient with Chronic Renal Failure on Hemodialysis. N Am J Med Sci. 2012 Feb; 4(2): 77–80.
12. Ishizaka N, Ishikaza Y, Toda E, Koike K, Seki G, Nagai R, et al. Association between Chronic Kidney Disease and Carotid Intima-Media Thickening in Individuals with Hypertension and Impaired Glucose Metabolism. Hypertension Research, 2007; 30, 1035–41.
13. Kumar KS, Laskhi AY, Shrinivas Rao PV, Das GC, Kumar Vs. Carotid intima media thickness in patients with end stage renal disease. Indian J Nephron. 2009; 19(1): 13-14.
14. Liu JE, Robbins DC, Palmieri V, Bella JN, Roman MJ, Fabsitz R, et al. Association of albuminuria with systolic and diastolic left ventricular dysfunction in
type 2 diabetes: the strong heart study. J Am Coll Cardill 2003; 41(11): 2022-8.
15. Huang Y, Chen Y, Xu M, Gu W, Bi Y, Li X, et al. Low grade albuminuria is associated with carotid intima-media thickness in chinese type 2 diabetic patients. J Clin Endocrinol Metab 2010; 95(11): 5122-28.
16. Kim JK, Song YR, Kim MG, Kim HJ, Kim SG. Clinical significance of subclinical carotid atherosclerosis and its relationship with echocardiographic parameters in non-diabetic chronic kidney disease patients. BMC Cardiovascular Disorders 2013, 13: 96.
17. Querfeld U, Anarat A, Bayazit AK, Bakkaloglu AS, Biliner Y, Caliskan S, et al. Cardiovascular comorbidity in children with cronic kidney disease study – objective, design and methodology. Clin J Am Soc Nephrol 2010; 5(9): 1642-1648.
