Factors predicting cardiovascular events in chronic kidney disease patients. Role of subclinical atheromatosis extent assessed by vascular ultrasound

Patients with chronic kidney disease (CKD) have an increased incidence of cardiovascular events (CVE). The contribution of subclinical atheromatosis extent, including femoral arteries, to CVE in CKD patients has not been investigated. In this paper, we examine the prognostic value of subclinical ath...

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Bibliographic Details
Published in:PloS one 2017-10, Vol.12 (10), p.e0186665-e0186665
Main Authors: Valdivielso, José M, Betriu, Angels, Martinez-Alonso, Montserrat, Arroyo, David, Bermudez-Lopez, Marcelino, Fernandez, Elvira
Format: Article
Language:English
Subjects:
Aged
Arteries
Atherosclerosis
Atherosclerosis - complications
Atherosclerosis - diagnostic imaging
Biology and Life Sciences
Calcification
Cardiovascular disease
Cardiovascular diseases
Care and treatment
Carotid arteries
Cholesterol
Chronic kidney failure
Cohort Studies
Diabetes
Diabetes mellitus
Diagnosis
Dialysis
Disease control
Family medical history
Female
Femoral artery
Femur
Follow-Up Studies
Glomerular filtration rate
Health aspects
Health care facilities
Health risk assessment
Hemodialysis
Humans
Incidence
Kaplan-Meier Estimate
Kidney diseases
Kidney transplantation
Laboratories
Male
Malnutrition
Medicine and Health Sciences
Methods
Middle Aged
Models, Biological
Mortality
Multivariate Analysis
Nephrology
Parathyroid hormones
Patients
Phosphates
Phosphorus
Physical Sciences
Population
Potassium
Predictions
Regression Analysis
Renal Dialysis
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - diagnostic imaging
Research and Analysis Methods
Studies
Territory
Ultrasonic imaging
Ultrasonography
Ultrasound
Vitamin D
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Summary:Patients with chronic kidney disease (CKD) have an increased incidence of cardiovascular events (CVE). The contribution of subclinical atheromatosis extent, including femoral arteries, to CVE in CKD patients has not been investigated. In this paper, we examine the prognostic value of subclinical atheromatosis extent, assessed as the number of arterial territories with plaque, in predicting the incidence of major and minor CVE. The NEFRONA is a multicenter, prospective cohorts study that recruited 2445 CKD subjects and 559 controls, free from previous cardiovascular disease, in 81 medical centers across Spain. The presence of atheroma plaque was assessed by arterial ultrasound in ten arterial territories (carotid and femoral). The predictive power of the presence or absence of atheroma plaque in any territory was compared with the quantification of atheroma extent as the number of territories with plaque. During the median follow up of 48 months, 216 CVE were reported. Factors predicting the incidence of CVE in the whole cohort were being male, CKD patient, lower levels of 25(OH) vitamin D, higher levels of cholesterol and the extent of subclinical atheromatosis, yielding a higher concordance (C) index than the presence or absence of plaque. In stratified analysis including specific factors of CKD patients not on dialysis, the variables predicting CVE were the same as in the whole cohort, plus higher levels of potassium. Again, the inclusion of the information about atheromatosis as number of territories with plaque, presented a higher C index than the presence or absence of plaque. In the dialysis population, significant variables were older age, diabetes, dialysis vintage and higher levels of cholesterol and phosphate. In this case the higher C index was obtained with the information about plaque presence. Subclinical atheromatosis extent, including femoral arteries, influences CVE in CKD and its detection could improve the prediction of cardiovascular events.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0186665