Abstract
Background: Cardiovascular disease complications are the commonest causes of mortality in patients with Chronic Kidney Disease (CKD). Carotid intima-media thickness (CIMT) measurements provide information on arterial wall thickness. This study explores CIMT in CKD patients.
Methods: one hundred and seven pre-dialysis CKD patients were consecutively recruited. Eighty one healthy subjects served as control. A pre-tested questionnaire was administered and physical examination done. Fasting blood samples were collected. CIMT was measured using high resolution B mode ultrasonography at 3 sites - the distal common carotid artery, the internal carotid artery and the carotid bulb. The mean value was calculated.
Results: CIMT was significantly increased in CKD patients. Mean CIMT among CKD patients was 0.120 ± 0.015mm and 0.092 ± 0.034mm in controls, p<0.001. CIMT correlated significantly with age, eGFR, creatinine level, triglyceride level, and history of diabetes. Serum creatinine however best predicted CIMT. There was no correlation between CIMT and total cholesterol, HDL, LDL, calcium phosphate product and blood pressure in the CKD patients.
Conclusion: CIMT is increased in CKD patients suggesting that carotid atherosclerosis is more prevalent in them. It is recommended that CIMT measurements be done in our CKD patients to identify patients at high risk of cardiovascular episodes for possible intervention.
Keywords: Carotid artery, intima-media thickness, chronic kidney disease, Nigeria.
References
- National Kidney Foundation – K/DOQ1. Clinical practice guideline for chronic kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002; 39(I): SI – S266.
- Ulasi II, Ijoma CK. The enormity of CKD in Nigeria: The situation in a Teaching Hospital in South East Nigeria. J Trop Med 2010; 10:1155-1160.
- Guidelines for the detection and management of chronic kidney disease. Nigerian Association of Nephrology handbook. 2011; 7.
- Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351:1296-1305.
- Pun PH, Smarz TR, Honeycutt EF, et al. Chronic kidney disease is associated with increased risk of sudden cardiac death among patients with coronary artery disease. Kidney Int 2009; 76:652-658.
- Touboul PJ, Hennerici S, Meairs H, et al. Mannheim intima-media thickness consensus. Cerebrovasc Dis 2004; 18: 346-349
- World Health Organization: International Society of Hypertension Writing Group. 2003 World Health Organization/ International Society of Hypertension (ISH) Statement on Management of Hypertension. J Hypertens 2003; 21: 1983-1992.
- Scramek A, Bosch J G, Reiber JH, et al. Ultrasound assessment of atherosclerotic vessel wall changes: reproducibility of intima-media thickness measurements in carotid and femoral arteries. Invest Radiology 2000 Dec; 35 (12): 699-706.
- Arije A, Kadiri S, Akinkugbe OO. The viability of haemodialysis as a treatment option for renal failure in a developing economy. Afr J Med Sci 2000; 29: 311-314.
- Benette PC, Gill PS, Silvermen S, et al: Ethnic differences in common carotid intima-media thickness and the relationship to cardiovascular risk factors and peripheral arterial disease. Oxford Journals, QJM 2011; 104(3): 245-25
- Rostland SG, Kirk A, Rutsky PA, Pate BA. Racial difference in the incidence and treatment of end stage renal disease. N Engl J Med 1982; 306:1271-1279.
- Bamgboye EL. End stage renal disease in Sub Saharan Africa. Ethn Dis. 2006; 16(Suppl 2): S25-29.
- Balsam, A, El-Kossi MM, Lord R, El-Nahas, AM, Cardiovascular disease on hemodialysis: Predictors of atherosclerosis and survival. Int 2009, 13: 278-285.
- Kumar KS, Lakshmi AY, Rao PVS, et al. Carotid intima-media thickness in patients with end-stage renal disease. Indian J. Nephrol.2009; 19: 13-14.
- Prasad N, Kumar S, Singh A, et al. Carotid intimal thickness and flow-mediated dilatation in diabetic and nondiabetic continuous ambulatory peritoneal dialysis patients. Dial. Int.2009; 29: S96-S101.
- Abolhassan S, Mehdi A, Hamid T and Rohollah F. Common Carotid Artery Intima-media Thickness and Atherosclerotic Plaques in Carotid Bulb in Patients with Chronic Kidney Disease on Hemodialysis: A Case-control Study. Pakistan Journal of Biological Science 2011; 14: 844-848.
- Craven TE, Ryu JE, Espeland MA, Kahl FR, et al. Evaluation of the association between carotid artery atherosclerosis and coronary artery stenosis: a case control study. Circulation 1990; 82: 1230-42.
- Burdick L, Periti M, Salvaggio A, et al. Relation between carotid artery atherosclerosis and time on dialysis. A non-invasive study. Clin Nephrol 1994; 42: 121-6.
- Anita R, Aleksandra A, Stanislaw P, et al. Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients with and without microangiopathy, Arch Med Sci. 2012 July 4; 8(3): 484–490.
- Kalanthar-Zadeh K, Ikizler TA, Block G, Avram MM. Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 2003; 42: 864-81.
Corresponding Author
Afolabi OF.
Nephrology Unit, Federal Teaching Hospital, Abakaliki, Nigeria
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone - +2348136494979
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.01
