Carotid IntimaMedia Thickness IMT in Patients with Moderate Chronic Kidney Disease

1
Carotid Intima-Media Thickness (IMT) in Patients
with Moderate Chronic Kidney Disease Sylvia E.
Rosas, Marshall Joffe, Emile Mohler, Shirish
Amrutia, Raymond R. Townsend For the CRIC
Investigators Department of Medicine and
Biostatistics, University of Pennsylvania,
Philadelphia, PA

• Introduction
• Cardiovascular disease is the major cause of
  mortality in chronic kidney disease (CKD)
  patients.
• IMT is the distance between the lumen-intima
  interface and the media-adventitia interface
• Increased intima-media thickness (IMT) is a known
  risk factor for cardiovascular events and is a
  standard for surrogate measurements of
  atherosclerosis.
• It is non-invasive, sensitive and specific
  quantitative measure of subclinical coronary
  atherosclerosis.
• Objective
• We examined variation in baseline carotid IMT in
  191 patients enrolled into the Chronic Renal
  Insufficiency Cohort (CRIC) at the University of
  Pennsylvania and its association with
  characteristics at entry into the study.
• CRIC is a multicenter, national prospective study
  of 3,000 subjects with CKD (GFR between 20-70
  ml/min/1.73m2) to determine risk factors for
  progression of CKD and CVD.
• Statistical Analysis
• We examined associations of clinical and
  demographic characteristics with IMT at baseline.
  Categorical variables were summarized by
  frequencies.
• Mean (standard deviation) and median summarized
  continuous variables. To explain variation in
  baseline carotid IMT and carotid plaque we
  performed t-tests and/or Wilcoxon rank sum tests,
  and linear regression.

• Demographics
• Consented 256 of 346 CRIC subjects (8/31/05)
• 21 were ineligible (history of endarcterectomy or
  unable to lay flat and 16 refused.
• IMT performed in 195 subjects
• Age 60.7 (9.5) years
• 62 male
• 46.2 Caucasians
• 52.3 AA
• 1.5 Asian
• Comorbidities
• BMI 31.7 (6.8)
• CAD 25.7
• PVD 3.8
• CVA 10.3
• CVD 35.1
• DM 53.2
• HTN 85.3
• Hypercholesterolemia 71.1
• Smokers 52.9

• IMT Differences across groups
• Differences between subjects with increased IMT
  and those without increased IMT

• Unadjusted linear regression of IMT (log) and GFR
  (log)
• Conclusions
• Increased IMT and carotid plaque is found in
  patients with moderate CKD.
• Carotid IMT is a promising tool to detect
  atherosclerosis in CKD subjects.
• We were unable to find an association between GFR
  and IMT in this preliminary analysis.
• Further research will determine the associations
  of traditional and novel cardiovascular risk
  factors with IMT cross-sectionally and
  prospectively.

IMT (log)
IMT (log)
GFR (log)
GFR (log)