Kidney function and progression of carotid intima-media thickness in a community study.
BACKGROUND
Limited data exist regarding the relationship between decreased kidney function, carotid intima-media thickness (IMT) progression, and vascular events.


METHODS
A community-based cohort study.


METHODS
3,364 participants in the Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria Study.


METHODS
Quartiles of kidney function level estimated by means of creatinine clearance (Ccr) using the Cockcroft-Gault equation (Ccr <64, 64 to 75, 75 to 89, and >89 mL/min/1.73 m(2)).


METHODS
Change in carotid IMT during 2 years. Composite clinical study end point is the occurrence of major adverse cardiovascular events, a composite of myocardial infarction, stroke, and vascular death after 2 years.


RESULTS
Baseline mean carotid IMT was 0.79 +/- 0.19 (SD) mm. Mean change in carotid IMT was 0.02 +/- 0.11 mm/y. Lower Ccr quartile at baseline was associated with a greater change in adjusted mean values: 0.024 (95% confidence interval [CI], 0.020 to 0.027); 0.019 (95% CI, 0.015 to 0.023); 0.012 (95% CI, 0.009 to 0.016); and 0.0077 (95% CI, 0.005 to 0.011), respectively (P < 0.01). After evaluation of change in carotid IMT, 36 patients (1.1%) experienced a fatal and nonfatal vascular event. Subjects with baseline Ccr less than the median (75 mL/min/1.73 m(2)) and change in carotid IMT greater than the median (0.008 mm/y) had the worst prognosis (log-rank test, P = 0.04). By means of multivariable analysis with the Cox proportional hazard model, lower baseline Ccr (hazard ratio, 1.04; 95% CI, 1.02 to 1.23; P = 0.03 per 1-mL/min/1.73 m(2) decrease) and faster change in carotid IMT (hazard ratio, 1.15; 95% CI, 1.11 to 1.93; P = 0.01 per 0.1-mm increase) were associated with fatal and nonfatal vascular events.


CONCLUSIONS
Microalbuminuria, associated with carotid atherosclerosis, was not available.


CONCLUSIONS
Decreased kidney function is associated strongly with faster change in carotid IMT. In addition, decreased kidney function and faster change in carotid IMT are associated with cardiovascular events.
Desbien
Angela M
AM
Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Chonchol
Michel
M
Gnahn
Hannes
H
Sander
Dirk
D
D000368:Aged; D002339:Carotid Arteries / Q000473:pathology*; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*