[Inflammation and atherothrombosis. Premature vascular injury. Diagnostic and therapeutic options for primary prevention].
Atherosclerosis, an inflammatory disease, develops prematurely in CKD (Strength of Recommendation B). The performance of tests for the diagnosis of subclinical atherosclerosis and systemic inflammation should therefore be considered in these patients. - Patients with CKD are at high risk of vascular disease, implying the need for goal-based treatment of the vascular risk factors. - In this context, imaging tests for the diagnosis of subclinical atherosclerosis can be considered with the goal of individualizing treatment decisions on the management of cardiovascular risk factors when the patient is no longer receiving treatment consistent with the maximum risk level (Strength of Recommendation C). - The presence of subclinical atherosclerosis would raise cardiovascular risk to the maximum level (Strength of Recommendation C). - Carotid artery ultrasound with determination of carotid intima- media thickness (CIMT) and the presence of atheromatous plaques would be the technique of choice for the assessment of subclinical atherosclerosis in ACKD (Strength of Recommendation C). - C-reactive protein, measured by high-sensitivity assay (hs-CRP), is the only marker of inflammation used routinely in clinical practice. However, there is no evidence that routine determination of hs-CRP improves the outcomes of therapeutic decisions on cardiovascular protection in either the general population or ACKD population. Therefore, routine CRP determination cannot be recommended in patients with CKD to stratify their cardiovascular risk (Strength of Recommendation C).
Ortiz Arduán
A
A
Fundación Jiménez Díaz, Madrid.
Ruiz Ortega
M
M
Cases Amenós
A
A
D050197:Atherosclerosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D002908:Chronic Disease; D003663:Decision Trees; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D007674:Kidney Diseases / Q000150:complications*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy