title: Carotid plaque, carotid intima-media thickness, and coronary calcification equally discriminate prevalent cardiovascular disease in kidney disease.
abstract: BACKGROUND
  Despite the significant morbidity and mortality attributable to cardiovascular disease (CVD), risk stratification remains an important challenge in the chronic kidney disease (CKD) population. We examined the discriminative ability of noninvasive measures of atherosclerosis, including carotid intima-media thickness (cIMT), carotid plaque, coronary artery calcification (CAC) and ascending and descending thoracic aorta calcification (TCAC), and Framingham risk score (FRS) to predict self-reported prevalent CVD.
  
  
  RESULTS
  Participants were enrolled in the cIMT ancillary study of the Chronic Renal Insufficiency Cohort (CRIC) study and also had all of the above measures within an 18-month period. CVD was present in 21% of study participants. C-statistics were used to ascertain the discriminatory power of each measure of atherosclerosis. The study population (n = 220) was 64% male; 51% black and 45% white. The proportion of individuals with estimated glomerular filtration rate ≥60, 45-59, 30-44, and <30 ml/min/1.73 m(2) was 21, 41, 28, and 11%, respectively. In multivariable analyses adjusting for demographic factors, we failed to find a difference between CAC, carotid plaque, and cIMT as predictors of self-reported prevalent CVD (C-statistic 0.70, 95% CI: 0.62-0.78; C-statistic 0.68, 95% CI: 0.60-0.75, and C-statistic 0.64, CI: 0.56-0.72, respectively). CAC was statistically better than FRS. FRS was the weakest discriminator of self-reported prevalent CVD (C-statistic 0.58).
  
  
  CONCLUSIONS
  There was a significant burden of atherosclerosis among individuals with CKD, ascertained by several different imaging modalities. We were unable to find a difference in the ability of CAC, carotid plaque, and cIMT to predict self-reported prevalent CVD.
authors.affiliation: Renal Division, Department of Medicine, University of Southern California Keck School of Medicine, USA.
authors.forename: Gbemisola A
authors.initials: GA
authors.lastname: Adeseun
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.forename: Emile R
authors.initials: ER
authors.lastname: Mohler
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: Sylvia E
authors.initials: SE
authors.lastname: Rosas
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000401:mortality*; D059168:Carotid Intima-Media Thickness / Q000706:statistics & numerical data*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult