title: Association of carotid intima-media thickness with cardiovascular risk factors and patient outcomes in advanced chronic kidney disease: the RRI-CKD study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is associated with accelerated atherosclerosis and an increased risk of adverse cardiovascular disease (CVD) outcomes. The relationships of intima-media thickness (IMT), a measure of subclinical atherosclerosis, with traditional and nontraditional risk factors and with adverse outcomes in CKD patients are not wellestablished.
  
  
  METHODS
  IMT, clinical characteristics, cardiovascular risk factors, and clinical outcomes were measured in 198 subjects from the Renal Research Institute (RRI) CKD study, a four-center prospective cohort of patients with estimated glomerular filtration rate (eGFR)≤50 mL/min/1.73 m2 not requiring renal replacement therapy.
  
  
  RESULTS
  The patients averaged 61±14 years of age; the mean eGFR was 29±12 mL/min/1.73 m2. Maximum IMT was more closely associated with traditional cardiovascular risk factors, including age, diabetes, dyslipidemia, and systolic blood pressure, than with nontraditional risk factors or with eGFR. Higher values of maximum IMT were also independently associated with clinical CVD and with other markers of subclinical CVD. Maximum IMT≥2.6 mm was predictive of the composite endpoint of CVD events and death (hazard ratio (HR): 5.47 (95% confidence interval (CI): 2.97-10.07, p<0.0001)) but was not related to progression to end-stage renal disease (HR: 1.67 (95% CI: 0.74-3.76, p=0.21)).
  
  
  CONCLUSIONS
  In patients with advanced pre-dialysis CKD, higher maximum IMT was associated with traditional cardiovascular risk factors, CVD, and other markers of subclinical CVD and as an independent predictor of cardiovascular events and death. Additional research is needed to examine the clinical utility of IMT in the risk stratification and clinical management of patients with CKD.
authors.forename: Alan
authors.initials: A
authors.lastname: Hinderliter
authors.forename: Robin L
authors.initials: RL
authors.lastname: Padilla
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Margaret
authors.initials: M
authors.lastname: Kiser
authors.forename: Fredric
authors.initials: F
authors.lastname: Finkelstein
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000473:pathology*; D012307:Risk Factors