title: Diabetic nephropathy is an independent factor associated to severe subclinical atheromatous disease.
abstract: BACKGROUND
  Atheromatous disease (AD) is a risk factor for death in renal patients. Traditional CV risk factors do not predict the presence of AD in this population. The aim of this study is to analyze whether the etiology of the primary renal disease influences in the risk of having silent AD.
  
  
  METHODS
  Observational cross-sectional study in chronic kidney disease patients without previous cardiovascular events.
  
  
  METHODS
  2436 CKD subjects without any previous CV event included in the prospective Spanish multicenter NEFRONA study. Patients were classified according to primary renal disease: diabetic nephropathy (n = 347), vascular nephropathy (n = 476), systemic/glomerular disease (n = 447), tubulointerstitial and drug toxicity nephropathy (n = 320), polycystic kidney disease (n = 238), non-filiated nephropathy (n = 406) and other causes (n = 202).
  
  
  METHODS
  B-mode and Doppler ultrasonography analysis of the carotid arteries were performed to measure intima media thickness (IMT) and the presence of plaques. Clinical and laboratory parameters related to CV risk were also determined.
  
  
  RESULTS
  AD was scored according with the ultrasonography findings and the ankle-brachial index into two large groups: absence or incipient AD and severe AD.
  
  
  RESULTS
  In multivariate regression analysis, older age (OR 1.09/year [1.088-1.108]), smoking habit (OR 2.10 [1.61-2.74]), male gender (OR 1.33 [1.09-1.64]), grade-5D of CKD (OR 2.19 [1.74-2.74]), and diabetic nephropathy (OR 2.59 [1.93-3.48]) are independent risk factors for severe AD. The prevalence of silent AD was highest for diabetic nephropathy with grade-5D of CKD (82.2%) and lowest with stages 2-3 CKD systemic/glomerular disease (36.6%).
  
  
  CONCLUSIONS
  Observational study with the potential for confounding.
  
  
  CONCLUSIONS
  In CKD patients without any CV event in the background clinical history, diabetic nephropathy as primary renal disease is the most significant factor associated to severe silent AD. Furthermore, this difference was independent of other conventional risk factors for atherosclerosis and CV events.
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Barrios
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Barcelona, Spain. Electronic address: julpascual@gmail.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.affiliation: Nephrology Service, Consorci Sanitari del Garraf, Barcelona, Spain.
authors.forename: Sol
authors.initials: S
authors.lastname: Otero
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Barcelona, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Soler
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Rodríguez
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Collado
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Faura
authors.affiliation: Institute Mar for Medical Research, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Mojal
authors.affiliation: University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Research Unit, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Navarro-González
authors.affiliation: Department of Nephrology, Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Angels
authors.initials: A
authors.lastname: Betriu
authors.affiliation: Department of Nephrology, Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Elvira
authors.initials: E
authors.lastname: Fernandez
authors.affiliation: Department of Nephrology, Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Valdivielso
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D055109:Ankle Brachial Index; D058070:Asymptomatic Diseases; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: Atheromatous disease; Carotid ultrasound; Diabetic nephropathy