title: Increased arterial inflammation in individuals with stage 3 chronic kidney disease.
abstract: OBJECTIVE
  While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using18F-FDG PET/CT in patients with CKD and in matched controls.
  
  
  METHODS
  This restrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed.
  
  
  RESULTS
  Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC).
  
  
  CONCLUSIONS
  Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of cardiovascular events.
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.|Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Richard A P
authors.initials: RAP
authors.lastname: Takx
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Megan H
authors.initials: MH
authors.lastname: MacNabb
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Emami
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Abdelbaky
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.|Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Parmanand
authors.initials: P
authors.lastname: Singh
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Zachary R
authors.initials: ZR
authors.lastname: Lavender
authors.affiliation: Division of Radiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Marcelo
authors.initials: M
authors.lastname: di Carli
authors.affiliation: Division of Radiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Viviany
authors.initials: V
authors.lastname: Taqueti
authors.affiliation: Division of Radiology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Foster
authors.affiliation: F. Hoffmann-La Roche Ltd., Basel, Switzerland.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mann
authors.affiliation: F. Hoffmann-La Roche Ltd., Basel, Switzerland.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Comley
authors.affiliation: F. Hoffmann-La Roche Ltd., Basel, Switzerland.
authors.forename: Chek Ing Kiu
authors.initials: CIK
authors.lastname: Weber
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. atawakol@partners.org.|Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. atawakol@partners.org.|Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA. atawakol@partners.org.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tawakol
keywords: Atherosclerosis; Chronic kidney disease; FDG PET/CT; Inflammation