title: Predictors of Subclinical Atheromatosis Progression over 2 Years in Patients with Different Stages of CKD.
abstract: OBJECTIVE
  Ultrasonographic detection of subclinical atheromatosis is a noninvasive method predicting cardiovascular events. Risk factors predicting atheromatosis progression in CKD are unknown. Predictors of atheromatosis progression were evaluated in patients with CKD.
  
  
  METHODS
  Our multicenter, prospective, observational study included 1553 patients with CKD (2009-2011). Carotid and femoral ultrasounds were performed at baseline and after 24 months. A subgroup of 476 patients with CKD was also randomized to undergo ultrasound examination at 12 months. Progression of atheromatosis was defined as an increase in the number of plaque territories analyzed by multivariate logistic regression.
  
  
  RESULTS
  Prevalence of atheromatosis was 68.7% and progressed in 59.8% of patients after 24 months. CKD progression was associated with atheromatosis progression, suggesting a close association between pathologies. Variables significantly predicting atheromatosis progression, independent from CKD stages, were diabetes and two interactions of age with ferritin and plaque at baseline. Given that multiple interactions were found between CKD stage and age, phosphate, smoking, dyslipidemia, body mass index, systolic BP (SBP), carotid intima-media thickness, plaque at baseline, uric acid, cholesterol, 25-hydroxy vitamin D (25OH vitamin D), and antiplatelet and phosphate binders use, the analysis was stratified by CKD stages. In stage 3, two interactions (age with phosphate and plaque at baseline) were found, and smoking, diabetes, SBP, low levels of 25OH vitamin D, and no treatment with phosphate binders were positively associated with atheromatosis progression. In stages 4 and 5, three interactions (age with ferritin and plaque and plaque with smoking) were found, and SBP was positively associated with atheromatosis progression. In dialysis, an interaction between body mass index and 25OH vitamin D was found, and age, dyslipidemia, carotid intima-media thickness, low cholesterol, ferritin, and uric acid were positively associated with atheromatosis progression.
  
  
  CONCLUSIONS
  Atheromatosis progression affects more than one half of patients with CKD, and predictive factors differ depending on CKD stage.
authors.affiliation: Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain;
authors.forename: Marta
authors.initials: M
authors.lastname: Gracia
authors.affiliation: Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain;
authors.forename: Àngels
authors.initials: À
authors.lastname: Betriu
authors.affiliation: Biostatistics, IRBLleida, Lleida, Spain; and.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Martínez-Alonso
authors.affiliation: Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Arroyo
authors.affiliation: Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain;
authors.forename: María
authors.initials: M
authors.lastname: Abajo
authors.affiliation: Biostatistics, IRBLleida, Lleida, Spain; and.
authors.forename: Elvira
authors.initials: E
authors.lastname: Fernández
authors.affiliation: Experimental Nephrology, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain; edfernandez.lleida.ics@gencat.cat valdivielso@medicina.udl.cat.
authors.forename: José M
authors.initials: JM
authors.lastname: Valdivielso
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
keywords: atherosclerosis; blood pressure; cardiovascular disease; carotid intima-media thickness; chronic kidney disease; follow-up studies; humans; renal insufficiency, chronic; smoking; vitamin D