Advertisement

Carotid atherosclerosis in chronic renal failure—the central role of increased plaque burden

      Abstract

      Studies on carotid artery atherosclerosis have been performed in order to understand the high risk for cardiovascular disease in chronic renal failure (CRF). The purpose of this study was to evaluate the extent and nature of carotid artery atherosclerosis in patients with CRF. Of the 135 patients with CRF (52±11 years), 58 had moderate to severe predialysis CRF (PR), 36 were on dialysis treatment (DI), and 41 were renal transplant recipients (TR). In addition, 58 control subjects (CO) were examined. Common carotid artery intima-media thickness (IMT), plaque prevalence, plaque score, and stiffness index beta were determined. Furthermore, plaque calcification and internal carotid artery stenoses were classified. Plaque prevalence (PR 64%, DI 61%, TR 51%, CO 28%; P<0.001) and plaque score (PR 3.3±4.3, DI 3.0±3.4, TR 2.5±3.2, CO 0.8±1.7 mm; P<0.001) were significantly greater in the CRF patient groups compared to the controls, whereas no difference in IMT was noted between the study groups. The prevalences of plaque calcification and internal carotid artery stenoses were higher among the CRF patient groups. In addition, the stiffness index beta was higher in the CRF patient groups. The present study shows that the characteristic alterations of the carotid arteries in CRF include increased plaque burden, calcification and increased arterial stiffness.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Muntner P.
        • He J.
        • Hamm L.
        • Loria C.
        • Whelton P.K.
        Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States.
        J. Am. Soc. Nephrol. 2002; 13: 745-753
        • Foley R.N.
        • Parfrey P.S.
        • Sarnak M.J.
        Clinical epidemiology of cardiovascular disease in chronic renal disease.
        Am. J. Kidney. Dis. 1998; 32: S112-S119
        • Kasiske B.L.
        Cardiovascular disease after renal transplantation.
        Semin. Nephrol. 2000; 20: 176-187
        • Goldsmith D.J.
        • Covic A.
        Coronary artery disease in uremia: etiology, diagnosis, and therapy.
        Kidney Int. 2001; 60: 2059-2078
        • Crouse III, J.R.
        • Thompson C.J.
        An evaluation of methods for imaging and quantifying coronary and carotid lumen stenosis and atherosclerosis.
        Circulation. 1993; 87: II17-II33
        • Kawagishi T.
        • Nishizawa Y.
        • Konishi T.
        • Kawasaki K.
        • Emoto M.
        • Shoji T.
        • et al.
        High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia.
        Kidney Int. 1995; 48: 820-826
        • London G.M.
        • Guerin A.P.
        • Marchais S.J.
        • Pannier B.
        • Safar M.E.
        • Day M.
        • et al.
        Cardiac and arterial interactions in end-stage renal disease.
        Kidney Int. 1996; 50: 600-608
        • Stenvinkel P.
        • Heimburger O.
        • Paultre F.
        • Diczfalusy U.
        • Wang T.
        • Berglund L.
        • et al.
        Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure.
        Kidney Int. 1999; 55: 1899-1911
        • Fujisawa M.
        • Haramaki R.
        • Miyazaki H.
        • Imaizumi T.
        • Okuda S.
        Role of lipoprotein (a) and TGF-beta 1 in atherosclerosis of hemodialysis patients.
        J. Am. Soc. Nephrol. 2000; 11: 1889-1895
        • Kennedy R.
        • Case C.
        • Fathi R.
        • Johnson D.
        • Isbel N.
        • Marwick T.H.
        Does renal failure cause an atherosclerotic milieu in patients with end-stage renal disease?.
        Am. J. Med. 2001; 110: 198-204
        • Haraki T.
        • Takegoshi T.
        • Kitoh C.
        • Kajinami K.
        • Wagasugi T.
        • Hirai J.
        • et al.
        Hyperhomocysteinemia, diabetes mellitus, and carotid atherosclerosis independently increase atherosclerotic vascular disease outcome in Japanese patients with end-stage renal disease.
        Clin. Nephrol. 2001; 56: 132-139
        • Shoji T.
        • Emoto M.
        • Tabata T.
        • Calabro A.
        • Rossi G.
        • Saller A.
        • et al.
        Advanced atherosclerosis in predialysis patients with chronic renal failure.
        Kidney Int. 2002; 61: 2187-2192
        • Rossi A.
        • Bonfante L.
        • Giacomini A.
        • et al.
        Carotid artery lesions in patients with nondiabetic chronic renal failure.
        Am. J. Kidney Dis. 1996; 27: 58-66
        • Savage T.
        • Clarke A.L.
        • Giles M.
        • Tomson C.R.
        • Raine A.E.
        Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease.
        Nephrol. Dial. Transplant. 1998; 13: 2004-2012
        • Rossi M.
        • Cupisti A.
        • Santoro G.
        • Morelli E.
        • Meola M.
        • Barsotti G.
        Ultrasonic tissue characterization of the carotid artery in chronic renal failure patients.
        Nephron. 2002; 91: 270-275
        • Pascazio L.
        • Bianco F.
        • Giorgini A.
        • Galli G.
        • Curri G.
        • Panzetta G.
        Echo color Doppler imaging of carotid vessels in hemodialysis patients: evidence of high levels of atherosclerotic lesions.
        Am. J. Kidney Dis. 1996; 28: 713-720
        • Leskinen Y.
        • Salenius J.P.
        • Lehtimäki T.
        • Huhtala H.
        • Saha H.
        The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: requirements for diagnostics.
        Am. J. Kidney Dis. 2002; 40: 472-479
      1. WHO Study Group: Diabetes mellitus. World Health Organ. Tech. Rep. Ser. 1985;727:9–20.

      2. Rose GA, Blackburn H, Gillum RF, Prineas RJ: Classification of the electrocardiogram for population studies. In: Rose GA, Blackburn H, Gillum RF, Prineas RJ, editors. Cardiovascular survey methods, 2nd ed., Geneva: World Health Organization; 1982. p. 123–43.

        • Salonen J.T.
        • Salonen R.
        Ultrasound B-mode imaging in observational studies of atherosclerotic progression.
        Circulation. 1993; 87: II56-II65
        • Moneta G.L.
        • Edwards J.M.
        • Chitwood R.W.
        • Taylor L.M.
        • Lee R.W.
        • Cummings C.A.
        • et al.
        Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning.
        J. Vasc. Surg. 1993; 17 (discussion 157–9): 152-157
        • Hirai T.
        • Sasayama S.
        • Kawasaki T.
        • Yagi S.
        Stiffness of systemic arteries in patients with myocardial infarction. A noninvasive method to predict severity of coronary atherosclerosis.
        Circulation. 1989; 80: 78-86
      3. Yatsu FM. Atherosclerosis and stroke. In: Barnett HJM, Mohr JP, Stein PM, editors. Pathology, diagnosis and management. New York: Churchill Livingstone; 1986. p. 45–56.

        • Ebrahim S.
        • Papacosta O.
        • Whincup P.
        • Wannamethee G.
        • Walker M.
        • Nicolaides A.N.
        • et al.
        Carotid plaque, intima-media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study.
        Stroke. 1999; 30: 841-850
        • Nagai Y.
        • Kitagawa K.
        • Yamagami H.
        • Kondo K.
        • Hougaku H.
        • Hori M.
        • et al.
        Carotid artery intima-media thickness and plaque score for the risk assessment of stroke subtypes.
        Ultrasound Med. Biol. 2002; 28: 1239-1243
        • Schwarz U.
        • Buzello M.
        • Ritz E.
        • Stein G.
        • Raabe G.
        • Wiest G.
        • et al.
        Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure.
        Nephrol. Dial. Transplant. 2000; 15: 218-223
        • Goodman W.G.
        • Goldin J.
        • Kuizon B.D.
        • Yoon C.
        • Gales B.
        • Slider D.
        • et al.
        Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis.
        N. Engl. J. Med. 2000; 342: 1478-1483
        • Davies M.R.
        • Hruska K.A.
        Pathophysiological mechanisms of vascular calcification in end-stage renal disease.
        Kidney Int. 2001; 60: 472-479
        • Hulthe J.
        • Wikstrand J.
        • Emanuelsson H.
        • Wiklund O.
        • de Feyter P.J.
        • Wendelhag I.
        Atherosclerotic changes in the carotid artery bulb as measured by B-mode ultrasound are associated with the extent of coronary atherosclerosis.
        Stroke. 1997; 28: 1189-1194
        • Zoccali C.
        • Benedetto F.A.
        • Mallamaci F.
        • Tripepi G.
        • Fermo I.
        • Foca A.
        • et al.
        Inflammation is associated with carotid atherosclerosis in dialysis patients. Creed investigators. Cardiovascular risk extended evaluation in dialysis patients.
        J. Hypertens. 2000; 18: 1207-1213
        • Tozawa M.
        • Iseki K.
        • Iseki C.
        • Oshiro S.
        • Yamazato M.
        • Higashiuesato Y.
        • et al.
        Evidence for elevated pulse pressure in patients on chronic hemodialysis: A case-control study.
        Kidney Int. 2002; 62: 2195-2201
        • London G.M.
        Increased arterial stiffness in end-stage renal failure: why is it of interest to the clinical nephrologist?.
        Nephrol. Dial. Transplant. 1994; 9: 1709-1712
        • Blacher J.
        • Pannier B.
        • Guerin A.P.
        • Marchais S.J.
        • Safar M.E.
        • London G.M.
        Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease.
        Hypertension. 1998; 32: 570-574
        • Blacher J.
        • Guerin A.P.
        • Pannier B.
        • Marchais S.J.
        • Safar M.E.
        • London G.M.
        Impact of aortic stiffness on survival in end-stage renal disease.
        Circulation. 1999; 99: 2434-2439