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. 2018 Sep;46(9):3873-3883.
doi: 10.1177/0300060518781619. Epub 2018 Jul 3.

Chronic kidney disease is associated with carotid atherosclerosis and symptomatic ischaemic stroke

Nobuo Kajitani  1 , Haruhito A Uchida  2 , Isao Suminoe  3 , Yuki Kakio  1 , Masashi Kitagawa  1 , Hajime Sato  4 , Jun Wada  1
Affiliations

Chronic kidney disease is associated with carotid atherosclerosis and symptomatic ischaemic stroke

Nobuo Kajitani et al. J Int Med Res. 2018 Sep.

Abstract

Objective We aimed to investigate the relationships among chronic kidney disease (CKD), symptomatic ischaemic stroke, and carotid atherosclerosis. Methods We enrolled 455 patients who underwent carotid ultrasonography in our hospital, including 311 patients with symptomatic ischaemic stroke and 144 patients without symptomatic ischaemic stroke. Carotid intima-media thickness (IMT), the rate of internal carotid artery stenosis, and maximal plaque size were evaluated. Results The mean age of the patients was 68.5 ± 11.0 years and the mean estimated glomerular filtration rate (eGFR) was 68.8 ± 18.2 mL/min/1.73 m2. After adjustment for cardiovascular risk factors, the mean IMT was significantly higher in patients with CKD than in those without CKD. The IMT and eGFR were negatively correlated in patients with stroke (r = -0.169). Multiple logistic regression analyses showed that mean IMT, plaque size, and internal carotid artery stenosis were significant determinants of symptomatic ischaemic stroke after adjustment of multivariate risk factors. Furthermore, the eGFR was a negative determinant of symptomatic ischaemic stroke after adjusting for classical risk factors (odds ratio [95% confidence interval] = 0.868 [0.769-0.979]). Conclusion CKD might be associated with the carotid atherosclerosis and symptomatic ischaemic stroke.

Keywords: Chronic kidney disease (CKD); carotid atherosclerosis; glomerular filtration rate (GFR); intima–media thickness (IMT); ischaemic stroke; ultrasonography.

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Figures

Figure 1.
Figure 1.
Relationship between IMT and cardiovascular risk factors. The relationships between the IMT and cardiovascular risk factors are shown in all of the patients. Risk factors were a history of diabetes (a), hypertension (b), dyslipidaemia (c), atrial fibrillation (d), metabolic syndrome (e), a smoking habit (f), and patients with CKD (g). †P < 0.001, ‡P < 0.01 IMT; intima–media thickness, DM; diabetes mellitus, HT; hypertension, DL; dyslipidaemia, Af; atrial fibrillation, MetS; metabolic syndrome, Smoke; smoking habit, and CKD; chronic kidney disease.
Figure 2.
Figure 2.
Carotid atherosclerotic changes in patients with symptomatic BI. Mean IMT (a), plaque size (b), and internal carotid artery stenosis (c) significantly progressed in the BI group. †P < 0.001, ‡P < 0.01. IMT; intima–media thickness, BI; brain infarction.
Figure 3.
Figure 3.
Correlation between IMT and eGFR. The IMT and eGFR were only negatively correlated in the BI group. IMT; intima–media thickness, eGFR; estimated glomerular filtration rate, BI; brain infarction.
See this image and copyright information in PMC

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