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. 2025 Jan;38(1):207-214.
doi: 10.1007/s40620-024-02146-9. Epub 2024 Nov 23.

Assessment of total carotid plaque area progression in patients with chronic kidney disease. Good practices for decision-making

Daniela J Porta  1 , Mariana N Carrillo  1 , Hernán A Pérez  2   3 , María A Rivoira  1 , Grisel N Ledesma  1 , Sonia E Muñoz  1 , Laura R Aballay  1 , Luis J Armando  3 , Jeffrey R Schelling  4 , J David Spence  5 , Néstor H García  6   7
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Assessment of total carotid plaque area progression in patients with chronic kidney disease. Good practices for decision-making

Daniela J Porta et al. J Nephrol. 2025 Jan.

Abstract

Background: Chronic kidney disease (CKD) increases cardiovascular risk, however, traditional cardiovascular risk factors cannot entirely explain it. A real-world investigation examined the concept that renal function decline is linked to carotid total plaque area progression, which strongly confirms cardiovascular risk. We analyzed CKD patients in stages 1-3 to find risk factor relationships before the onset of severe CKD.

Methods: We monitored 328 patients for 16 ± 5 months. Participants were classified at baseline by estimated glomerular filtration rate (eGFR) stage: G1 (≥ 90), G2 (60-89), and G3 (30-59 ml/min/1.73m2). Ultrasound-guided total plaque area tracked atherosclerosis. Age, sex, blood pressure, lipids, and HbA1c were covariates. Total plaque area and variables were measured on day 1 and at the conclusion of observation. We used a multilevel mixed effects model to assess biological and behavioral factors on total plaque area progression in the general population. For validation, this research was conducted on 73 CKD patients with optimal traditional cardiovascular risk factor management during 15 ± 5 months.

Results: Multiple analyses showed an inverse relationship between eGFR decline and total plaque area progression [β-exponent = 0.99 (95% CI = 0.98-0.99)], regardless of age, lipid profile, blood pressure, smoking, diabetes, or hypertension. The correlation remained significant in the 73-patient sample with optimal traditional cardiovascular risk factor management (β-exponent = 0.99; 95% CI 0.97-0.99). Although traditional cardiovascular risk factor management was excellent, total plaque area increased considerably in G2-G3 patients compared to G1.

Conclusions: CKD, total plaque area, and eGFR are inversely correlated, independent of traditional cardiovascular risk factors, suggesting that non-traditional mechanisms are responsible for resistant atherosclerosis. The combination of eGFR and total plaque area may be useful in identifying high-risk patients.

Keywords: Atherosclerosis; Carotid arteries; Chronic renal insufficiency; Ultrasound.

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Conflict of interest statement

Declarations. Conflict of interests: JDS receives small royalties on a share of a patent on the measurement of carotid plaque by 3D ultrasound; JDS and LJA are officers of a dormant corporation, Vascularis Inc. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethical approval: The Institutional Committee for Ethical Evaluation of Health Research, National Clinical Hospital (CIEIS HNC-FCM) N°: 119/12, approved the protocol. Informed consent to participate: Informed consent was waived by the Ethics Committee. Human and animal rights statement: The Institutional Committee for Ethical Evaluation of Health Research, National Clinical Hospital (CIEIS HNC-FCM) N°: 119/12, approved the protocol.

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