Carotid arteries remodelling in chronic kidney diseae

Abstract

Background. Chronic kidney disease (CKD) is a state of increased cardiovascular risk. Cardiovascular morbidity and mortality increases with the decline in glomerular filtration rate (GFR). Accelerated atherosclerosis, increased arterial stiffness and arterial wall calcification were revealed in dialysis patients. Less is known about arterial remodelling in non-dialysed CKD patients. The aim of the study was to evaluate carotid arteries (CA) structure in CKD patients, arterial remodelling during 1-year follow-up and its relationship with cardiovascular risk factors.
Material and methods. Ultrasound duplex-scan of carotid arteries was performed in 34 CKD patients and 18 healthy volunteers. Carotid artery intima-media thickness (IMT), CA internal diastolic (CAd) and systolic diameter (CAs) were measured. Relative wall thickness (2*IMT /CAd), difference between systolic and diastolic diameter (ΔD = CAs – CAd) and distensibility coefficient: DC = 2 (ΔD/CAd)/PP (PP = pulse pressure) were subsequently calculated.
Results. In CKD patients we found: increased CA diameter and increased IMT compared with the control group, while relative wall thickness and DC did not differ significantly. Significant positive correlations were found between IMT and: age, systolic blood pressure, fasting blood glucose and C-reactive protein (CRP) concentration. Also significant positive correlations were found between CAd and: age, fasting blood glucose and CRP. No correlation was found between CA structure and GFR. Twenty patients were evaluated again after 12 months follow-up. We found significant decrease in DC, while CA diameter and IMT did not change significantly.
Conclusions. Our results indicate that unfavourable arterial remodelling starts in early stages of CKD. Inflammation and glucose metabolism disturbances are associated with carotid artery remodelling in CKD patients.