Key result
Higher overall mean carotid intima-media thickness was significantly associated with an increased risk of incident ESRD (HR 1.46; 95% CI 1.02-2.08 for quartile 4 vs 1).
Why the study?
Does higher carotid intima-media thickness predict incident ESRD in a general population without baseline cardiovascular disease?
Cohort (n=13,197)
Yes
Does higher carotid intima-media thickness predict incident ESRD in a general population without baseline cardiovascular disease?
Carotid intima-media thickness is independently associated with incident ESRD in the general population, suggesting a shared etiology between atherosclerosis and ESRD.
Answers are grounded in this paper and cite their sources.
May identify ESRD risk via carotid intima-media thickness in general populations; extends observational links to atherosclerosis but leaves clinical utility open.
BACKGROUND AND OBJECTIVES: Carotid intima-media thickness has been reported to predict kidney function decline. However, whether carotid intima-media thickness is associated with a hard kidney end point, ESRD, has not been investigated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 13,197 Atherosclerosis Risk in Communities participants at visit 1 (1987-1989) without history of cardiovascular disease, including coronary heart disease, stroke, and heart failure, at baseline and assessed whether carotid intima-media thickness measured by B-mode ultrasound is associated with ESRD risk using Cox proportional hazards models. Regarding carotid intima-media thickness parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation, and internal carotid arteries) measurements. RESULTS: Mean age was 54.0 (SD=5.7) years old, and there were 3373 (25.6%) blacks and 7370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid intima-media thickness was significantly associated with ESRD risk (hazard ratio [HR] between quartiles 4 and 1, 1.46; 95% confidence interval [95% CI], 1.02 to 2.08 for overall mean intima-media thickness and HR between quartiles 4 and 1, 1.75; 95% CI, 1.24 to 2.48 for overall maximum intima-media thickness). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific intima-media thicknesses, the associations with ESRD were most robust for bifurcation carotid (e.g., adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.49; 95% CI, 1.04 to 2.13 for bifurcation; adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.36; 95% CI, 0.94 to 1.97 for common; and adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 0.93; 95% CI, 0.67 to 1.29 for internal). CONCLUSIONS: Carotid intima-media thickness was independently associated with incident ESRD in the general population, suggesting the shared etiology of atherosclerosis and ESRD.
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Pang et al. (2016) conducted a cohort in General population without cardiovascular disease (n=13,197). Carotid intima-media thickness vs. Lower carotid intima-media thickness (Quartile 1) was evaluated on Incident ESRD (HR 1.46, 95% CI 1.02-2.08). Higher overall mean carotid intima-media thickness was significantly associated with an increased risk of incident ESRD (HR 1.46; 95% CI 1.02-2.08 for quartile 4 vs 1).
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