Impact of Chronic Kidney Disease on Carotid Atherosclerosis According to Blood Pressure Category

BACKGROUND AND PURPOSE: We aimed to clarify the association of chronic kidney disease (CKD) with carotid atherosclerosis and the impact of CKD on carotid atherosclerosis according to blood pressure categories in an urban general population. METHODS: We studied 3466 Japanese individuals (35-93 years old) in the Suita Study. Carotid atherosclerosis was expressed as the maximum carotid intima-media thickness and the presence of stenosis (>25%). The estimated glomerular filtration rate was calculated using the equations recommended by the Japanese Society of Nephrology. CKD was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2. Blood pressure categories were defined by the European Society of Hypertension and European Society of Cardiology 2007 criteria. RESULTS: The multivariable-adjusted maximum carotid intima-media thickness and odds ratio for stenosis in subjects with estimated glomerular filtration rate<50 mL/min per 1.73 m2 were greater than those in subjects with estimated glomerular filtration rate≥90 mL/min per 1.73 m(2). When subjects were stratified according to blood pressure categories, the multivariable-adjusted maximum carotid intima-media thickness was significantly greater in CKD subjects than in non-CKD subjects only in subjects with hypertension. Similarly, the impact of CKD on stenosis was evident only in subjects with hypertension (multivariable-adjusted odds ratios for stenosis [95% confidence interval] were 2.21 [1.53-3.19] in non-CKD/hypertension and 3.16 [2.05-4.88] in CKD/hypertension compared with non-CKD/optimal blood pressure). CONCLUSIONS: In a general population, the association of CKD with carotid atherosclerosis was modest, but CKD was independently associated with carotid atherosclerosis in subjects with hypertension.