Assessment of subclinical atherosclerosis and endothelial dysfunction in chronic kidney disease by measurement of carotid intima media thickness and flow-mediated vasodilatation in North Indian population

• Published in: Journal of family medicine and primary care Vol. 8; no. 4; pp. 1447 - 1452
• Main Authors: Patel, Munna Lal, Sachan, Rekha, Singh, Gaurav Prakash, Chaudhary, S C, Gupta, K K, Atam, Virendra, Parihar, Anit
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.04.2019; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Atherosclerosis; C-reactive protein; Cardiovascular risk; Carotid arteries; chronic kidney disease; Chronic kidney failure; Complications and side effects; Diagnosis; Endothelium; Health aspects; Hemodialysis; Hemodynamics; Kidney diseases; Medical research; noninvasive risk markers; Original; Physiological aspects; Risk factors; subclinical atherosclerosis; Type 2 diabetes; Vasodilation; India; chronic kidney disease; noninvasive risk markers; subclinical atherosclerosis; Cardiovascular risk
• ISSN: 2249-4863; 2278-7135
• DOI: 10.4103/jfmpc.jfmpc_191_19

Chronic kidney disease (CKD) predisposes to accelerated atherosclerosis that is measured by carotid artery intima media thickness (CIMT) and brachial artery flow-mediated dilation (FMD). The aim of this study was to assess the noninvasive risk markers of subclinical atherosclerosis and endothelial dysfunction and their correlation with disease severity. This was a cross-sectional study conducted in 62 patients with CKD: 38 predialysis and 24 on hemodialysis and 50 age- and gender-matched controls. In both the patients and controls, high-sensitivity C-reactive protein (CRP) levels, %FMD, and CIMT were measured. Patients with CKD had increased CRP levels {[5.8 (1.0-6.0)] mg/L vs [1.0 (0.5-2.20)] mg/L; < 0.001}; %FMD was significantly lower in patients on hemodialysis (5.51%) compared with stage IV (7.62%) and stage III (15.02%) and 17.95% in control subjects ( < 0.001); and CIMT values in hemodialysis patients (0.88 ± 0.06 mm) were significantly higher compared with stage IV (0.67 ± 0.10) and stage III (0.61 ± 0.12) ( < 0.001). Increased CIMT values were seen in patients with CKD (0.82 ± 0.21 mm) than in the healthy controls (0.55 ± 0.16 mm). In patients with CKD, a significant negative correlation was found between CRP levels and FMD responses ( = -0.315; < 0.001), while a significant positive correlation was found between CRP and CIMT values ( = 0.327; < 0.001). Compared with predialysis, hemodialysis subjects had significantly lower FMD and higher CRP and IMT values. CKD confers a higher inflammatory status when compared with apparently healthy general population. Abnormal FMD responses and CIMT values are more commonly found in dialysis patients. Our findings suggest that CIMT and FMD can be used as noninvasive markers for early risk assessment and stratification in various stages of CKD.