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Published ahead of print on January 9, 2008
J Am Soc Nephrol 19: 757-763, 2008
© 2008 American Society of Nephrology
doi: 10.1681/ASN.2007070813
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CLINICAL EPIDEMIOLOGY

Rate of Atherosclerotic Plaque Formation Predicts Cardiovascular Events in ESRD

Francesco Antonio Benedetto*, Giovanni Tripepi{dagger}, Francesca Mallamaci{dagger} and Carmine Zoccali{dagger}

{dagger} CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension, Reggio Calabria, Italy; and * Cardiology Unit, Morelli Hospital, Reggio Calabria, Italy

Correspondence: Prof. Carmine Zoccali, CNR-IBIM, Istituto di Biomedicina, Unità Operativa di Nefrologia Dialisi e Trapianto Renale, Epidemiologia Clinica e Fisiopatologia, delle Malattie Renali e dell’Ipertensione Arteriosa, c/o EUROLINE di Ascrizzi Vincenzo, Via Vallone Petrara 55-57, 89125, Reggio Calabria, Italy. Phone: 0039-0965-397010; Fax: 0039-0965-26879; E-mail: carmine.zoccali{at}tin.it

Received for publication July 25, 2007. Accepted for publication September 24, 2007.

Carotid intima media thickness (IMT) is a strong, independent predictor of cardiovascular events in both the general population and among those with end-stage renal disease (ESRD), but it is unknown whether changes in IMT or other ultrasound-measured indicators of atherosclerosis over time provide additional prognostic information. The progression of atherosclerosis with carotid ultrasound was followed in a cohort of 135 ESRD patients, 103 of whom had a repeat ultrasound after 15 mo of follow-up. The number of plaques and the proportion of patients with severe atherosclerosis increased substantially during the follow-up period, but IMT, common carotid artery diameter, common carotid artery wall-to-lumen ratio, and cross-sectional area, did not change. The rate of formation of new plaques was a strong, independent predictor of incident cardiovascular events, even after adjusting for baseline plaque burden and other potential confounders. New plaque formation over time was independently predicted by background plaque burden and serum C-reactive protein (P = 0.004 and P = 0.02, respectively). Changes in IMT and the other ultrasound-measured indicators of atherosclerosis progression did not predict cardiovascular outcomes. Therefore, monitoring IMT over time is unlikely to provide additional prognostic information compared with a single measurement, but longitudinal ultrasound monitoring of plaque formation may be useful for cardiovascular risk stratification in the ESRD population.






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