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CLINICAL EPIDEMIOLOGY
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Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis

Anna Mathew, Michael Eliasziw, P.J. Devereaux, Jose G. Merino, Henry J.M. Barnett, Amit X. Garg and for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators
JASN January 2010, 21 (1) 145-152; DOI: https://doi.org/10.1681/ASN.2009030287
Anna Mathew
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Michael Eliasziw
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P.J. Devereaux
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Jose G. Merino
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Henry J.M. Barnett
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Amit X. Garg
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Abstract

Endarterectomy is generally recommended for symptomatic high-grade (70 to 99%) stenosis of the internal carotid artery, but whether this procedure is beneficial among patients with chronic kidney disease (CKD) is unknown. In this re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial, we included patients with symptomatic stenosis and either stage 3 CKD (n = 524) or preserved kidney function (n = 966; estimated GFR ≥ 60). For medically treated patients with high-grade stenosis, risk for ipsilateral stroke at 2 yr was significantly higher in patients with CKD than in those with preserved renal function (31.6 versus 19.3%; P = 0.042); carotid endarterectomy significantly reduced this risk by 82 and 51%, respectively. To prevent one ipsilateral stroke, the number needed to treat by endarterectomy was four for patients with CKD and 10 for patients with preserved renal function. Compared with patients with preserved renal function, those with CKD had similar rates of perioperative stroke and death but higher rates of cardiac events. In conclusion, patients with stage 3 CKD and symptomatic high-grade carotid stenosis gain a large benefit in stroke risk reduction after endarterectomy.

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    • Copyright © 2010 by the American Society of Nephrology
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    Journal of the American Society of Nephrology: 21 (1)
    Journal of the American Society of Nephrology
    Vol. 21, Issue 1
    1 Jan 2010
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    Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis
    Anna Mathew, Michael Eliasziw, P.J. Devereaux, Jose G. Merino, Henry J.M. Barnett, Amit X. Garg, for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators
    JASN Jan 2010, 21 (1) 145-152; DOI: 10.1681/ASN.2009030287

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    Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis
    Anna Mathew, Michael Eliasziw, P.J. Devereaux, Jose G. Merino, Henry J.M. Barnett, Amit X. Garg, for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators
    JASN Jan 2010, 21 (1) 145-152; DOI: 10.1681/ASN.2009030287
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    More in this TOC Section

    • Association of Multiple Plasma Biomarker Concentrations with Progression of Prevalent Diabetic Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study
    • Conventional and Genetic Evidence on the Association between Adiposity and CKD
    • The Relationship between AKI and CKD in Patients with Type 2 Diabetes: An Observational Cohort Study
    Show more Clinical Epidemiology

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