FP373FACTORS PREDICTING SUBCLINICAL ATHEROMATOSIS PROGRESSION IN CHRONIC KIDNEY DISEASE. THE NEFRONA STUDY

Abstract

Introduction and Aims: Subclinical atheromatous disease (AD) is a noninvasive marker of arterial injury that predicts incident cardiovascular events in both the general population and among patients with chronic kidney disease (CKD). However, data on risk factors for progression of AD in CKD are scarce. We evaluated predictors of changes in AD in a cohort of chronic kidney disease patients. Methods: Multicenter, prospective and observational study of 1553 CKD patients (709 stage 3, 578 stages 4-5 and 266 on dialysis) without previous cardiovascular events from the NEFRONA cohort. A carotid and femoral ultrasound examination was performed at baseline and 24 months follow-up after. A unique reader performed the evaluation of the images. Progression of AD was defined as formation of new atherosclerotic plaques. CKD progression was defined as doubling of serum creatinine or the onset of dialysis. Results: Prevalence of atherosclerotic plaque was 69 % and progression of AD occurred in 60% patients after 24 months. Variables significantly and positively predicting AD progression in multivariate analysis were age, smoking, diabetes, dyslipidemia, baseline plaque, Systolic blood pressure, being on dialysis and CKD progression, whereas only treatment with antiplatelet drugs at baseline protected from AD progression (Figures 1a and Figure 1b). Predictors of AD progression varied in the different CKD Stages and in patients with or without plaque at baseline. Thus, in early stages of CKD factors were similar to those described in the general population, whereas in late stages specific factors appear. Furthermore, the degree of renal impairment or its progression only affected AD progression in patients with plaque at baseline. Conclusions: Presence of plaque at baseline and CKD progression are two factors highly predicting AD progression. Ultrasound monitoring may be a useful tool in cardiovascular risk assessment in CKD patients. (Figure Presented).