Marcos Andrea Gaspar, Watanabe Renato, Lemos Marcelo Montebello, Canziani Maria Eugenia Fernandes
Universidade Federal de Sao Paulo.
J Bras Nefrol. 2014 Jan-Mar;36(1):35-41. doi: 10.5935/0101-2800.20140007.
Increased carotid intima-media thickness (IMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events in general population. The prognostic value of IMT in patients with early-stage chronic kidney disease (CKD) has not been clearly established.
We aimed to evaluate the association between IMT and cardiovascular (CV) events and mortality in CKD patients.
A cohort of CKD patients in stage 2-4 was evaluated the occurrence of CV events and death in a 24 months follow-up. Laboratory data, carotid ultrasound and coronary computed tomography were performed at baseline.
A total of 117 patients (57 ± 11 years-old, 61% male) were evaluated. Mean glomerular filtration rate (eGFR) was 36 ± 17 mL/min, 96% of patients had hypertension, 23% diabetes and 27% were obese. Coronary calcification was found in 48% of the patients, with higher prevalence among CKD stage 4 (p = 0.02). The median value of IMT was 0.6 mm (0.4-0.7 mm). When compared to patients with IMT ≤ 0.6 mm, those with IMT > 0.6 mm were older (p = 0.001), had higher prevalence of male (p = 0.001) and had lower eGFR (p = 0.01). These patients also had higher prevalence of coronary calcification (p = 0.001). During the follow-up, there were no differences in the occurrence of cardiovascular events and deaths between the two groups.
IMT in early-stage CKD patients was related to coronary calcification, but not with the occurrence of cardiovascular events or death.
颈动脉内膜中层厚度（IMT）增加被认为是早发性动脉粥样硬化的一个标志，并且似乎可以预测普通人群中的心血管事件。IMT在早期慢性肾脏病（CKD）患者中的预后价值尚未明确确立。
我们旨在评估CKD患者中IMT与心血管（CV）事件及死亡率之间的关联。
对一组2-4期的CKD患者进行了为期24个月的随访，评估CV事件的发生情况和死亡情况。在基线时进行了实验室检查、颈动脉超声和冠状动脉计算机断层扫描。
共评估了117例患者（年龄57±11岁，男性占61%）。平均肾小球滤过率（eGFR）为36±17 mL/分钟，96%的患者患有高血压，23%患有糖尿病，27%为肥胖患者。48%的患者发现有冠状动脉钙化，在CKD 4期患者中的患病率更高（p = 0.02）。IMT的中位数为0.6毫米（0.4 - 0.7毫米）。与IMT≤0.6毫米的患者相比，IMT>0.6毫米的患者年龄更大（p = 图001），男性患病率更高（p = 0.001），eGFR更低（p = 0.01）。这些患者冠状动脉钙化的患病率也更高（p = 0.001）。在随访期间，两组之间心血管事件和死亡的发生率没有差异。
早期CKD患者的IMT与冠状动脉钙化有关，但与心血管事件的发生或死亡无关。
