Elsevier

Atherosclerosis

Volume 212, Issue 2, October 2010, Pages 661-667
Atherosclerosis

eGFR is associated with subclinical atherosclerosis independent of albuminuria: The Dong-gu Study

https://doi.org/10.1016/j.atherosclerosis.2010.06.039Get rights and content

Abstract

Objectives

This study evaluated the relationships between estimated glomerular filtration rate (eGFR) and carotid atherosclerosis, peripheral arterial disease (PAD), arterial stiffness, and left ventricular hypertrophy, independent of albuminuria.

Methods

The study population consisted of 6694 people aged 50 years and older who participated in the baseline survey of the Dong-gu Study conducted in Korea between 2007 and 2009. The common carotid artery intima-media thickness (CCA-IMT), carotid plaque, ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and left ventricular mass index (LVMI) of each subjects was assessed.

Results

After adjustment for risk factors and albumin–creatinine ratio (ACR), kidney dysfunction (eGFR = 30–44 ml/min per 1.73 m2) was significantly associated with carotid plaque presence (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.21–2.53) and PAD (OR, 2.64; 95% CI, 1.51–4.62) compared to normal kidney function (eGFR  60 ml/min per 1.73 m2). Similarly, mean LVMI and baPWV differed significantly according to eGFR after adjustment for other risk factors and ACR; in contrast, no significant difference was observed for CCA-IMT.

Conclusions

Independent of albuminuria, eGFR is associated with carotid plaque, PAD, baPWV, and LVMI but not with CCA-IMT in Koreans aged 50 years and older.

Introduction

Cardiovascular disease (CVD) is the main cause of mortality and morbidity in most parts of the world [1]. Thus, methods for estimating the risk of CVD are needed to decrease both its incidence and disease burden. One such method involves the assessment of renal dysfunction, which is defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2. A decreased eGFR is a risk factor of CVD [2] and is correlated with cardiovascular mortality and morbidity in both high-risk groups [3], [4] and the general population [5]. In addition, several measures of assessing subclinical atherosclerosis have been developed as surrogate measures for CVD. The carotid artery intima-media thickness (CCA-IMT) is correlated with coronary artery disease, stroke, and several other risk factors [6], [7]. In contrast, the presence of carotid plaque exhibits different pathogenic characteristics from IMT [8]; however, both IMT and carotid plaque share a common association with atherosclerosis and ischemic heart symptoms [9], [10]. The ankle-brachial index (ABI) is a simple measure of the severity of peripheral arterial disease (PAD); therefore, ABI is commonly used to screen for PAD in diabetics [11]. Pulse wave velocity (PWV) is also a strong independent predictor of cardiovascular risk [12]. Finally, increased left ventricular mass is a subclinical marker of CVD [13].

Several studies have evaluated the relationship between eGFR and these surrogate measures. However, most of these studies examined the relationship between kidney dysfunction and atherosclerosis without adjustment for albuminuria. Because albuminuria is also associated with IMT, carotid plaque presence, ABI, PWV, and left ventricular mass index (LVMI)[14], [15], [16], these studies were unable to determine whether the apparent relationship between kidney function and surrogate measures of CVD had been distorted by the effects of albuminuria.

In the present study, we sought to improve upon these previous investigations in two ways. First, we examined the relationship between kidney function and subclinical atherosclerosis phenotypes after adjusting for albuminuria. Second, we extended the previous studies by examining common CCA-IMT, carotid plaque presence, ABI, brachial-ankle PWV (baPWV), and LVMI; this expanded investigation allowed us to evaluate the overall association between kidney function and carotid atherosclerosis, arterial stiffness, PAD, and LVH.

Section snippets

Subjects

Participants had been recruited into the baseline survey of the Dong-gu Study between 2007 and 2009. The Dong-gu Study is an ongoing prospective study that was designed to investigate the prevalence, incidence, and risk factors for chronic disease in urban people. We used the national resident registration records to identify potential participants. In total, 26,323 eligible subjects aged 50 years and over who resided in one of five towns in the Dong-gu district of Gwangju Metropolitan City in

General characteristics of the subjects according to eGFR and albuminuria

Table 1 shows the general characteristics of the subjects and the relationship between these characteristics and eGFR and the presence of albuminuria. Body mass index, abdominal circumference, glucose, HbA1c, baPWV, CCA-IMT, and LVMI tended to be higher in participants with decreased eGFR. Decreased eGFR was prevalent among participants with diabetes, hypertension, increased presence of carotid artery plaque, and an ABI of less than 0.9.

Odds ratios for carotid plaque presence and PAD according to eGFR

Table 2 lists the odds ratios (ORs) for carotid plaque

Discussion

We evaluated the relationship between kidney dysfunction and several subclinical atherosclerosis phenotypes, including carotid atherosclerosis, PAD, arterial stiffness, and LVH in Korean subjects aged 50 years and older. Our data demonstrate that, independent of the presence of albuminuria, decreased eGFR is significantly associated with carotid plaque presence, PAD, baPWV, and LVMI but not with CCA-IMT.

As in this study, previous studies showed an association between kidney function and

Conflicts of interest

None.

Acknowledgements

This study was supported by a grant (CRI07021-1) provided by the Chonnam National University Hospital Research Institute of Clinical Medicine.

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