Dhanapriya, J (2010) Correlation of Carotid Intimal Medial Thickness with eGFR and Cardiovascular Risk Factors in Patients with Chronic Kidney Disease. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Chronic kidney disease is characterized by a decrease in glomerular filtration rate and histological evidence of reduction in nephron population1. The clinical course is typically one of a progressive and unrelenting loss of nephron function ultimately leading to end stage renal disease. Kidney failure is the most visible aspect of the spectrum, but it represents only a minority of the total population affected by kidney disease. The time between initial onset of disease and development of terminal renal failure may vary considerably not only between different diseases but also in different patients with similar disease processes. The progressive nature of CKD and the ensuing ESRD is putting a substantial burden on global health resources since all modalities of treatment are expensive. There are multiple causes of kidney injury that lead to the final common pathway of ESRD, and this syndrome is characterized by hypertension, anemia, renal bone disease, nutritional impairment, neuropathy, impaired quality of life, and reduced life expectancy. Increasing evidence acquired in the past decades indicates that the adverse outcomes of CKD such as renal failure, cardiovascular disease, and premature death can be prevented or delayed by early detection of CKD3. Earlier stages of CKD can be detected through laboratory testing only. Treatment of earlier stages of chronic kidney disease, as well as initiation of treatment of cardiovascular risk factors at early stages of CKD should be effective in reducing the rate of progression of CKD to ESRD. In patients with CKD, the atherosclerotic cardiovascular disease is leading cause for morbidity and mortality2. Carotid intima-media thickness (cIMT) has been used as a marker for early atherosclerosis. The increased incidence of CVD is the consequence of a high prevalence of both traditional risk factors, uremia-related,and “new factors,” such as hyperhomocysteinemia, infections (herpes virus and Chlamydia pneumoniae) and oxidative stress, which increases atherosclerotic risk among these patients. According to the 1999-2004 National Health and Nutrition Examination Survey (NHANES), the prevalence of CKD among the USA population is 15.3%. It becomes apparent that the severity of CKD along with CVD severity in any population makes a 'devastated' combination for both patients and healthcare systems. Approximately 50% of patients with ESRD die from a cardiovascular event, which indicates a cardiovascular mortality that is times higher in dialysis patients and 500 times higher in 25- to 34-year-old ESRD patients than in individuals from the general population of the same age and race. Previous studies have suggested that carotid intimal medical thickness can be used as a marker for atherosclerosis cardio vascular disease. Non invasive assessment of intima medial thickness of carotid arteries by high resolution B – mode ultrasonography is widely used in observational studies and trials as an intermediate or proxy measure of generalized atherosclerosis. Increased intima medial thickness of carotid arteries has been associated with unfavourable levels of established cardiovascular risk factors, prevalent cardiovascular disease and atherosclerosis elsewhere in the arterial system. In this study we attempt to evaluate the association of increased intimal medial thickness with traditional and nontraditional cardiovascular risk factors in CKD patients. AIMS AND OBJECTIVES: 1. To study the prevalence of traditional and non traditional cardiovascular risk factors in patients with CKD. 2. Correlation of carotid intimal medial thickness to eGFR, traditional risk factors and non traditional risk factors for cardio vascular disease in patients with CKD. MATERIALS AND METHODS: Setting: Patients attending the department of Internal medicine and department of Nephrology, Madras Medical College and Government General Hospital, Chennai. Collaboration Departments: Institute of Internal Medicine and Department of Nephrology. Study Design: Single Center, Non randomized cross sectional study. Duration of Study: February 2009 to December 2009. Selection of Patients: Inclusion Criteria: CKD patients getting treated at Nephrology department and Department of Internal Medicine, Government General Hospital with stage 2, 3, and 4. Exclusion Criteria: 1. CKD stage 1 & 5, 2. Patients with nephrotic syndrome, 3. Patients on statins. Sample Size: In the study period of 11 months among the patients seen under the Department of Internal medicine and nephrology, after applying inclusion criteria, 60 patients were included in this study. Selection Of Study Subjects: The patients who were diagnosed as chronic kidney disease based on the National Kidney Foundation definition. METHODOLOGY: Patients who were included in the study were asked for the history of diabetes mellitus, hypertension, smoking, intake of alcohol and hyperlipidemia. pulse rate and blood pressure were taken. Height and weight were measured for body mass index calculation. The information was entered based on the proforma prepared. Patients are subjected to carotid Doppler for measuring carotid intimal medial thickness. Urine sample for urine protein and blood samples for hemoglobin, hematocrit, urea, creatinine, fasting blood sugar, calcium, phosphorus, albumin, fibrinogen, lipid profile are collected and subjected to biochemical tests. Statistical Analysis: Excel and SPSS 12 were used for data analysis. CONCLUSION: High prevalence of traditional risk factors like diabetes, hypertension, smoking, increased BMI, dyslipidemia and non traditional risk factors like anemia, elevated phosphate levels,hypoalbuminemia and lipoprotein (a) in Chronic kidney disease patients in the study population. 1. More than half of the patients were illiterates and one fourth patients give family history of CVD. 2. Complications like anemia and hyperphosphatemia increased with progression of stage of chronic kidney disease. 3. Significant correlation between IMT with serum phosphate levels, anemia, hypoalbuminemia, eGFR, serum lipoprotein (a) levels were noted. 4. Lipoprotein (a) as a non traditional risk factor in progression of atherosclerosis could play an important role in accelerating progressive atherosclerosis observed in CKD patients which needs more attention. 5. Carotid IMT is a strong predictor of cardiovascular disease in CKD patients and may be usefully applied for risk stratification in this group of patients. 7. Correlation between IMT and dyslipidemia could not be established in the study. 8. Association of IMT with DM, HT, smoking, alcoholism and obesity could not be correlated significantly in this study. 9 Identifying modifiable risk factors for the progression of cardiovascular disease may lead to targeted medical interventions in high-risk groups.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Carotid Intimal Medial Thickness ; estimated Glomerular Filtration Rate (eGFR) ; Cardiovascular Risk Factors ; Patients ; Chronic Kidney Disease. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 29 Mar 2018 02:09 |
| Last Modified: | 29 Mar 2018 02:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6720 |
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