Arterial endothelial function, carotid artery intima-media thickness and abdominal aortic calcification in diabetic and nondiabetic CKD stage 4-5 patients not on dialysis

Abstract

Aims: We aimed to study the effect of diabetes (DM) on endothelial dysfunction assessed by flow-mediated vasodilatation (FMD), carotid intima-media thickness (cIMT) and abdominal aortic calcification score (AAC) in chronic kidney disease (CKD) stage 4-5 patients not on dialysis.

Methods: Altogether 199 non-dialysis CKD stage 4-5 patients enrolled in the Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study with plain lumbar radiograph for the assessment of AAC were included. Data on cIMT and FMD were available for 172 and 161 patients, respectively.

Results: Median age was 65 (IQR 54-76) years, 88 (44.2%) patients had DM and median eGFR was 12 (IQR 10-14) ml/min/1.73 m² in the study. FMD [controls: 3.3(2.0-6.7)% vs. DM-patients: 4.3(1.3-6.6)%, p = 0.73] and cIMT [controls: 0.65(0.58-0.87)mm vs. DM-patients: 0.67(0.59-0.81)mm, p = 0.65], were similar between the groups. AAC was higher in patients with DM [controls: 5(1-9) vs. DM-patients: 7(2-13), p = 0.01]. The significant multivariate determinants for AAC were older age (β = 0.22, p < 0.0001), pulse pressure (β = 0.05, p < 0.0001), DM (β = 1.33, p = 0.04) and ProBNP (per µg/l β = 0.18, p = 0.0008). AAC and cIMT were associated with incident cardiovascular death independent of DM.

Conclusions: DM is associated with increased AAC but not increased cIMT or attenuated FMD in advanced CKD patients.

Keywords: Abdominal aortic calcification score; Atherosclerosis; Carotid intima-media thickness; Chronic kidney disease; Flow-mediated dilatation.