Carotid atherosclerosis in kidney disease.

Recently, chronic kidney disease (CKD) has become a major public health problem and a risk factor for all-cause mortality, cardiovascular disease (CVD). To prevent cardiovascular disease as early as possible, subclinical studies for CKD are essential. Recently, carotid atherosclerosis has been evaluated by measurement of the intima-media thickness (IMT) of the carotid artery wall, which is a good predictor of incidence of CVD. In this manuscript, I reviewed subclinical studies on the relationship between the carotid atherosclerosis and kidney dysfunction in a general population. Cross-sectional studies for general populations have shown an inverse association of carotid IMT with renal function. In one large cross-sectional study in a US population, the cystatin C level had no independent association with carotid IMT. However, in cross-sectional studies for outpatients, a significant association was observed between the two in subjects with kidney dysfunction. The association between CKD and carotid IMT tends to be weaker in apparently healthy populations than in patients. A higher level of blood pressure decreases renal function, and a decreased GFR raises blood pressure. In other words, increases in blood pressure and decreases of renal function exacerbate each other. Therefore, an investigation of the incidence of CVD and subclinical analyses of both renal dysfunction and blood pressure categories is called for. The impact of high-normal blood pressure and hypertension on stenosis were more evident in subjects with CKD. Carotid atherosclerosis tended to be more severe in subjects with CKD and high blood pressure. These findings pointed to the importance of early detection of subjects with decreased renal function and the strict management of blood pressure in general populations.