Benedetto FA et al. (2008) Rate of atherosclerotic plaque formation predicts cardiovascular events in ESRD. J Am Soc Nephrol [doi:10.1681/ASN.2007070813]

Carotid intima–media thickness (IMT) is a predictor of cardiovascular events in end-stage renal disease (ESRD), but whether changes in IMT or in other indicators of atherosclerosis have additional predictive value is not known. Benedetto et al. used carotid ultrasonography in patients with ESRD to assess whether longitudinal measurement of markers of atherosclerosis provides useful information on cardiovascular prognosis.

All 135 dialysis patients enrolled in this observational study underwent echo-color Doppler of the carotid arteries at baseline, and 103 underwent this procedure again, after an average of 15 months (range 11–19 months). Changes in mean carotid IMT, wall:lumen ratio, internal diameter, and cross-sectional area were not significant, were not related to the increase observed in the number of carotid atherosclerotic plaques (which was significant [P<0.001]), and failed to predict death and cardiovascular events during follow-up after the second ultrasound assessment (mean follow-up 28 ± 14 months). After adjustment for various risk factors including age and smoking, formation of new atherosclerotic plaques was found to be associated with fatal or nonfatal cardiovascular events (P = 0.01). The number of plaques at baseline also independently predicted formation of new plaques (P = 0.004), but the prognostic power of baseline plaque number for cardiovascular events (P = 0.003) increased by 8% when new plaque formation was added as a variable.

Ultrasound imaging of changes in carotid plaque burden, but not of changes in IMT or other markers of carotid atherosclerosis, could, therefore, be useful for determining cardiovascular prognosis in patients with ESRD.