Patients with chronic kidney disease are at high risk for developing cardiovascular complications.Cardiovascular diseases are major cause of morbidity and mortality in patients of chronic kidney disease due to accelerated atherosclerosis. Measuring the CIMT is a useful marker of atherosclerosis in chronic kidney disease patients. Coronary artery atherosclerosis can also be correlated with CIMT thickness.

This study focuses on assessing the carotid intima media thickness in patients of non-diabetic kidney disease among the patients admitted in medical wards of saveetha medical college hospital, Chennai.

This was a prospective study of carotid intima media thickness in patients of non-diabetic CKD, done in the Department of Medicine, saveetha Medical College & Hospital, Chennai. A total of 50 patients of non-diabetic CKD were enrolled. Measurement of intima media thickness was done bilaterally in the common carotid arteries and higher value of CIMT of any one carotid artery was recorded using Doppler Ultrasound.

Out of 50 patients of CKD, 42 were males and 8 were females. 22 patients belonged to Stage 3 CKD, 18 patients belonged to stage 4 and stage 5 CKD was observed in 10 patients. CIMT in CKD patients was between 0.9 to 1.0mm. The mean age was 52.6(35-74) years. Hypertension was observed in 38 patients and Dyslipidaemia in 15 patients.

CIMT measurement was done in our study population of 50 patients and CIMT was found to be increased in patients of non-diabetic chronic kidney disease irrespective of the stage of CKD. Patients with High mean blood pressure had high CIMT values as compared to patients having low mean blood pressure. Patients with dyslipidaemia were found to have high levels of CIMT. It is concluded in our study that CIMT was higher in patients with chronic kidney disease irrespective of the stage in Non-diabetic patients.

Keywords: CIMT, CKD.

Global burden of chronic kidney disease has been increasing in the recent times. As the morbidity and mortality from communicable diseases decline, life expectancy increases and degenerative diseases have become more common .CKD is amongst the chronic-non-infectious illnesses in that there is a very real opportunity to continue living comfortably in spite of being terminally ill. Chronic kidney patients are at high risk for developing cardiovascular diseases. The risk of cardiovascular disease in those with CKD compared to the age and sex matched general population ranges from 10-20 folds, depending on the stage of CKD.

Measuring the carotid intima media thickness by ultrasonography in patients with chronic kidney disease is a relatively simple, non-invasive and cost effective method of assessing atherosclerosis. CKD patients are vulnerable to develop cardiovascular and cerebrovascular complications. CIMT measurements assess the risk for future cardiovascular events and analyse the effect of drug therapy. Carotid intima media thickness is taken as a useful surrogate marker of atherosclerosis. Agarwal et al. found a higher CIMT in patients with Diabetes mellitus who also had coronary artery disease which was not clinically overt, leading to the conclusion that measuring the CIMT is a reliable marker for diagnosing subclinical coronary artery disease in patients with Diabetes mellitus. The Aim of the present study is to assess the CIMT in non-diabetic CKD patients thereby demonstrating that CKD as such is an inflammatory disease leading to atherosclerosis irrespective of the stage of CKD.

Study was conducted in the Department of Medicine, Saveetha Medical College & Hospital, Chennai. After obtaining consent from CKD patients of all aetiologies belonging to stage [3-5] were included in the study. Patients with Acute kidney injury and diabetes were excluded from the study. Total 50 patients of CKD were enrolled and the study was conducted for a period of 6 months. Complete blood count, urea, creatinine, Fasting lipid profile, urine routine examination, serum electrolytes reports were collected. eGFR was calculated using the MDRD formula. The MDRD formula is as follows: eGFR = 186.3x (serum creatinine^-1.154) x (age^-0.203) x 1.212 (if black) x0.742 (if female).Patients with CKD were subjected for high resolution B-mode carotid ultrasonography. Bilateral assessment of intimal thickness was done in common carotid artery and higher CIMT value of any carotid artery was recorded. Hypertension was considered as blood pressure ≥140 mmHg systolic and/or ≥90 mmHg diastolic. Dyslipidaemia was considered as LDL cholesterol ≥100 mg/dl or total cholesterol ≥200 mg/dl or HDL in males <40 mg/dl or HDL in females <30 mg/dl, triglycerides level ≥200 mg/dl or VLDL ≥30 mg/dl. Analysis was done using SPSS software; t test was applied to compare the CIMT of patients and controls.

Out of total 50 patients of CKD, 42 were males and maximum numbers of CKD patients were in age group between 34 to 74 years. 85.1% patients were having anemia, 61.2% patients were having edema and 48% patients were having complaints of decreased urine output.

Table 1: Risk factors like hypertension, dyslipidaemia, and smokers were also found in CKD patients

Table 2: The stage wise distribution of CKD patients and their respective mean CIMT values

24% of total patients were having mean BP between 90 to 130 mmHg, 76% of total patients has mean BP >130 mmHg. Patients having high mean BP was having higher mean CIMT in comparison to patients having lower mean BP (figure 1).

Figure 1 – BLOOD PRESSURE VS CIMT