18100006009 THESIS

TITLE:

“EVALUATION OF CAROTID INTIMAL MEDIAL THICKNESS AND ESTIMATED GLOMERULAR FILTRATION RATE IN CHRONIC KIDNEY DISEASE”

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 loss of nephron function leading to end stage renal disease. 

Kidney failure is the most common 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 end stage renal failure may vary widely not only between different diseases with different histopathological findings but also in different patients with similar disease processes. 

The progressive nature of CKD and the final stage ESRD is putting a substantial burden on global and national health resources since all modalities of treatment are expensive. 

There are multiple causes of kidney injury that lead to the final common pathway of end stage renal disease, and this syndrome is characterized by hypertension, anaemia, nutritional impairment, neuropathy ,renal bone disease, 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 and other 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 in patients.

 The increased incidence of CVD is the consequence of a high prevalence of both traditional risk factors, uraemia-related ,and “new factors,” such as infections (Herpes virus and Chlamydia pneumoniae) and hyper-homocysteinemia, oxidative stress, which increases atherosclerotic risk among these patients. 

According to the 1999-2004 National Health and Nutrition Examination Survey(NHANES), the prevalence of Chronic Kidney Disease among the USA population is 15.3%. 

It becomes apparent that the severity of CKD along with CVD severity in any population makes a very fatal combination for both patients and healthcare systems. 

Approximately 50% of patients with ESRD die from a major cardiovascular event , which indicates a cardiovascular mortality that is 14 30times 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. 

Studies have suggested that carotid intimal medical thickness can be used as a screening test as well as marker for atherosclerosis in cardio vascular disease .

Non-invasive assessment of intima medial thickness of carotid arteries by B – mode ultrasonography is used widely in observational studies and trials as an indicational measure of generalised atherosclerosis. 

Increased intimal medial thickness of carotid arteries has been associated with disadvantageous levels of established cardiovascular risk factors, prevalent cardiovascular disease and atherosclerosis somewhere in the arterial system. 

In this study the attempt to evaluate the association of increased intimal medial thickness with traditional and non-traditional cardiovascular risk factors in CKD patients was tried. 

AIM:

Study of the carotid intimal medial thickness and estimated glomerular filtration rate in patients with Chronic Kidney Disease 

OBJECTIVES:

Determine the stage of chronic kidney disease (CKD) depending on estimated glomerular filtration rate (eGFR) 

To assess the carotid intimal medial thickness and estimated glomerular filtration rate in different stages of chronic kidney disease 

To study the effect of cardiovascular risk factors on the grade of chronic kidney disease based on history and lipid profile of the patient. 

To assess the carotid intimal medial thickness for detection of atherosclerosis in chronic kidney disease patients. 

PATIENTS AND METHODS:

PLACE OF STUDY: The patients attending Internal medicine and nephrology department in Kamineni Institute of Medical Sciences, Narketpally. 

STUDY DESIGN: Single centre, Cross sectional study 

DURATION OF STUDY: 2 years (i.e. October 2018 to September 2020). 

SAMPLE SIZE: 60 cases over 2 years 

INCLUSION CRITERIA: 

Patients diagnosed with chronic kidney disease getting treated at Department of Internal Medicine and Nephrology at Kamineni Institute of Medical Sciences, Narketpally. 

EXCLUSION CRITERIA:

Patients with Nephrotic syndrome 

Patients using statins 

Patients on treatment with antiplatelets 

Patients presenting with acute on chronic kidney disease 

Patients with previous history of cardiovascular events

CONCLUSION AND SUMMARY: 

High prevalence in traditional risk factors like diabetes, hypertension, smoking, age, alcohol, increased BMI was studied along with high prevalence in non-traditional risk factors like anaemia was studied.

More than half of the study population were illiterates 

Less than 1/10th of patients showed positive family history 

Carotid intimal medial thickness is a strong predictor of cardiovascular disease in CKD patients and maybe usefully applied in this group of patients 

Association of carotid intimal medial thickness with diabetes mellitus in CKD patients is strong and maybe useful in this group of patients 

Association of carotid intimal medial thickness with a non traditional risk factor like anaemia is strong as was correlated in this study 

Association between carotid intimal medial thickness and dyslipidemia could not be established in this study 

Association of carotiod intimal medial thickness with hypertension, smoking, alcoholism and obesity could not be correlated in this study 

Identifying modifiable risk factors for the progression of cardiovascular disease may lead to targeted medical interventions in high risk groups.

LINK TO COMPLETE THESIS WITH MASTER CHART

https://drive.google.com/file/d/167mtL-h9yvB-K5HFSsekrEyKhxIYKjNT/view?usp=drivesdk