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Increased carotid stiffness and remodelling at early stages of chronic kidney disease

Zanoli, Lucaa,b,c,*; Empana, Jean-Philipped,e,*; Perier, Marie-Cecilee; Alivon, Maureenb; Ketthab, Hakimb; Castellino, Pietroa; Laude, Dominiqued; Thomas, Frederiquef; Pannier, Brunob,f; Laurent, Stephaneb,c,d,*; Jouven, Xavierc,d,e,*; Boutouyrie, Pierreb,c,d,*

doi: 10.1097/HJH.0000000000002007

Objective: Increased carotid stiffness and remodelling is reported in patients with moderate and advanced chronic kidney disease (CKD) and is associated with cardiovascular events. Here, we tested the hypothesis that carotid artery alterations start earlier, during mild CKD.

Methods: Within the Paris Prospective Study 3, a large prospective observational survey of nonreferred people aged 50–75 who received an extensive health check-up, there were 294 participants with glomerular filtration rate (GFR) of at least 45 and less than 60 ml/min per 1.73 m2 (Stage 3A CKD), 840 participants with GFR 60–89 ml/min per 1.73 m2 with proteinuria (Stage 2 CKD), 4666 participants with GFR 60–89 ml/min per 1.73 m2 without proteinuria and 3317 individuals with GFR at least 90 ml/min per 1.73 m2 at study recruitment. Carotid artery measurements were performed using a high-resolution echotracking device.

Results: Compared with patients with GFR at least 90 ml/min per 1.73 m2, the carotid distensibility and strain progressively decreased (P for trend <0.0001), whereas carotid stiffness progressively increased (P for trend <0.0001) across GFR categories starting at early stage from GFR 60–89 ml/min per 1.73 m2 without proteinuria. Higher Young's elastic modulus was observed only for Stage 3A CKD, whereas carotid internal diastolic diameter did not differ between groups.

Conclusion: The large arterial stiffening starts early during CKD, even in participants with a very mild reduction in renal function.

aDepartment of Clinical and Experimental Medicine, School of Nephrology, University of Catania, Catania, Italy

bDepartment of Pharmacology, INSERM U970

cDepartment of Pharmacology, Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou

dUniversité Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine

eINSERM U970, Cardiovascular Epidemiology and Sudden Cardiac Death

fPreventive and Clinical Investigation Center (IPC), Paris, France

Correspondence to Luca Zanoli, MD, PhD Nephrology, Department of Clinical and Experimental Medicine, Policlinico Universitario di Catania, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy. Tel: +39 3474574122; fax: +39 0953782376; e-mail:

Abbreviations: BP, blood pressure; CKD, chronic kidney disease; GFR, glomerular filtration rate; PPS3, Paris Prospective Study 3

Received 12 July, 2018

Accepted 29 October, 2018

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