Carotid artery stenosis in patients with chronic kidney disease undergoing dialysis: epidemiological aspects, main risk factors and appropriate diagnostic criteria

Knowledge of the epidemiology and risk profile of peripheral vascular disease among patients with chronic kidney disease (CKD) has a potential role for determining its outcome. This study assessed the epidemiological aspects and risk factors of carotid artery stenosis (CAS),assessed by clinical ankle brachial index (ABI),in patients on dialysis. This study was performed on 84 patients with CKD undergoing hemodialysis (HD; n = 65) or peritoneal dialysis (PD; n = 19). The ABI was measured using a concurrent oscillometric method and Color Doppler sonography. An ABI value 0.9 was defined as normal. Severity of the stenosis was determined using B-Mode sonography. Overall,CAS was seen in 51.2% of the study patients. No significant difference was found in the overall prevalence of CAS between the HD and PD groups (50.8% vs. 52.6%,P = 0.552). The mean ABI in the HD and PD groups was 1.13 and 1.06,respectively. Among patient characteristics,advanced age was found to be a predictor of CAS in the study patients. Gender,type of dialysis or underlying risk factors could not predict CAS. ABI measurement was an acceptable predictor of CAS,with a receiver operator characteristic of 0.645. The optimal cut-off for ABI for predicting CAS was identified at 1.0; this yielded a sensitivity of 70.8% and a specificity of 63.6% for the test. In conclusion,a notable number of patients undergoing dialysis for CKD had CAS. The main predictive factor was advanced age. ABI measurement seems to be an acceptable tool to diagnose CAS.