Abstract P218: Carotid Intima-media Thickness and Incident End-stage Renal Disease: The Atherosclerosis Risk in Communities Study

Introduction: Carotid intima-media thickness (IMT) has been reported to predict kidney function decline. However, whether carotid IMT is associated with a hard kidney endpoint, end-stage renal disease (ESRD), has not been investigated. Hypothesis: We assessed the hypothesis that increased carotid IMT is associated with ESRD risk. Methods: We studied 13,197 ARIC participants at visit 1 (1987-1989) without history of cardiovascular disease including coronary heart disease, stroke and heart failure and assessed whether carotid IMT measured by B-mode ultrasound is associated with ESRD risk using Cox proportional-hazards models. Regarding carotid IMT parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation and internal carotid arteries) measurements. Results: Mean age was 54.0 (SD 5.7) years, and there were 3,373 (25.6%) blacks and 7,370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1,000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid IMT was significantly associated with ESRD risk (hazard ratios between quartiles 4 and 1, 1.43 [95%CI: 1.01-2.04] for overall mean IMT and 1.73 [95%CI: 1.22-2.44] for overall maximum IMT). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific IMTs, the associations with ESRD were most robust for bifurcation carotid. The adjusted hazard ratios between quartiles 4 and 1 were 1.48 (95%CI: 1.04-2.11) for mean bifurcation IMT and 1.42 (95%CI: 0.99-2.03) for maximum bifurcation IMT. Conclusions: Carotid IMT was independently associated with incident ESRD in the general population. Our findings suggest the shared etiology between atherosclerosis and ESRD and highlight the importance of monitoring kidney function over time in individuals with subclinical atherosclerosis.