Impact of non-invasive cardiovascular screening programs as a predictor of cardiovascular events among asymptomatic chronic kidney disease patients

Background: The clinical usefulness of physiological and radiological examinations for cardiovascular disease (CVD) risk stratification has not been fully demonstrated in chronic kidney disease (CKD) patients. In the present study, predictive values of CVD were investigated among asymptomatic CKD patients by comprehensive and non-invasive CVD screening programs. Methods: We prospectively evaluated 139 asymptomatic CKD patients. All patients were examined by comprehensive and non-invasive CVD risk screening programs that included carotid ultrasonography, coronary artery calcification score (CACS), pulse wave velocity, and flow-mediated vasodilation, and their associations with major adverse cardiovascular events (MACEs) were analyzed. Results: During the median follow-up of 32.3 months, 13 MACEs were observed. Among all CVD screening examinations, severity of the carotid plaque score (PS) and CACS was significantly higher in the MACE group than in the MACE-free group (11.3 ± 5.8 versus 6.1 ± 5.3, P = 0.001 and 657 versus 74, P = 0.020, respectively). Kaplan–Meier curves for the incidences of MACEs classified according to the combination of carotid PS and CACS showed that severe carotid PS and severe CACS groups had the highest event rate in comparison with the groups without any of these (29.9, 11.9, and 3.6 %, respectively, P < 0.001). Conclusions: In this long-term follow-up analysis, the combination of carotid atherosclerosis and CACS was a useful and non-invasive screening tool for predicting cardiovascular events among asymptomatic CKD patients.