Subclinical Atherosclerosis in Patients with Chronic Non-Dialytic Renal Disease

Cardiovascular diseases are currently the major cause of morbidity and mortality. Atherosclerosis alone is their most important cause and is characterized by a progressive multifactorial disease caused by genetic and acquired factors such as lipid accumulation, development of fibrosis and artery obstruction. The risk among patients with chronic renal failure (CRF) is higher than that among the general population, with a high prevalence of coronary artery disease (40%) and mortality from 10 to 20 times higher, especially among those in a hemodialysis program, accounting for 50% of deaths in dialytic patients^,. Investigation and assessment of subclinical atherosclerosis using imaging methods (calcium score in coronary CT scan, ultrasonography or angiography) may be used to identify and stratify the atherosclerotic risk, considering that the atherosclerotic plaque burden correlates with the risk of coronary events, especially in patients with chronic dialytic renal failure.

Measurement of the myointimal thickness is a safe, low-cost, easy-access method to identify patients with subclinical or obstructive disease. Groot et al. showed that myointimal thickness of up to 0.8 mm could be considered normal, and higher values would characterize early stages of arterial wall thickening. In patients with non-dialytic CRF, there is a high prevalence of myointimal thickening in the different age ranges, thus showing an active process of subclinical atherosclerosis. However, the lack of a standard reference table for the Brazilian population is a limitation for inferences.

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