Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease

Background: Chronic kidney disease (CKD) is strongly associated with peripheral artery disease (PAD). Detection of subclinical PAD may allow early interventions for or prevention of PAD in persons with CKD. Whether the presence of atherosclerotic plaque and femoral intima-media thickness (I MT) are associated with kidney function is unknown. Methods: We performed a cross-sectional observational study of 1029 community-living adults. We measured superficial and common femoral artery I MT and atherosclerotic plaque presence by ultrasound. Estimated glomerular filtration rate (eGFR; continuous) and eGFR <60 mL/min/1.73 m(2) (binary) were evaluated as outcomes. Results: Mean age was 70 +/- 10 years, mean eGFR was 78 +/- 17 mL/min/1.73 m(2), and 156 (15%) individuals had eGFR <60 mL/min/1.73 m(2); 260 (25%) had femoral artery plaque. In models adjusted for demographics and cardiovascular risk factors, individuals with femoral artery plaque had mean eGFR approximately 3.0 (95% confidence interval, -5.3 to -0.8) mL/min/1.73 m(2) lower than those without plaque (P <.01). The presence of plaque was also associated with a 1.7- fold higher odds of eGFR <60 mL/min/1.73 m(2) (95% confidence interval, 1.1-2.8; P <.02). Associations were similar in persons with normal ankle-brachial index. The directions of associations were similar for femoral I MT measures with eGFR and CKD but were rendered no longer statistically significant with adjustment for demographic variables and cardiovascular disease risk factors. Conclusions: Femoral artery plaque is significantly associated with CKD prevalence in community-living individuals, even among those with normal ankle-brachial index. Femoral artery ultrasound may allow evaluation of relationships and risk factors linking PAD and kidney disease earlier in its course.