Carotid ultrasound for the early diagnosis of atherosclerosis in chronic kidney disease

Abstract

Atherothrombotic disease (ATD) is a progressive disorder and its most common clinical manifestations, acute myocardial infarction and stroke, are responsible for the highest morbidity and mortality rates in the Western world. Sudden death due to infarction with no prior symptoms occurs in 50% of men and 64% of women.1 One of the main tools to control the incidence of vascular disease is prevention. Formulas are available to estimate cardiovascular risk (Framingham risk score, etc.)2 They are based on epidemiological studies that determine the risk of suffering a cardiovascular event (fatal or non-fatal) within 5 to 10 years.3 While the available system to calculate cardiovascular risk is easily generalisable, and universal, it does present some difficulties. The main drawback is its low sensitivity for detecting individuals at a high risk to suffer a cardiovascular event. Large epidemiological studies show that 62% of subjects with a prior history of myocardial infarction present none or only one of the cardiovascular risk factors,4 which, undoubtedly, prevents them from being properly identified at a time to take effective preventive actions. In recent years, there have been significant technological advances in medical imaging techniques, particularly in the field of vascular disease. Below, we describe the advantages, disadvantages and uses of imaging techniques in the general population and in chronic kidney disease (CKD) patients.