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

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.