Kidney Week

Abstract: TH-PO0346

Patterns and Predictors of MRI-Based Atherosclerotic Burden in CKD: Baseline Analysis of the MaCK Study Participants

Session Information

• Hypertension and CVD: Clinical - 1
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Shukla, Ashutosh M., US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States

Ashutosh M. Shukla, MD, FASN

• Joyce, Malea, University of New Mexico Consortium of the Americas for Interdisciplinary Science, Albuquerque, New Mexico, United States

Malea Joyce

• Parmar, Cydney El Cid, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States

Cydney El Cid Parmar, MPH

• Senthil, Nandita, University of Florida, Gainesville, Florida, United States

Nandita Senthil

• Lyles, Teresa A., US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States

Teresa A. Lyles, PhD

• Ftouni, Darin, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States

Darin Ftouni, MD

• Pepine, Carl J., University of Florida, Gainesville, Florida, United States

Carl J. Pepine, MD

• Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States

Alfred K. Cheung, MD

• Shah, Sudhir V., University of Arkansas System, Little Rock, Arkansas, United States

Sudhir V. Shah, MD

• Segal, Mark S., US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States

Mark S. Segal, MD, PhD, FASN

Background

CKD is associated with a higher cardiovascular disease (CVD) burden, with an increase in both vascular atherosclerosis and stiffness. While epidemiological studies support using eGFR and albuminuria to stratify CVD risks in CKD, we lack credible evidence associating these measures with vascular pathology in CKD.

Methods

Management of CVD in CKD (MaCK) study is a VA-based phase 2b randomized controlled trial (NCT03636152) to evaluate the impact of 18-month hydroxychloroquine (HCQ) on atherosclerosis (primary outcome, as measured by carotid MRI), vascular stiffness, and CKD progression. This cross-sectional analysis was conducted after achieving target enrollments (n=100) and used baseline study data, including clinical phenotype, blood test results, and measures of aortic pulse wave velocity (APWV) and carotid MRI to quantify atherosclerotic burden and characteristics.

Results

Ninety-six of the 100 enrolled Veteran participants with complete baseline data set were included in this analysis. Pertinent participant characteristics: age(±SD) 71±6 years; male 95%; history of smoking 49%; diabetes 83%; eGFR 39±10ml/min/1.73m²; RAAS blockers 53%; beta blockers 52%; UACR 489±908 mg/gm; APWV 9.54±1.9m/s; and carotid MRI parameters of total plaque volume 1640±419mm³, normalized wall index (NWI) 61±4.6, necrotic core volume 139±132mm³, fibrotic core volume 55.4±90mm³, and calcification volume 153±153mm³. When cluster analysis was conducted on MRI findings, vascular pathology was found to have three distinct clusters of ‘near-normal,’ ‘necrotic-heavy,’ and ‘calcification-heavy’ pathologies. While eGFR was statistically associated with APWV (correlation coefficient: -0.07, 95%CI: -0.11, -0.02, P=0.005), no significant correlations between eGFR, UACR, and APWV with any MRI atherosclerotic parameter were evident.

Conclusion

Among moderate-severe CKD patients, clinical, blood tests, and vascular functional markers were found to have limited correlations with carotid artery atherosclerotic pathology. A secondary analysis focusing on the predictors of heterogeneous cluster of necrotic vs. calcification-heavy phenotypes may allow better predictive modeling of CVD in CKD.

Funding

• Other U.S. Government Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025zpb489z8