Chronic kidney disease (CKD) is characterized by a very high cardiovascular risk even at moderate stage. Patients with CKD are exposed to traditional cardiovascular factors and to uremia-associated CV factors such as inflammation, oxidative stress, anemia, mineral metabolism disturbance which could affect the structure of large and small arteries. In moderate CKD, large artery damage is mainly characterized by an increase in aortic and carotid stiffness compared to hypertensive and healthy subjects. Interestingly, we recently demonstrated that aortic stiffness did not increase during CKD progression and was not associated with CKD progression. On the contrary, aortic stiffness has a clear impact on the cardiovascular prognostic in end stage renal disease. A maladaptive remodeling of large arteries is the second main abnormality in moderate CKD and is characterized by dilation and a thinning of the arterial wall leading to an increase in circumferential wall stress. The longitudinal measurements of carotid remodeling parameters have shown that intima-media thickness decreased with a slope comparable to the one measured in high cardiovascular risk patients but in an opposite way. We recently demonstrated that, in opposition to aortic stiffness, circumferential wall stress measured at the level of the carotid artery was associated with CKD progression and end stage renal disease.

In conclusion, arterial damage in moderate CKD is characterized by an increase in arterial stiffness, associated with a poor cardiovascular outcome at end stage but with debated impact on CKD progression, and a paradoxical thinning of the arterial wall, associated with CKD progression.