[Evaluation of atherosclerosis progression in patients treated repeatedly with hemodialysis].
The main cause of increased morbidity and mortality in patients on maintenance hemodialysis are cardiovascular complications due to accelerated atherosclerosis. Lipid profile disturbances, increased levels of homocysteine (HC), fibrinogen, iPTH as and Ca-P abnormalities seem to be the important factors in atherosclerosis progression. The aim of the study was to evaluate the advancement of atherosclerosis in patients on maintenance hemodialysis and to assess levels of pro-atherosclerotic factors. The study included 50 patients (30 M, 20 F) aged 21-75 years (mean 48.6 y) hemodialyzed three times a week for 12 to 282 months (mean 114.5 m). The homocysteine, fibrinogen, iPTH, calcium, phosphate and indices of lipid metabolism such as total cholesterol, HDL, LDL, triglicerides, Lp (a) and Apo B were measured before hemodialysis. To evaluate the advancement of atherosclerosis, all patients underwent MSCT using Somatom plus 4 apparatus with calcium scoring (CS) calculation and B-mode ultrasound for IMT using Acuson 128 XP 10 apparatus. The above applied methods helped to evaluate changes in central and peripheral arteries. In CS testing, coronary artery calcifications were present in 36 patients (72%). The CS ranged from 0 to 4345, with the mean CS being 584 (SD = 1012). The CS correlated significantly with age (r = 0.39; p < 0.005), P (r = 0.33; p < 0.05), CaxP product (r = 0.39; p < 0.05), iPTH (r = 0.43; p < 0.001) and with IMT (r = 0.56; p < 0.0001). The IMT ranged from 0.5 to 1.5, with mean of 0.89 (SD = 0.28). The IMT correlated significantly with age (r = 0.54; p < 0.0001), time on dialysis (r = 0.40; p < 0.01), fibrinogen (r = 0.43; p < 0.02), LDL (r = 0.30; p < 0.05), P (r = 0.29; p < 0.05), and CaxP product (r = 0.3; p < 0.05). Based on our study, we conclude that age, time on dialysis, increased levels of homocysteine, LDL cholesterol, fibrinogen, P, and iPTH as well as Ca-P disturbances are strong predictors of atherosclerosis in HD patients.
Kraśniak
Andrzej
A
Katedra i Klinika Nefrologii Collegium Medicum Uniwersytetu Jagiellońskiego, 31-501 Kraków, ul. Kopernika 15c.
Drozdz
Maciej
M
Chmiel
Grzegorz
G
Szumilak
Dorota
D
Kowalczyk-Michałek
Martyna
M
Podolec
Piotr
P
Pasowicz
Mieczysław
M
Klimeczek
Piotr
P
Konieczyńska
Małgorzata
M
Wicher-Muniak
Ewa
E
Tracz
Wiesława
W
Sułowicz
Władyslaw
W
D000328:Adult; D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D002118:Calcium / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006710:Homocysteine / Q000378:metabolism; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000378:metabolism; D006435:Renal Dialysis / Q000009:adverse effects*; D014463:Ultrasonography
D008078:Cholesterol, LDL; D010710:Phosphates; D006710:Homocysteine; D005340:Fibrinogen; D002118:Calcium