title: Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients.
abstract: BACKGROUND
  Cardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 +/- 13 years; time on hemodialysis, 13 +/- 7 years; male/female, 144/75).
  
  
  METHODS
  We measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years.
  
  
  RESULTS
  During the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 +/- 0.02 mm) than in those who survived (0.62 +/- 0.01 mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1 mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality.
  
  
  CONCLUSIONS
  These findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis.
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Shizuoka Cancer Center Hospital, Shizuoka, Japan. a.kato@scchr.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kato
authors.forename: Takako
authors.initials: T
authors.lastname: Takita
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Kumagai
authors.forename: Akira
authors.initials: A
authors.lastname: Hishida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography