Carotid plaques and their predictive value for cardiovascular disease and all-cause mortality in hemodialysis patients considering renal transplantation: a decade follow-up.
BACKGROUND
Carotid plaque formation is very common in dialysis patients. The prognostic value of plaques, both calcified and noncalcified, rarely was investigated prospectively in these patients. By using a carotid plaque score, this study aims to determine the risk for combined cardiovascular disease (CVD) events and all-cause mortality in 165 hemodialysis patients in a long-term follow-up considering phases of renal transplantation.


METHODS
Baseline carotid ultrasonography was performed in 165 hemodialysis patients to screen for carotid plaques. Patients subsequently were followed up for a period up to 13 years (average, 86 months). Because of biases associated with renal transplantation, 3 methods of multivariate analysis were compared by using Cox proportional hazards regression models.


RESULTS
Plaques were present in 107 of 165 patients (65%). During the observation period, 50 patients (30%) experienced a combined CVD event, 95 patients (58%) died, and 79 patients (48%) underwent at least 1 renal transplantation. Mean plaque score differed significantly between patients who reached an end point and those who did not (CVD events, 3.1 +/- 2.7 versus 2.0 +/- 2.4; P = 0.01; all-cause mortality, 3.5 +/- 2.6 versus 0.9 +/- 1.3; P < 0.001). Plaque score entered all 3 tested Cox regression models for CVD events and all-cause mortality. The lowest statistical power was associated with censoring at the time of renal transplantation. Not considering transplantation at all neglected a major change in risk.


CONCLUSIONS
We identified carotid plaque score and treatment modality as highly significant predictors for CVD events and all-cause mortality.
Schwaiger
Johannes P
JP
Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria.
Lamina
Claudia
C
Neyer
Ulrich
U
König
Paul
P
Kathrein
Hermann
H
Sturm
Wolfgang
W
Lhotta
Karl
K
Gröchenig
Ernst
E
Dieplinger
Hans
H
Kronenberg
Florian
F
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D014463:Ultrasonography