title: Carotid atherosclerosis and endothelial cell adhesion molecules as predictors of long-term outcome in chronic hemodialysis patients.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) remains the leading cause of increased morbidity and mortality for hemodialysis (HD) patients. The aim of this study was to investigate the predictive values of carotid artery atherosclerotic lesions and endothelial adhesion molecule levels for long-term outcome in non-diabetic HD patients.
  
  
  METHODS
  112 HD patients (60 male, mean age 59 years) consecutively entered the study. Atherosclerotic disease was assessed by measuring the mean and maximum intima-media thickness (IMT and IMTmax respectively) of the common carotid arteries using an ultrasound scanner. Circulating intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels were measured by ELISA. Patients were followed for the next 5 years and primary end points on follow-up were all-cause death, death from CVD causes and incidence of a CVD event.
  
  
  RESULTS
  Kaplan-Meier analysis showed that survival curves for all-cause mortality, CVD mortality and morbidity differed significantly between the upper and lower tertiles of baseline IMT (p = 0.002, p = 0.01 and p = 0.001 respectively) and IMTmax values (p = 0.0007, p = 0.006 and p = 0.0003 respectively), as well as ICAM-1 (p = 0.008, p = 0.003 and p = 0.02 respectively) and VCAM-1 levels (p = 0.004, p = 0.012 and p = 0.025 respectively). In non-adjusted analysis all-cause mortality and CVD mortality and morbidity were significantly associated with IMT (p = 0.003, p = 0.01 and p = 0.001 respectively) and IMTmax values (p = 0.001, p = 0.007 and p = 0.0007 respectively). After adjusting for other significant covariates, IMT values remained associated only with CVD morbidity (p = 0.03), while IMTmax were associated with both CVD mortality and morbidity (p = 0.03 and p = 0.01 respectively). All-cause mortality and CVD mortality and morbidity were also significantly associated with serum ICAM-1 (p = 0.004, p = 0.005 and p = 0.01 respectively) and VCAM-1 levels (p = 0.008, p = 0.02 and p = 0.03 respectively). After adjusting for the same covariates, the associations between ICAM-1 and all-cause mortality and CVD mortality and morbidity remained significant (p = 0.02, p = 0.01 and p = 0.02 respectively), while serum VCAM-1 levels were independently associated only with all-cause mortality (p = 0.02).
  
  
  CONCLUSIONS
  In non-diabetic HD patients, carotid atherosclerosis and adhesion molecule levels are independent predictors of long-term clinical outcomes and may be useful surrogate markers for risk stratification in these patients.
authors.affiliation: University Department of Nephrology, Hippokration General Hospital, Thessaloniki, Greece. aikpapag@otenet.gr
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Papagianni
authors.forename: Spyros
authors.initials: S
authors.lastname: Dovas
authors.forename: Christos
authors.initials: C
authors.lastname: Bantis
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Belechri
authors.forename: Michalis
authors.initials: M
authors.lastname: Kalovoulos
authors.forename: Chrysostomos
authors.initials: C
authors.lastname: Dimitriadis
authors.forename: Georgios
authors.initials: G
authors.lastname: Efstratiadis
authors.forename: Efstathios
authors.initials: E
authors.lastname: Alexopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Memmos
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D002448:Cell Adhesion; D042783:Endothelial Cells / Q000166:cytology* / Q000473:pathology; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000378:metabolism
chemical_list: D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1