Influence of haemodialysis on early markers of atherosclerosis.
BACKGROUND
End-stage renal disease (ESRD) patients treated by haemodialysis (HD) have impaired endothelium-dependent vasodilatation and increased intima-media thickness (IMT) of the carotid artery The aim of the study was to analyse the relationships between parameters of chronic HD treatment and non-invasive assessments of preclinical atherosclerosis (endothelial dysfunction and carotid IMT) in ESRD patients on HD.


METHODS
Fifty-two (19 females, 33 males) adult patients on chronic maintenance (4.65 +/- 3.29 years) HD aged 59.88 +/- 15.49 years were investigated. Ultrasonographic studies were performed with a 7.5 MHz high-resolution probe. The common carotid artery IMT was measured. Brachial artery diameter was analysed to the rest. In order to assess flow-mediated dilatation (FMD), hyperaemia was induced by a pneumatic cuff, and an analysis of the diameter was performed 1, 2, 3 and 4 min after cuff deflation.


RESULTS
Significant differences were found in the average carotid IMT value between subjects with delivered dialysis dose (Kt/V) > or =1.2 and <1.2 (0.89 +/- 0.21 vs 1.04 +/- 0.11, P = 0.0045). A correlation between Kt/V and IMT (r = 0.366, P = 0.004) was demonstrated. FMD values of the brachial artery did not correlate with Kt/V. A correlation between low molecular weight heparin per kg of body mass and maximal percent of FMD was demonstrated (r = -0.242, P = 0.049). The maximal percent of brachial FMD was correlated with absolute difference between pre- and postdialysis pulse pressure values (r = -0.265, P = 0.033). In a partial correlation with haemoglobin as control, a variable significant correlation between total erythropoietin dose and maximal carotid IMT (r = -0.262, P = 0.036) was found. In a multiple linear regression model, Kt/V was independently correlated with carotid IMT values (beta = -0.227, P = 0.0335).


CONCLUSIONS
This study has demonstrated the association between HD procedure and early atherosclerosis markers. HD treatment has to be considered as potential modifying factor in atherosclerosis development.
Department of Nephrology, Internal Clinic, University Hospital Split, Split, Croatia. vedkovac@inet.hr
Vedran
V
Kovacic
Dragan
D
Ljutic
Josipa
J
Dodig
Mislav
M
Radic
Darko
D
Duplancic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers; D002339:Carotid Arteries / Q000473:pathology; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000502:physiology; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D015415:Biomarkers; D011994:Recombinant Proteins; D004921:Erythropoietin