Evaluation of atherosclerosis, arterial stiffness and related risk factors in chronic hemodialysis patients in Siriraj Hospital.

Abstract

Additional to traditional risk factors for cardiovascular disease (CVD), recent evidence demonstrates that nontraditional risk factors such as high-sensitive C-reactive protein (hsCRP), hyperhomocysteinemia and vascular calcification may cause progressive atherosclerosis in hemodialysis patients. We aim to determine the prevalence of atherosclerosis and assess the arterial stiffness and related risk factors. Common carotid artery intima-media thicknesses (CIMT), atherosclerotic plaque occurrence were determined by B-mode ultrasonography in 105 hemodialysis patients (mean age, 53 +/- 15.5 years; mean dialysis duration 82 +/- 59.5 months). A history of clinically significant atherosclerotic vascular disease was elicited by patient questionnaire and verified by careful patient chart review and physical examination. Cardiovascular ankle index (CAVI) was use to assess arterial stiffness. Serum biochemical marker for traditional risk factors, hsCRP and homocysteine were measured by standard method. Atherosclerotic vascular disease (defined by a history of CVD or presence of atherosclerotic plaque) was present in 79% of patients. Compared to non-atherosclerotic group, the mean CIMT and serum hsCRP in atherosclerotic group was higher (1.9 +/- 0.8 mm vs. 0.8 +/- 0.6 mm, p < 0.001; 6.5 +/- 8.8 mg/L vs. 3.3 +/- 3.5 mg/L, p = 0.03, respectively), while other biochemical markers were not significantly different, as well as the percentage of abnormal CAVI (69% vs. 54.5%, p = 0.28). CAVI was positively correlated with maximum carotid intima-meida thickness (r = 0.44, p < 0.001). CAVI was also significantly greater in patients with carotid plaque (soft plaque (p < 0.05) and calcified plaque (p < 0.05)) compared with patients without carotid plaque. A high prevalence of atherosclerosis and arterial stiffness was observed in hemodialysis patients. Carotid atherosclerosis is associated with an increased inflammatory marker (hsCRP). CAVI may be a useful index to assess arterial stiffness and associated with arterial intima-media thickness.