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Advanced atherosclerosis in predialysis patients with chronic renal failure
Tetsuo Shoji1, Masanori Emoto, Tsutomu Tabata
1Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan. t-shoji@med.osaka-cu.ac.jp
Insights
Chronic renal failure, not hemodialysis, significantly increases carotid artery intima-media thickness (CA-IMT). This suggests renal failure itself drives advanced atherosclerosis in these patients, independent of dialysis treatment.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Atherosclerosis is accelerated in hemodialysis patients, evidenced by increased carotid artery intima-media thickness (CA-IMT).
- It remains unclear if hemodialysis treatment or underlying chronic renal failure (CRF) drives this accelerated atherosclerosis.
Purpose of the Study:
- To investigate the independent effects of chronic renal failure and hemodialysis treatment on CA-IMT.
Main Methods:
- Carotid artery intima-media thickness (CA-IMT) was measured using high-resolution B-mode ultrasonography.
- Study included 110 patients with CRF before dialysis, 345 hemodialysis patients, and 302 healthy controls.
- All participants were nondiabetic and comparable in age and gender.
Main Results:
- Both CRF and hemodialysis groups exhibited significantly greater CA-IMTs compared to healthy controls.
- No significant difference in CA-IMT was observed between CRF and hemodialysis groups.
- Multiple regression analysis identified renal failure, not hemodialysis, as a significant independent factor associated with increased CA-IMT.
Conclusions:
- Arterial wall thickening (atherosclerosis) is present in patients with chronic renal failure even before dialysis initiation.
- Findings support the hypothesis that advanced atherosclerosis in hemodialysis patients is primarily due to renal failure and associated metabolic abnormalities, rather than the hemodialysis treatment itself.
Background:
Atherosclerosis is advanced in hemodialysis patients as shown by increased intima-media thickness of carotid arteries (CA-IMT), although it is not established whether the advanced atherosclerosis results from hemodialysis treatment or from chronic renal failure. The purpose of this study was to evaluate the effects of hemodialysis and renal failure on CA-IMT in patients with chronic renal failure.
Methods:
CA-IMT was measured by high-resolution B-mode ultrasonography in 110 patients with chronic renal failure before starting dialysis (CRF group), and compared with CA-IMT of 345 hemodialysis patients (HD group) and 302 healthy control subjects. They were all nondiabetic and the three groups were comparable in age and gender.
Results:
As compared with the healthy control subjects, the CRF and HD groups had greater CA-IMTs, whereas CA-IMTs of the CRF and HD groups were not statistically different. There was no significant correlation between duration of hemodialysis and CA-IMT in the HD group. Multiple regression analysis in the total subjects indicated that presence of renal failure, but not being treated with hemodialysis, was a significant factor associated with increased CA-IMT independent of age, gender, blood pressure, smoking, high-density lipoprotein (HDL) and non-HDL cholesterol levels.
Conclusions:
These results demonstrate that thickening of arterial wall is present in patients with chronic renal failure before starting hemodialysis treatment, and support the concept that advanced atherosclerosis in hemodialysis patients is due not to hemodialysis treatment, but to renal failure and/or metabolic abnormalities secondary to renal failure.