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[Evaluation of atherosclerosis progression in patients treated repeatedly with hemodialysis]
Andrzej Kraśniak1, Maciej Drozdz, Grzegorz Chmiel
1Katedra i Klinika Nefrologii Collegium Medicum Uniwersytetu Jagiellońskiego, 31-501 Kraków, ul. Kopernika 15c.
Insights
Accelerated atherosclerosis in hemodialysis patients is linked to cardiovascular risks. Key predictors include age, dialysis duration, homocysteine, LDL cholesterol, fibrinogen, phosphate, and iPTH levels, alongside calcium-phosphate imbalances.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Cardiovascular complications from accelerated atherosclerosis are a primary cause of morbidity and mortality in hemodialysis patients.
- Factors like lipid profile disturbances, elevated homocysteine (HC), fibrinogen, intact parathyroid hormone (iPTH), and calcium-phosphate (Ca-P) abnormalities contribute to atherosclerosis progression.
Purpose of the Study:
- To evaluate the advancement of atherosclerosis in patients undergoing maintenance hemodialysis.
- To assess the levels of various pro-atherosclerotic factors in this patient group.
Main Methods:
- The study involved 50 maintenance hemodialysis patients, assessing homocysteine, fibrinogen, iPTH, calcium, phosphate, and lipid metabolism markers.
- Atherosclerosis advancement was evaluated using Multi-Slice Computed Tomography (MSCT) with calcium scoring (CS) and B-mode ultrasound for intima-media thickness (IMT) measurements.
Main Results:
- Coronary artery calcifications (CS) were present in 72% of patients, with a mean CS of 584. CS significantly correlated with age, phosphate, Ca-P product, iPTH, and IMT.
- Mean IMT was 0.89, showing significant correlations with age, time on dialysis, fibrinogen, LDL cholesterol, phosphate, and Ca-P product.
Conclusions:
- Age, duration of dialysis, and elevated levels of homocysteine, LDL cholesterol, fibrinogen, phosphate, and iPTH are significant predictors of atherosclerosis in hemodialysis patients.
- Calcium-phosphate disturbances also play a crucial role in predicting atherosclerosis in this population.
Abstract:
The main cause of increased morbidity and mortality in patients on maintenance hemodialysis are cardiovascular complications due to accelerated atherosclerosis. Lipid profile disturbances, increased levels of homocysteine (HC), fibrinogen, iPTH as and Ca-P abnormalities seem to be the important factors in atherosclerosis progression. The aim of the study was to evaluate the advancement of atherosclerosis in patients on maintenance hemodialysis and to assess levels of pro-atherosclerotic factors. The study included 50 patients (30 M, 20 F) aged 21-75 years (mean 48.6 y) hemodialyzed three times a week for 12 to 282 months (mean 114.5 m). The homocysteine, fibrinogen, iPTH, calcium, phosphate and indices of lipid metabolism such as total cholesterol, HDL, LDL, triglicerides, Lp (a) and Apo B were measured before hemodialysis. To evaluate the advancement of atherosclerosis, all patients underwent MSCT using Somatom plus 4 apparatus with calcium scoring (CS) calculation and B-mode ultrasound for IMT using Acuson 128 XP 10 apparatus. The above applied methods helped to evaluate changes in central and peripheral arteries. In CS testing, coronary artery calcifications were present in 36 patients (72%). The CS ranged from 0 to 4345, with the mean CS being 584 (SD = 1012). The CS correlated significantly with age (r = 0.39; p < 0.005), P (r = 0.33; p < 0.05), CaxP product (r = 0.39; p < 0.05), iPTH (r = 0.43; p < 0.001) and with IMT (r = 0.56; p < 0.0001). The IMT ranged from 0.5 to 1.5, with mean of 0.89 (SD = 0.28). The IMT correlated significantly with age (r = 0.54; p < 0.0001), time on dialysis (r = 0.40; p < 0.01), fibrinogen (r = 0.43; p < 0.02), LDL (r = 0.30; p < 0.05), P (r = 0.29; p < 0.05), and CaxP product (r = 0.3; p < 0.05). Based on our study, we conclude that age, time on dialysis, increased levels of homocysteine, LDL cholesterol, fibrinogen, P, and iPTH as well as Ca-P disturbances are strong predictors of atherosclerosis in HD patients.