[Calcification of peripheral arteries in patients with terminal renal failure on programmed hemodialysis]

To estimate incidence and clinical significance of carotid and femoral arteries calcification in patients with terminal renal failure (TRF) on programmed hemodialysis (PH).

Thirty four patients (25 males and 9 females) with TRF were divided into two groups by severity of hyperphosphatemia: 15 patients with P < 6 mg/dl (group 1) and 19 patients with P > 6 mg/dl. The groups were matched by age (44.4 +/- 15.05 and 42.7 +/- 14.23 years, respectively) and PH duration (2.4 +/- 1.1 and 2.6 +/- 1.16 years, respectively). Calcification of the arteries and structure of the vascular wall were examined with ultrasonic dopplerography of the common carotid and femoral arteries. Measurements were made of intima-media complex (IMC) thickness, systolic and diastolic diameter of the right and left carotid artery. The arteries were studied for the presence of calcinates and atherosclerotic plaques.

Patients of group 2 showed a correlation between a P level, incidence rate of common carotid arteries calcification, atherosclerotic plaques in the femoral arteries, IMC of the carotid and femoral arteries, left ventricular hypertrophy and a decline in a left ventricular diastolic function. A significant correlation was established between the rate of atherosclerotic plaques detection and age, male sex, smoking and history of PH. An increase in IMC and arterial rigidity was revealed in 12 (63.2%) of 19 patients of group 2. They had episodes of intradialysis hypotonia, 6 (31.6%) patients had acute coronary syndrome, 5 (26.3%) patients--cardiac arrhythmia.

A significant contribution to formation of risk factors of cardiovascular complications in TRF patients on PH is made by disturbed phosphorus-calcium metabolism resulting in higher rigidity and diameter of the arteries. The above changes lead to a rise in systolic pressure and fall in diastolic one. Increased pulse pressure is an independent predictor of the risk to develop acute coronary syndrome.