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Cardiovascular disease on hemodialysis: predictors of atherosclerosis and survival

Ahmed Balsam1, Mohsen M El Kossi, Robert Lord

  • 1Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.

Hemodialysis International. International Symposium on Home Hemodialysis
|July 21, 2009
PubMed

Insights

Cardiovascular disease is a major risk for hemodialysis patients. Atherosclerosis, indicated by high carotid intima-media thickness (IMT), inflammation, and homocysteine, significantly increases mortality risk in these patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Cardiovascular disease (CVD) is the primary cause of death in hemodialysis (HD) patients, exceeding traditional risk factors.
  • Atherosclerosis, a key contributor to CVD, requires further investigation in HD populations.

Purpose of the Study:

  • To identify factors influencing atherosclerosis, measured by carotid artery intima-media thickness (IMT).
  • To assess the impact of IMT and associated markers on cardiovascular mortality in HD patients.

Main Methods:

  • A cohort of 50 new HD patients was studied.
  • Baseline assessments included carotid artery IMT, atheromatous plaques, plasma homocysteine (Hcy), C-reactive protein (CRP), and other biochemical markers.
  • Patients were followed for 2 years, with mortality analyzed using survival analysis and Cox proportional hazards models.

Main Results:

  • 40% of patients had IMT > 0.8 mm at baseline, associated with older age, higher CRP, and lower albumin.
  • Increased IMT was linked to higher calcium and CRP levels.
  • During 2-year follow-up, 30% of patients died, primarily from CVD. High IMT, Index of Coexistent Disease, and Hcy were significant predictors of mortality.

Conclusions:

  • Inflammation markers and elevated serum calcium predict increased carotid artery IMT in HD patients.
  • High IMT, comorbidity index, and plasma Hcy are associated with increased all-cause mortality risk in this cohort.

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