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The role of hypertension in hemodialysis-associated atherosclerosis
Insights
Atherosclerosis is common in patients on hemodialysis, particularly with increasing age and hypertension. Strict blood pressure control may prevent this vascular condition in uremic patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pathology
Background:
- Atherosclerosis is a significant concern in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
- Patients undergoing hemodialysis (HD) are at increased risk for cardiovascular complications, including atherosclerosis.
- The relationship between HD, uremia, and the progression of atherosclerosis requires further investigation.
Purpose of the Study:
- To assess the prevalence and severity of atherosclerosis in nondiabetic patients undergoing hemodialysis at the time of renal transplantation.
- To investigate potential correlations between atherosclerosis and patient demographics, duration of hemodialysis, metabolic abnormalities, and hypertension.
Main Methods:
- Intraoperative examination and histologic evaluation of the iliac vasculature in 50 nondiabetic patients undergoing renal transplantation.
- Patients were categorized into minimal, moderate, and severe atherosclerosis groups.
- Statistical analysis was performed to identify correlations with age, sex, metabolic factors, hemodialysis duration, and hypertension.
Main Results:
- Sixty-two percent of patients exhibited atherosclerosis, with half showing severe involvement.
- A significant positive correlation was found between patient age and the degree of atherosclerosis (p < 0.02).
- Atherosclerosis was observed in 35% of patients under 30, while control subjects had none. Hypertension was prevalent in 90% of patients with moderate to severe atherosclerosis. In patients aged 25-40, atherosclerosis was exclusively found in those with prior hypertension (p < 0.02).
Conclusions:
- Atherosclerosis is highly prevalent in nondiabetic hemodialysis patients, correlating strongly with age and hypertension.
- Hemodialysis itself may not accelerate atherosclerosis.
- More stringent control of hypertension in uremic patients could be a key preventive strategy against atherosclerosis.
Abstract:
Atherosclerosis in 50 nondiabetic patients undergoing hemodialysis was assessed at the time of renal transplantation by intraoperative examination and histologic evaluation of the iliac vasculature. Patients were grouped accordingly: minimal (group 1), moderate (group 2) or severe (group 3) atherosclerosis. Sixty-two per cent of the patients had atherosclerosis, half of them with severe involvement. No sex differences were noted. There was a significant correlation between the patient's age and the degree of atherosclerosis (p less than 0.02). Thirty-five per cent of the patients under 30 years of age had atherosclerosis whereas similarly studied nonuremic control subjects had no atherosclerosis. Metabolic and lipid abnormalities, and duration of hemodialysis did not correlate with degree of atherosclerosis. Hypertension was present in 90 per cent of the patients in groups 2 and 3. When patients between the ages of 25 and 40 years were selected, atherosclerosis was present only in previously hypertensive patients (p less than 0.02). Atherosclerosis may not be accelerated by hemodialysis and may be prevented by more stringent control of hypertension in uremia.