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Arteriosclerosis in dialysis patients
J Bommer1, E Strohbeck, J Goerich
1Medizinische Universitätsklinik, Heidelberg, Germany.
Insights
Chronic hemodialysis accelerates arteriosclerosis, particularly in the abdominal aorta. This condition is linked to factors like age, smoking, and metabolic disturbances common in dialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Radiology
Background:
- Arteriosclerosis is a significant complication for patients undergoing long-term hemodialysis.
- Computer tomography (CT) provides a reliable method for assessing aortosclerosis.
Purpose of the Study:
- To evaluate the prevalence and progression of aortosclerosis in chronic hemodialysis patients.
- To identify risk factors associated with accelerated and progressive aortosclerosis in this population.
Main Methods:
- Cross-sectional study comparing aortosclerosis in hemodialysis patients versus controls using CT.
- Longitudinal study tracking aortosclerosis progression over time in hemodialysis patients using serial CT scans.
Main Results:
- Hemodialysis patients exhibited significantly accelerated aortosclerosis compared to age-matched controls.
- Risk factors included age, smoking, dialysis duration, dyslipidemia (elevated VLDL, reduced HDL), hypertriglyceridemia, elevated uric acid, and calcium-phosphate product.
- Parathyroidectomy was associated with reduced aortosclerosis progression.
Conclusions:
- Patients on maintenance hemodialysis experience premature and accelerated arteriosclerosis.
- Disturbances in calcium-phosphate and parathyroid hormone metabolism are key contributors to aortosclerosis in dialysis patients, beyond common risk factors.
Abstract:
Arteriosclerosis is a constant problem in long-term hemodialysis patients. Computer tomography of the abdominal aorta allows a well-defined and reproducible evaluation of aortosclerosis. In the cross-sectional study, aortosclerosis was significantly accelerated in 84 chronic hemodialysis patients and was comparable to the results found in 20-year older control patients without renal disease. The increase of aortosclerosis correlated significantly with age of the patient, smoking, and duration of dialysis therapy. Furthermore, increased VLDL cholesterol and decreased HDL cholesterol seem to enhance aortosclerosis in our dialysis patients. In the longitudinal study (two CT scans with a time interval of 87 +/- 62.7 months) in 36 dialysis patients, progressed aortosclerosis correlated significantly with the long duration of hypertriglyceridemia, VLDL cholesterol, uric acid, and calcium phosphate products. Progression of aortosclerosis was reduced in parathyroidectomized patients. The study suggests that premature aortosclerosis is found in dialysis patients. In addition to the common risk factor of aortosclerosis disturbed calcium phosphate and parathyroid hormone metabolism seem to enhance aortosclerosis in patients under maintenance hemodialysis.