Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients

Kidney Int. 2003 Oct;64(4):1472-9. doi: 10.1046/j.1523-1755.2003.00205.x.

Abstract

Background: Cardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 +/- 13 years; time on hemodialysis, 13 +/- 7 years; male/female, 144/75).

Methods: We measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years.

Results: During the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 +/- 0.02 mm) than in those who survived (0.62 +/- 0.01 mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1 mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality.

Conclusion: These findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / mortality
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnostic imaging*
  • Carotid Artery, Common / diagnostic imaging
  • Diabetes Complications
  • Female
  • Humans
  • Kidney Diseases / complications
  • Kidney Diseases / therapy
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Renal Dialysis / mortality*
  • Survival Analysis
  • Time Factors
  • Tunica Intima / diagnostic imaging
  • Tunica Media / diagnostic imaging
  • Ultrasonography