Atherosclerotic risk factors and carotid stiffness in elderly asymptomatic HD patients

Abstract

Several studies showed that carotid atherosclerosis and stiffness are independent prognostic factors of cardiovascular morbidity and mortality in the general population and in end-stage renal disease patients. However, the impact of established risk factors on carotid structural and elastic properties in non-diabetic elderly hemodialysis patients with negative history for cardiovascular disease has not been fully elucidated. In this paper, we investigated the effect of established and potential risk factors on carotid atherosclerosis and stiffness. Thirty stable, non-symptomatic, non-diabetic patients, aged 65-years and older (mean age 71.4+/-4.15, range 65-79) on hemodialysis for more than 6 months, were included. All patients underwent B-mode ultrasonography of common carotid artery estimating intima-media wall thickness and wall-to-lumen ratio bilaterally and checking for the presence of plaques. Carotid elasticity was evaluated by compliance, distensibility, and the incremental elastic modulus (Einc), whereas systemic arterial stiffening was evaluated by the augmentation index provided by tonometry of radial artery. Our results showed that presence of carotid plaques and wall thickening were frequent findings in this population (76% and 73.3%, respectively) and they were positively associated with fibrinogen (P<0.005), diastolic blood pressure (P<0.004), visceral obesity (P<0.001) and bio-intact PTH (i-PTH) (P=0.03). Overall, systemic and carotid stiffness were strongly correlated with hs-CRP (P=0.018), serum ferritin (P=0.02) with age (P=0.03), lipids (P=0.03) and i-PTH (P=0.05). In conclusion, our findings show that stiffening and atherosclerosis in non-symptomatic elderly HD patients are very common and they are related not only to hemodynamic changes (diastolic blood pressure), inflammation (hs-CRP, fibrinogen, ferritin) or metabolic dysfunction (increased i-PTH, abnormal lipid profile), but also to abnormal fat deposition (increased waist to hip ratio and waist circumference). Considering the high morbidity and mortality of elderly patients, close monitoring of these parameters could be useful to prevent cardiovascular events.

Relation of stiffness parameter β to carotid arteriosclerosis and silent cerebral infarction in patients on chronic hemodialysis

“…These reports and our results suggest that the correlation between stiffness parameter b and plaque score may be stronger in HD patients with chronic inflammation in HD patients. Moreover, Tseke et al [26] reported that stiffening and atherosclerosis are associated with chronic inflammation as well as DBP in HD patients.…”

Bone and mineral disorders in pre-dialysis CKD

“…Secondary hyperparathyroidism is associated with a variety of complications including bone disease [63][64][65][66], uremic pruritus [67], refractory anemia [68], and cognitive and sexual dysfunction [69,70]. In patients receiving MHD, SHPT has been associated with increased cardiovascular morbidity [48, [71][72][73] and mortality [2,3]. The association of SHPT with mortality or with progression of kidney disease in CKD has not been well characterized.…”

Effect of Low-and High-Dose Atorvastatin on Carotid Artery Distensibility Using Carotid Magnetic Resonance Imaging ^|^mdash;A Post-Hoc Sub Group Analysis of ATHEROMA (Atorvastatin Therapy: Effects on Reduction of Macrophage Activity) Study

“…Much emphasis has been placed on its role in the initial development of atheroma and its potential to improve risk stratification in medium-or low-risk patients [2][3][4][5] . In the carotid artery region, it has been suggested as a risk factor for the development of stroke 6) .…”