Echo color doppler imaging of carotid vessels in hemodialysis patients: evidence of high levels of atherosclerotic lesions

“Does chronic kidney disease define a particular risk pattern of cerebral vessels modifications in patients with symptomatic ischemic cerebrovascular disease?”

“…Irrespective of age, male gender was an important risk factor in CKD (+) patients, data which is in keeping with several studies [25,26,29]. Hypertension is one of the most significant factors involved in the hypertrophytype of the cerebral vessels, irrespective of the level of renal function impairment [30].…”

“…Hypertension was present in the vast majority of the cases with CKD in our study group. Some authors underline the fact that the high levels of SBP are a strong predictor of severe and extensive atherosclerotic lesions than are those of DBP [29], while other authors state that neither the levels, nor the duration of hypertension are of predictive value [25,26]. Hypertension plays an important role in the occurrence of silent brain infarction (a small vessel disease of the brain).…”

“…Commonly, patients with severe cerebral vessels lesions have elevated levels of total cholesterol, LDL-cholesterol and triglycerides, while the levels of HDL-cholesterol are low [25,26,29]. Carotid arterial changes occur early in the course of CKD and may be related to dyslipidaemia of the early stages [32].…”

Cystatin C and Subclinical Brain Infarction

“…Impaired renal function is increasingly being recognized as an important and highly prevalent vascular risk factor associated with an increased risk for cerebrovascular disease. Previous reports have found both renal insufficiency and ESRD to be associated with an increased risk for clinical stroke (8 -12) and subclinical carotid artery atherosclerosis (13)(14)(15)(16)(17)(18)(19). Consequently, the estimated 8 million individuals in the United States with decreased renal function may also be at increased risk for SBI and its associated morbidity.…”

Hemodialysis Impairs Endothelial Function via Oxidative Stress

“…[1][2][3][4] Morphological and mechanical alterations of conduit arteries have been characterized by atherosclerosis in hemodialyzed patients. [5][6][7][8][9] Endothelium-derived NO plays a crucial role not only in control of vascular tone of conduit arteries but also in antiatherosclerosis by several mechanisms, such as inhibition of platelet aggregation/adhesion or of smooth muscle cell proliferation. 10 -12 Recent reports demonstrated that NOdependent flow-mediated vasodilation is blunted in patients undergoing hemodialysis, 13,14 suggesting that the impaired bioactivity of endothelium-derived NO in the conduit artery may contribute to the progression of atherosclerosis in hemodialyzed patients.…”