Cardiovascular disease on hemodialysis: Predictors of atherosclerosis and survival
- 1 July 2009
- journal article
- Published by Wiley in Hemodialysis International
- Vol. 13 (3), 278-285
- https://doi.org/10.1111/j.1542-4758.2008.00337.x
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in hemodialysis (HD) patients. This could not be explained by the known traditional CVD risk factors. In this study, we attempted to elucidate the factors influencing atherosclerosis, as measured by carotid artery intima-media thickness (IMT), in HD patients and their impact on cardiovascular mortality. A cohort of 50 patients started on HD was selected for this study. At baseline, IMT and the presence of atheromatous plaques were assessed. Plasma homocysteine (Hcy), malondialdehyde, total antioxidant capacity, von Willebrand factor, vitamins C, E, B(6), B(12), folate, and C-reactive protein (CRP) were also measured. Patients were followed up for 2 years to determine the impact of IMT and associated markers on mortality using survival analysis as well as Cox proportional hazard. At baseline, 40% of the patients had IMT>0.8 mm. They were older, had higher CRP (P0.8 mm was associated with high calcium (risk ratio [RR]: 6.06; confidence interval [CI]: 0.75-12.25) and CRP (RR: 10.94 [CI: 2.56-46.74]). Fifteen patients (30%) died during the 2-year follow-up; the main cause of death was CVD (42%). The relative risk mortality was high with increased IMT (RR: 120.04 [CI: 4.18-3445.9]), Index of Coexistent Disease for CVD (RR: 4.04 [CI: 1.92-8.5]), and plasma Hcy (RR: 1.08 [CI: 1.02-1.13]). Markers of inflammation and increased serum calcium were significant predictors of increased carotid artery IMT. High IMT, Index of Coexistent Disease, and Hcy were associated with a high RR of all-cause mortality among a cohort of HD patients.Keywords
This publication has 45 references indexed in Scilit:
- C-reactive protein is neither a marker nor a mediator of atherosclerosisNature Clinical Practice Nephrology, 2008
- Role of fat mass and adipokines in chronic kidney diseaseCurrent Opinion in Nephrology and Hypertension, 2008
- Endothelial dysfunction in CKD: a new player in town?Nephrology Dialysis Transplantation, 2007
- The kidney disease wasting: Inflammation, oxidative stress, and diet-gene interactionHemodialysis International, 2006
- Endothelial Dysfunction Contributes to Renal Function–Associated Cardiovascular Mortality in a Population with Mild Renal InsufficiencyJournal of the American Society of Nephrology, 2006
- THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Clinical Epidemiology of Cardiovascular Disease in Chronic Kidney Disease Prior to DialysisSeminars in Dialysis, 2003
- Hyperhomocysteinemia predicts cardiovascular outcomes in hemodialysis patientsKidney International, 2002
- Arterial Calcifications, Arterial Stiffness, and Cardiovascular Risk in End-Stage Renal DiseaseHypertension, 2001
- Inflammation enhances cardiovascular risk and mortality in hemodialysis patientsKidney International, 1999
- Elevated Fasting Total Plasma Homocysteine Levels and Cardiovascular Disease Outcomes in Maintenance Dialysis PatientsArteriosclerosis, Thrombosis, and Vascular Biology, 1997