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.
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.
Authors: Claudio Rigatto; Adeera Levin; Andrew A House; Brendan Barrett; Euan Carlisle; Adrian Fine Journal: Clin J Am Soc Nephrol Date: 2009-01-14 Impact factor: 8.237
Authors: Anh L Bui; Ronit Katz; Bryan Kestenbaum; Ian H de Boer; Linda F Fried; Joseph F Polak; Bruce A Wasserman; Mark J Sarnak; David Siscovick; Michael G Shlipak Journal: Am J Kidney Dis Date: 2008-09-27 Impact factor: 8.860
Authors: Anjali Ganda; Martin Magnusson; Laurent Yvan-Charvet; Bo Hedblad; Gunnar Engström; Ding Ai; Thomas J Wang; Robert E Gerszten; Olle Melander; Alan R Tall Journal: Circulation Date: 2013-02-01 Impact factor: 29.690