Atherosclerosis in uremia: a longitudinal study.

The ways by which uremia may lead to atherosclerosis are still unknown. Furthermore, whether atherosclerosis is accelerated with prolonged hemodialysis is still under debate. The results of a longitudinal study carried out in 47 selected patients who were treated first with dietary regimen followed by dialysis and then transplantation indicate: 1) The longer the duration of uremia on low protein diet, the worse are the clinical and metabolic problems of atherosclerosis. 2) In subsequent regular dialysis treatment 2 distinct clinical and metabolic pictures may emerge, slowly progressive or comparatively accelerated, according to whether dialysis is initiated early or late. 3) In subsequent transplantation the avoidance of risk factors largely depends on the time at which regular dialysis begins. 4) Early direct transplantation without dialysis proves similar to transplantation in patients treated with early dialysis as far as prevention of accelerated atherosclerosis is concerned.