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Objective: To evaluate the progression of carotid intima-media thickness (CIMT) and to search for possible associations between these changes and other risk factors of atherosclerosis for 2 years in stable patients with chronic renal failure (CRF) on haemodialysis (HD).
A prospective, non-randomized study was conducted on 50 patients, with newly diagnosed CKD and planned for HD treatment via an arteriovenous fistula (AVF).
Inclusion criteria were: newly diagnosed of ESRD, sinus rhythm, LV ejection fraction (EF) above 50%, no history of myocardial infarction, or evidence of valvular disease. Patients' left and right common carotid arteries were examined ultrasonographically before creation of AVF and after long-term HD treatment. SPSS 15.0 statistical software (SPSS, Chicago, IL, USA) was used for the statistical analysis. Comparison of biochemical and clinical findings before and after HD treatment are shown in Table 2.All variables tested as normally distributed except parathyroid hormone, C-reactive protein and CIMT after HD treatment.
Mean CIMT measured at baseline and after HD treatment were not significantly different between groups based on different causes of renal failure, and presence of hypertension and diabetes. Previous studies have demonstrated that the CIMT correlated significantly with age in patients with CKD.8,9 We found a significant negative association between CIMT and age after long-term HD treatment.
Albumin was also shown to be inversely and independently associated with CIMT in some studies of haemodialysis patients.10,20 Albumin may represent the state of enhanced inflammatory response as a negative acute-phase protein. Limitations of the study were that the sample size was relatively small (major limitation of our study) and lack of a control group.
To our knowledge this study has the longest follow-up period to provide data on the repeated measurement of CIMT. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
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Levels of serum haemoglobin, albumin, calcium, and alkaline phosphatase were significantly increased after HD treatment compared to baseline values. The correlation between variables and CIMT before and after long-term HD treatment are shown in Table-3.Only male gender and smoking were related with baseline CIMT.


These patients were found to have traditional risk factors of advanced atherosclerosis as well as nontraditional factors that occur in patients with CKD.
Previous studies did not confirm the role of blood pressure as a determinant of CIMT in HD patients.3,11 In our study, we also did not find an association between systolic and diastolic blood pressure, history of hypertension and CIMT, plaque occurence at basal and after HD treatment and DCIMT. High sensitivity CRP is also elevated in CKD and reflects micro and macroinflammation.15 Kawagashi et al.
However, we did not find an association between serum albumin and CIMT measured before and after HD treatment, DCIMT, plaque occurrence despite the fact that albumin concentration increased significantly during the 2 years follow-up.
Secondly, we know that it is erroneous to perform a lot of univariate and regression analysis in only 22 patients but we performed this analysis to provide information on this topic.
Contrary to previous studies, we found that CIMT was significantly decreased on HD patients in the long term. All scans were performed by the same cardiologist (MD) who was blinded to the patients' clinical and laboratory data. In addition, levels of blood urea nitrogen, uric acid, phosphorus and calcium x phosphorus product were significantly decreased after HD treatment compared to baseline values. After long-term HD treatment, age, total cholesterol, LDL cholesterol, triglyceride and BMI were associated with CIMT.
These results can be explained by the fact that most hypertensive HD patients received long-term antihypertensive treatment and their blood pressure was well-controlled. Thirdly, there may be many other variables such as influence of antihypertensive and antihyperlipidaemic medications, apolipoproteins and genetic markers that might have an impact on the progression of subclinical atherosclerosis, which we did not analyze in our study. Although we found that decrease of CIMT might be due to decrease in BUN, uric acid, phosphorus, calcium-phosphorus ion product and increase in haemoglobin, albumin, and calcium, we must take into consideration that the sample size was too small to perform such an analysis. The evaluation incidence and risk factors of mortality among patients with end stage renal disease in southeast Turkey. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: Prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Intima-media thickness of carotid artery predicts cardiovascular mortality in hemodialysis patients. Evaluation of the association between carotid artery atherosclerosis and coronary artery stenosis: a case control study. Carotid atherosclerosis is associated with in?ammation and endothelial cell adhesion molecules in chronic haemodialysis patients. C-reactive protein, lipoprotein (a), homocysteine, and male sex contribute to carotid atherosclerosis in peritonealdialysis patients.
Iron therapy, advanced oxidation protein products, and carotid artery intima-media thickness in end-stage renal disease.
Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure.


Carotid atherosclerosis is associated with in?ammation, malnutrition and intercellular adhesion molecule-1 in patients on continuous ambulatory peritoneal dialysis. Acute phase proteins, calcium-phosphate balance and lipid profile were assessed and anthropometric parameters were measured.
After long-term HD treatment, age, total cholesterol, LDL cholesterol, and triglyceride were related with CIMT. The CIMT was measured on the common carotid arteries bilaterally, 2-4 cm proximal to the bifurcations in the plaque-free section. Twelve patients with CKD were taking anti-hypertensive treatment before and after starting HD treatment.
There was no significant difference regarding other parameters including white blood cell count, total cholesterol, high density lipoprotein, low density lipoprotein, triglyceride, serum creatinine, glucose, parathyroid hormone, C-reactive protein, body mass index, blood pressure between before and after HD treatment. Kawagashi et al3 and London et al10 found an association between CIMT and smoking in HD patients. Fourthly, we showed lipid profiles of patients and their changes with time but we did not have enough information on medication status of the patients (e.g. Three digitalized still images from the same section of the artery were measured and the average value was calculated. Presence of plaque before HD only correlated with creatinine level and after long-term HD treatment only correlated with total cholesterol level. To compare variables before and after HD treatment, paired t test (for parametric variables), Wilcoxon test (for the nonparametric variables), and McNemar test (for categorized variables) were used. However, we did not observe an association between cigarette smoking and plaque occurrence. We measured CIMT and assessed plaque occurrence in the carotid arteries by B-mode ultrasonography. The common, internal and external carotid arteries were also scanned longitudinally and transversely to assess occurrence of plaques before and after HD treatment. Clinical and laboratory data were obtained from the patients on the day of ultrasonographic examination at baseline and after 2 years. Systolic and diastolic blood pressures were routinely measured before and after haemodialysis. The local ethics committee approved the study, and informed consent was obtained from each patient.



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