Carotid ultrasonographic parameters as markers of atherogenesis and mortality rate in patients on hemodialysis

Abstract

Background/Aim. Vascular endothelium plays an important role in atherogenesis. The aim of this study was to estimate the correlation of endothelium malfunction and arteriosclerosis in patients on hemodialysis. Methods. The investigation was designed as a clinical, non-randomized, fiveyear study in the 'Kragujevac' Clinical Center and included 146 patients. We evaluated demographic characteristics, smoking, duration of dialysis, existence of tissue calcification and duplex ultrasound parameters of the carotid artery. All lethal outcomes, including the cause and time of death were recorded. Results. The cumulative survival rate was 57.5%. Survival was short in patients with wider lumen diameter of the carotid arteries. Carotid artery lumen diameter in men was wider than in women. The area cross section was closely correlated with intima media thickness (r = 0.913; p < 0.0001), as well as with the lumen diameter of the carotid arteries (r = 0.527; p < 0.0001). Carotid artery lumen diameter was negatively associated with serum cholesterol (r = - 0.278; p = 0.019), while serum triglycerides correlated negatively with the cross section of intima media (r = -0.261; p = 0.028). Positive correlations were found between the serum total protein level and carotid artery lumen diameter (r = 0.235; p = 0.047), cross section intima media (r = 0.269; p = 0.022) and cholesterol (r = 0.248; p = 0.037). Time on dialysis showed a negative correlation with carotid artery cross section (r = -0.241; p = 0.04), while age was positively correlated with intima media (r = 0.295; p = 0.013), lumen diameter (r = 0.296; p = 0.012) and intima media cross section (r = 0.347; p = 0.003). Regression analysis pointed to predictive importance of carotid artery lumen diameter for survival (Beta = 0.437; p = 0.011) of the examined patients. The cumulative rate of survival was 57%. Conclusion. In our study patient age correlated positively with all parameters of arteriosclerosis. The average duration of dialysis was negatively associated with carotid artery diameter, which was significantly higher in males. Regression correlation analyses indicated that the survival rate of the patients on hemodialysis was lower if the carotid artery diameter was larger.Uvod/Cilj. Endotel krvnih sudova ima veliki znacaj u procesu aterogeneze. Cilj ovog rada bio je da se utvrdi korelacija endotelne disfunkcije i ateroskleroze kod bolesnika na hemodijalizi. Metode. Studija je organizovana kao klinicka i nerandomizirana, u periodu 2004-2008. godine u Centru za hemodijalizu Klinickog centra 'Kragujevac'. Analizirane su demografske karakteristike, pusenje, duzina trajanja hemodijalize, mekotkivne kalcifikacije i dopler ultrazvucni parametri karotidnih arterija. Evidentirani su svi letalni ishodi, uzrok i vreme smrti. Rezultati. Kod muskaraca zabelezen je statisticki znacajno siri precnik karotidnih arterija u odnosu na zene. Pozitivna korelacija postignuta je izmedju povrsine poprecnog preseka i debljine intime medije (r = 0,913; p < 0,0001), kao i precnika karotidnih arterija (r = 0,527; p < 0,0001). Holesterol negativno utice na precnik karotidnih arterija (r = -0,278; p = 0,019). I trigliceridi negativno korelisu sa povrsinom poprecnog preseka intime medije (r = -0,261; p = 0,028). Pozitivna korelacija utvrdjena je izmedju nivoa ukupnih proteina u serumu i precnika lumena karotidnih arterija (r = 0,235; p = 0,047), povrsine poprecnog preseka intime medije (r = 0,269; p = 0,022) i holesterola (r = 0,248; p = 0,037). Duzina dijaliziranja ima negativnu korelaciju sa precnikom karotidne arterije (r = -0,241; p = 0,04), a starost pozitivno korelise sa intimom medijom (r = 0,295; p = 0,013), dijametrom lumena (r = 0,296; p = 0,012) i povrsinom poprecnog preseka intime medije (r = 0,347; p = 0,003). Regresiona analiza ukazuje na prediktivni znacaj precnika lumena karotidnih arterija za prezivljavanje (Beta = 0,437; p = 0,011) ispitivanih bolesnika. Kumulativna stopa prezivljavanja u nasoj studiji bila je 57,5%. Zakljucak. Starost pacijenata pozitivno korelise sa svim parametrima ateroskleroze. Prosecno trajanje dijalize negativno korelise sa precnikom karotidnih arterija koji je veci kod muskaraca. Sto je precnik karotidnih arterija veci, prezivljavanje bolesnika na hemodijalizi je kraci.