[Predictive value of ultrasonographical assessments of carotid artery for cardiovascular events in patients under hemodialysis: add on comparison with stroke patients].

ABSTRACT

BACKGROUND: The prognosis of patients on hemodialysis (HD) was determined with respect to cardiovascular disease. We analyzed the relationships between several parameters of carotid artery echograms and cardiovascular events (CVE) in patients on HD. We also compared the characteristic findings of carotid artery echography in patients with stroke and patients on HD. METHOD: We enrolled 104 patients on HD (male female, 72 32; mean age, 63.0 +/- 11.2 years) and 48 with stroke (male female, 36 12; mean age, 66.0 +/- 7.7 years) who were admitted to our hospital between 1998 and 2004. We measured intima media thickness (IMT), plaque score (PS), resistive index (RI), common carotid artery (CCA) stenosis and plaque echogenicity using B-mode ultrasonography. The correlation between carotid artery echographic findings and CVE were analyzed over a period of 37.5 +/- 22.9 months of follow-up. The characteristic findings of carotid artery echography were compared among groups of patients on initial HD (iHD) and maintenance HD (mHD) and with stroke accompanied by eGFR > 60 mL/min/1.73 m2. RESULTS: Both PS and RI significantly correlated with CVE (p < 0.005 and p < 0.05, respectively), and CVE occurred at the early phase of follow up in patients with increased PS. Both PS and RI were also higher in mHD than in stroke (p < 0.005). Both PS and CCA stenosis were higher in mHD than in iHD (p < 0.01, p< 0.05). More hard plaques were identified in patients on mHD than in those with stroke (p < 0.005). Multivariate analysis showed that the numbers of soft and hard plaques were significantly associated with CCA stenosis(p < 0.05) and the duration of dialysis (p < 0.05), respectively. CONCLUSIONS: Increasing PS and RI were powerful predictors of CVE in patients on HD. Atherosclerotic changes were equal in patients on iHD and those with stroke. Plaque score, the numbers of hard plaques and CCA stenosis were increased in mHD, suggesting the development of atherosclerotic changes in patients on HD.