Evaluation of Atherosclerosis, Arterial Stiffness and Related Risk Factors in Chronic Hemodialysis Patients in Siriraj Hospital
Manoch Rattanasompattikul MD*, Kullanuch Chanchairujira MD**, Leena On-Ajyooth MD*, Thawee Chanchairujira MD*
Affiliation : * Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Additional to traditional risk factors for cardiovascular disease (CVD), recent evidence demonstrates that non-
traditional risk factors such as high-sensitive C-reactive protein (hsCRP), hyperhomocysteinemia and vascular calcification
may cause progressive atherosclerosis in hemodialysis patients.
Objective : We aim to determine the prevalence of atherosclerosis and assess the arterial stiffness and related risk factors.
Material and Method: Common carotid artery intima-media thicknesses (CIMT), atherosclerotic plaque occurrence were
determined by B-mode ultrasonography in 105 hemodialysis patients (mean age, 53 + 15.5 years; mean dialysis duration 82
+ 59.5 months). A history of clinically significant atherosclerotic vascular disease was elicited by patient questionnaire and
verified by careful patient chart review and physical examination. Cardiovascular ankle index (CAVI) was use to assess
arterial stiffness. Serum biochemical marker for traditional risk factors, hsCRP and homocysteine were measured by
standard method.
Results : Atherosclerotic vascular disease (defined by a history of CVD or presence of atherosclerotic plaque) was present in
79% of patients. Compared to non-atherosclerotic group, the mean CIMT and serum hsCRP in atherosclerotic group was
higher (1.9 + 0.8 mm vs. 0.8 + 0.6 mm, p < 0.001; 6.5 + 8.8 mg/L vs. 3.3 + 3.5 mg/L, p = 0.03, respectively), while other
biochemical markers were not significantly different, as well as the percentage of abnormal CAVI (69% vs. 54.5%, p = 0.28).
CAVI was positively correlated with maximum carotid intima-meida thickness (r = 0.44, p < 0.001). CAVI was also
significantly greater in patients with carotid plaque (soft plaque (p < 0.05) and calcified plaque (p < 0.05)) compared with
patients without carotid plaque.
Conclusion : A high prevalence of atherosclerosis and arterial stiffness was observed in hemodialysis patients. Carotid
atherosclerosis is associated with an increased inflammatory marker (hsCRP). CAVI may be a useful index to assess arterial
stiffness and associated with arterial intima-media thickness.
Keywords : Arterial stiffness, Pulse wave velocity, Hemodialysis, Atherosclerosis, Cardio-vascular ankle index
