Relationsip between caRotid and caRdiac ultRasonogRaphic changes and Risk factoRs in hemodialysis patients

Cardiovascular disease is the leading cause of mortality in hemodialysis patients. Carotid and cardiac ultrasonographic abnormalities are the rule in these patients. The aim of this study is to evaluate the interrelation between these changes and cardiovascular risk factors in our patients. In 54 stable chronic hemodialysis patients current demographic and biochemical parameters were recorded. Ultrasonographic measurement of intima-media thickness, diastolic diameter of common carotid artery, evaluation of carotid atherosclerotic plaques and transthoracic ecocardiography with evaluation of left ventricular mass index and valvular calcifications were performed, and correlated with cardiovascular risk factors. We found a high frequency of ultrasonographic abnormalities. Remarkably, nontraditional cardiovascular risk factors such as malnutrition, anemia and calcium-phosphate imbalance seem more important than traditional risk factors such as age, gender, smoking, diabetes mellitus, arterial hypertension or obesity for these ultrasonographic changes in hemodialysis patients. keywords: cardiovascular risk, hemodialysis, ultrasonography theRapeutical pRactice cristian budurea Nefromed Dialysis Centers 40 Ana Aslan Str., Cluj-Napoca, Cluj, CP 400528 e-mail: [email protected] introduction C and cardiac ultrasonograpy are easily performed, noninvasive, safe, reproductible, and accurate. Increased intima-media thickness (IMT) and diastolic diameter of common carotid artery (DCCA) are non-invasive markers of damage of vascular wall, easily evaluated by ultrasonography. Increased IMT is an early marker of atherosclerosis, while increased DCCA is a marker of arteriosclerosis and both are strong predictors of cardiovascular events and mortality in general population. Echocardiographic abnormalities are associated with development of cardiac failure and death [1]. Abnormalities of left ventricular (LV) size, shape, or function are present in 70-80 % of dialysis patients. Causes of these echocardiographic abnormalities are highly diverse and include age, coronary artery disease, gender, hypertension (HT), anemia, the uremic internal milieu, hyperparathyroidism, large interdialytic fluid gains, and the presence of arteriovenous fistulae and grafts [2]. Poor cardiovascular prognosis in hemodialysis (HD) patients is determined both by traditional risk factors, present in the general population, such as age, gender, race, family history of cardiovascular disease, diabetes, dyslipidemia, arterial hypertension, obesity, smoking and by the so called nontraditional risk factors, such as anaemia, malnutrition, inflammation, calcium-phosphate imbalance, oxidative stress, hyperhomocysteinemia, hyperfibrinogenemia, hyperhidration and increase in renin-angiotensin-aldosterone system activity [3]. The aim of this study is to evaluate the interrelation between ultrasonographic changes such as increased IMT, atheromatous (ATS) plaques, increased DCCA and left ventricle mass (LVM), valvular calcifications, systolic and diastolic dysfunction and traditional risk factors such as age, gender, smoking, diabetes mellitus, arterial hypertension or