Dialysis – Transplantation
Kidney International (2003) 64, 1472–1479; doi:10.1046/j.1523-1755.2003.00205.x
Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients
Akihiko Kato, Takako Takita, Yukitaka Maruyama, Hiromichi Kumagai and Akira Hishida
Division of Nephrology, Endocrinology and Metabolism, Shizuoka Cancer Center Hospital, Shizuoka, Japan; Maruyama Hospital, Hamamatsu, Japan; Department of Clinical Nutrition, School of Food and Nutritional Science, University of Shizuoka, Shizuoka, Japan; and First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
Correspondence: Akihiko Kato, M.D., Division of Nephrology, Endocrine and Metabolism, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan. E-mail: a.kato@scchr.jp
Received 8 January 2003; Revised 10 March 2003; Re-revised 4 May 2003; Accepted 16 May 2003.
Abstract
Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients.
Background
Cardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 
13 years; time on hemodialysis, 13 7 years; male/female, 144/75).
Methods
We measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years.
Results
During the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 0.02 mm) than in those who survived (0.62 0.01 mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1 mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality.
Conclusion
These findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis.
Keywords:
IMT, %ACI, homocysteine, albumin, hemodialysis
