Increased risk of premature atherosclerosis at initiation of chronic hemodialysis: A possible link with hypertriglyceridemia?

Abstract

Background. Patients with end-stage renal failure have high rates of cardiovascular morbidity and mortality. It is not clear yet whether it is the hemodialysis procedure or the uremia itself that is the major determinant of this increased risk. We set out to determine whether atherosclerosis was more accelerated in patients with uremia at the initiation of chronic hemodialysis therapy compared with that in a control group of those without uremia who had a similar cardiovascular risk profile. Also, risk factors related to premature atherosclerosis were investigated. Patients and Methods. High-resolution B-mode ultrasonography was used to determine the intima-media thickness (IMT) of the carotid arteries in 30 patients with uremia just before the initiation of chronic hemodialysis therapy and in 26 controls without uremia. Results. The 2 groups were similar in age, sex, presence of hypertension, presence of dyslipidemia, and smoking habits. Serum levels of total cholesterol, triglycerides, total HDL, fibrinogen, inorganic phosphorus, and total calcium were evaluated. The IMT values of the patients with uremia were significantly higher than were those of the control group. The patients with uremia had higher levels of serum fibrinogen, inorganic phosphorus, and triglycerides. The IMT values significantly correlated with age, male sex, and triglyceride level in the patients with uremia. In the control group, only age showed a significant correlation with IMT values. Conclusion. These results indicate that patients with uremia at the initiation of chronic hemodialysis therapy had higher carotid IMT values than did a control group of those without uremia who have a similar cardiovascular risk profile. Thus, uremic status per se may be responsible for the increased risk of premature atherosclerosis. Identification of a positive correlation between carotid IMT and triglyceride levels may indicate that therapeutic interventions are necessary to reduce this risk.