Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients | springermedicine.com

Springer Medicine

Top

Clinical and Experimental Nephrology

Published in:

01-12-2009 | Original Article

Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients

Authors: Mayuko Akamatsu, Tetsuya Ogawa, Ayuko Fujiu, Nami Matsuda, Kosaku Nitta

Published in: Clinical and Experimental Nephrology | Issue 6/2009

Login to get access

Abstract

Background/aim

Atherosclerosis is evaluated by carotid mean intima-media thickness (mean IMT), pulse wave velocity (PWV), and the aortic calcification index (ACI). We have attempted to examine if these atherosclerotic parameters are associated with each other and which parameters are closely related to cardiac function in chronic HD patients.

Methods

The mean IMT, PWV and ACI were examined in 69 maintenance HD patients using carotid ultrasonography, a blood volume plethysmographic apparatus and abdominal CT, respectively. Echocardiographic studies were also performed for measuring left ventricular (LV) geometry. Serum total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, albumin, C-reactive protein (CRP), calcium and phosphate were measured.

Results

The mean IMT correlated positively with ACI (r = 0.461, P < 0.0001) and tended to be correlated with PWV, but did not reach statistical significance. The PWV value correlated positively with ACI (r = 0.494, P ≤ 0.0001). The mean IMT correlated positively with the LV mass index (r = 0.273, P = 0.0228), and fractional shortening (FS) correlated negatively with PWV value (r = −0.293, P = 0.0141) and ACI score (r = −0.289, P = 0.0158). Multivariate analyses indicated that the LV mass index was independently associated with mean IMT (P = 0.0231) as well as systolic blood pressure (P < 0.0001), pulse pressure (P < 0.0001) and hemoglobin (P = 0.016), and FS is independently associated with ACI (P = 0.0162) as well as PWV (P = 0.0144) and CRP (P = 0.0375).

Conclusion

Atherosclerosis and reduced LV function are associated with increased vascular calcification and arterial stiffness in chronic HD patients.

1.

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.CrossRefPubMed

2.

Foley RN, Murray AM, Li S, Herzog CA, McBean AM, Eggers PW, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998–1999. J Am Soc Nephrol. 2005;16:489–95.CrossRefPubMed

3.

Meyer KB, Levey AS. Controlling the epidemic of cardiovascular disease in chronic renal disease: report from the National Kidney Foundation Task Force on Cardiovascular Disease. J Am Soc Nephrol. 1998;9(Suppl 12):S31–42.PubMed

4.

Harnett JD, Foley RN, Kent GM, Barre PE, Murray D, Parfrey PS. Congestive heart failure in haemodialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int. 1995;47:884–90.CrossRefPubMed

5.

Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis. 1996;27:347–54.CrossRefPubMed

6.

Guerin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcification in end-stage renal disease. Nephrol Dial Transplant. 2000;15:1014–21.CrossRefPubMed

7.

Parfrey PS, Foley RN, Harnett JD, Kent GM, Murray DC, Barre PE. Outcome and risk factors for left ventricular disorders in chronic uremia. Nephrol Dial Transplant. 1996;11:1277–85.CrossRefPubMed

8.

Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.CrossRefPubMed

9.

Schiller NB. Two-dimensional echocardiographic determination of left ventricular volume, systolic function, and mass. Summary and discussion of the 1989 recommendations of the American Society of Echocardiography. Circulation. 1991;84:1280–7.

10.

Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.CrossRefPubMed

11.

Tanaka M, Babasono T, Takeda M, Iwamoto Y. Pulse pressure and chronic kidney disease in patients with type 2 diabetes. Hytertens Res. 2006;29:345–52.CrossRef

12.

Nitta K, Akiba T, Suzuki K, Uchida K, Ogawa T, Majima K, et al. Left ventricular hypertrophy is associated with arterial stiffness and vascular calcification in hemodialysis patients. Hypertens Res. 2004;27:47–52.CrossRefPubMed

13.

Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002;25:359–64.CrossRefPubMed

14.

Nitta K, Akiba T, Uchida K, Kawashima A, Yumura W, Kabaya T, et al. The progression of vascular calcification and serum osteoprotegerin levels in patients on long-term hemodialysis. Am J Kidney Dis. 2003;42:303–9.CrossRefPubMed

15.

Takei T, Otsubo S, Uchida K, Matsugami K, Mimuro T, Kabaya T, et al. Effects of sevelamer on the progression of vascular calcification in patients on chronic hemodialysis. Nephron Clin Pract. 2008;108:c278–83.CrossRefPubMed

16.

Gelev S, Spasovski G, Dzikova S, Trajkovski Z, Damjanovski G, Amitov V, et al. Vascular calcification and atherosclerosis in hemodialysis patients: what can we learn from the routine clinical practice? Int Urol Nephrol. 2008;40:763–70.CrossRefPubMed

17.

Joint committee with the guidelines subcommittee of the Japan Academy of Neurosonology for ultrasonic assessment of carotid artery disease and the subcommittee for research into methods of screening atherosclerosis lesions. Guidelines for ultrasonic assessment of carotid artery disease: preliminary report. Neurosonology 2002; 15: 20–33.CrossRef

18.

Shimada K. Japanese Society of Hypertension guidelines for the management of hypertension (JSH2004). Hypertens Res. 2006;29:7–14.

19.

Davies MR, Hruska A. Pathophysiological mechanisms of vascular calcification in end stage renal disease. Kidney Int. 2001;60:472–9.CrossRefPubMed

20.

Stompor T, Rajzer M, Pasowicz M, Krasniak A, Sulowicz W, Kawecka-Jaszcz K, et al. Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis. Int J Artif Organs. 2006;29:736–44.CrossRefPubMed

21.

Homma S, Hirose N, Ishida H, Ishii T, Araki G, Halsey JH. Carotid plaque and intima-media thickness assessed by B-mode ultrasonography in subjects ranging from young adults to centenarians. Stroke. 2001;32:830–5.CrossRefPubMed

22.

Silverberg DS, Wexler D, Iaina A, Schwartz D. The correction of anemia in patients with the combination of chronic kidney disease and congestive heart failure may prevent progression of both conditions. Clin Exp Nephrol. 2009;13:101–6.CrossRefPubMed

23.

Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:973–9.CrossRefPubMed

24.

Hashimoto H, Kitagawa K, Hougaku H, Shimizu Y, Sakaguchi M, Nagai Y, et al. C-reactive protein is an independent predictor of the rate of increase in early carotid atherosclerosis. Circulation. 2001;104:63–7.CrossRefPubMed

25.

Poli A, Tremoli E, Colombo A, Sirtori M, Pignoli P, Paoletti R. Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients. A new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects. Atherosclerosis. 1988;70:253–61.CrossRefPubMed

26.

Handa N, Matsumoto M, Maeda H, Hougaku H, Ogawa S, Fukunaga R, et al. Ultrasonic evaluation of early carotid atherosclerosis. Stroke. 1990;21:1567–72.CrossRefPubMed

27.

Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int. 1999;55:1899–911.CrossRefPubMed

28.

Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant. 2000;15:953–60.CrossRefPubMed

29.

Ishimura E, Okuno S, Kitatani K, Maekawa K, Izumotani T, Yamakawa T, et al. C-reactive protein is a significant predictor of vascular calcification of both aorta and hand arteries. Semin Nephrol. 2004;24:408–12.CrossRefPubMed

30.

Oikawa O, Higuchi T, Yamazaki T, Yamamoto C, Fukuda N, Matsumoto K. Evaluation of serum fetuin-A relationships with biochemical parameters in patients on hemodialysis. Clin Exp Nephrol. 2007;11:304–8.CrossRefPubMed

31.

Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99:2434–9.CrossRefPubMed

32.

Blacher J, Demuth K, Guerin AP, Safar ME, Moatti N, London GM. Influence of biochemical alterations on arterial stiffness in patients with end-stage renal disease. Arterioscler Thromb Vasc Biol. 1998;18:535–41.CrossRefPubMed

33.

Schwarz U, Buzello M, Ritz E, Stein G, Raabe G, Wiest G, et al. Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure. Nephrol Dial Transplant. 2000;15:218–23.CrossRefPubMed

34.

Raggi P, Bellasi A, Ferramosca E, Islam T, Muntner P, Block GA. Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients. Kidney Int. 2007;71:802–7.CrossRefPubMed

35.

Moe SM, Chen NX. Pathophysiology of vascular calcification in chronic kidney disease. Circ Res. 2004;95:560–7.CrossRefPubMed

36.

Ketteler M, Westenfeld R, Schlieper G, Brandenburg V. Pathogenesis of vascular calcification in dialysis patients. Clin Exp Nephrol. 2005;9:265–70.CrossRefPubMed

37.

Chertow GM, Burke SK, Raggi P. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62:245–52.CrossRefPubMed

38.

Block GA, Spiegel DM, Ehrlich J, Mehta R, Lindbergh J, Dreisbach A, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005;68:1815–24.CrossRefPubMed

39.

K/DOQI NKF: clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1–S201.

40.

Yildiz A, Memisoglu E, Oflaz H, Yazici H, Pusuroglu H, Akkaya V, et al. Atherosclerosis and vascular calcification are independent predictors of left ventricular hypertrophy in chronic hemodialysis patients. Nephrol Dial Transplant. 2005;20:760–7.CrossRefPubMed

41.

McMurray JJV, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting enzyme inhibitors: the CHARM-Added Trial. Lancet. 2003;362:767–71.CrossRefPubMed

42.

Nitta K, Akiba T, Suzuki K, Uchida K, Ogawa T, Majima K, Watanabe R, Aoki T, Nihei H. Assessment of coronary artery calcification in hemodialysis patients using multi-detector spiral CT scan. Hypertens Res. 2004;27:527–33.CrossRefPubMed

Title: Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients
Authors: Mayuko Akamatsu
Tetsuya Ogawa
Ayuko Fujiu
Nami Matsuda
Kosaku Nitta
Publication date: 01-12-2009
Publisher: Springer Japan
Published in: Clinical and Experimental Nephrology / Issue 6/2009
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI: https://doi.org/10.1007/s10157-009-0220-4

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Home
Congress Coverage
Clinical Collections
- Advances in Alzheimer’s
About Springer Medicine
Key Specialties