Cardiovascular disease on hemodialysis: predictors of atherosclerosis and survival
| Autor: | A. Meguid El Nahas, Mohsen M. El Kossi, Ahmed Balsam, Robert Lord |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Disease Von Willebrand factor Renal Dialysis Risk Factors Internal medicine medicine Humans cardiovascular diseases Survival analysis Cause of death Aged biology business.industry Vital Signs Hematology Middle Aged Atherosclerosis Survival Analysis Confidence interval Oxidative Stress Carotid Arteries Cross-Sectional Studies Treatment Outcome Nephrology Relative risk Case-Control Studies Cohort Cardiology biology.protein Female Hemodialysis business Tunica Intima |
| Zdroj: | Hemodialysis international. International Symposium on Home Hemodialysis. 13(3) |
| ISSN: | 1542-4758 |
| Popis: | Cardiovascular disease (CVD) is the leading cause of mortality in hemodialysis (HD) patients. This could not be explained by the known traditional CVD risk factors. In this study, we attempted to elucidate the factors influencing atherosclerosis, as measured by carotid artery intima-media thickness (IMT), in HD patients and their impact on cardiovascular mortality. A cohort of 50 patients started on HD was selected for this study. At baseline, IMT and the presence of atheromatous plaques were assessed. Plasma homocysteine (Hcy), malondialdehyde, total antioxidant capacity, von Willebrand factor, vitamins C, E, B(6), B(12), folate, and C-reactive protein (CRP) were also measured. Patients were followed up for 2 years to determine the impact of IMT and associated markers on mortality using survival analysis as well as Cox proportional hazard. At baseline, 40% of the patients had IMT0.8 mm. They were older, had higher CRP (P0.001), and lower serum albumin (P=0.03). Intima-media thickness0.8 mm was associated with high calcium (risk ratio [RR]: 6.06; confidence interval [CI]: 0.75-12.25) and CRP (RR: 10.94 [CI: 2.56-46.74]). Fifteen patients (30%) died during the 2-year follow-up; the main cause of death was CVD (42%). The relative risk mortality was high with increased IMT (RR: 120.04 [CI: 4.18-3445.9]), Index of Coexistent Disease for CVD (RR: 4.04 [CI: 1.92-8.5]), and plasma Hcy (RR: 1.08 [CI: 1.02-1.13]). Markers of inflammation and increased serum calcium were significant predictors of increased carotid artery IMT. High IMT, Index of Coexistent Disease, and Hcy were associated with a high RR of all-cause mortality among a cohort of HD patients. |
| Databáze: | OpenAIRE |
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