HIGH-RESOLUTION B-MODE ULTRASONOGRAPHY IN EVALUATION OF ATHEROSCLEROSIS IN UREMIA

We sought to determine whether atherosclerosis may be accelerated in uremic patients on maintenance hemodialysis and investigated the risk factors for carotid and femoral atherosclerosis in such patients. High-resolution B-mode ultrasonography was used to determine the intima-media thickness (IMT) of the carotid and femoral arteries in 199 hemodialysis patients and 81 age-matched healthy control subjects. The IMT values of the carotid and femoral arteries in the hemodialysis patients were significantly higher than in age-matched control subjects in most age groups. The IMT values of the carotid or femoral artery were significantly correlated with age in both the hemodialysis patients and the control subjects. There was a significant relationship between the IMT values of the two arteries in the hemodialysis patients (r = 0.418, P = 0.0001) and in the control subjects (r = 0.321, P = 0.0037). Multiple regression analysis showed that age, cigarette smoking, and uremic state were independent risk factors for atherosclerosis of both arteries in the patients and the control subjects (R(2) = 0.174; P < 0.0001; R(2) = 0.205, P < 0.0001, respectively). In the hemodialysis patients, the independent risk factors associated with the extent of the IMT of the carotid artery were age, cigarette smoking, and serum phosphorus level (R(2) = 0.180 P < 0.0001), while those associated with the extent of the IMT of the femoral artery were age, cigarette-smoking and serum m-PTH level (R(2) = 0.230, P < 0.0001). The results indicated that hemodialysis patients showed advanced atherosclerosis in the carotid and femoral arteries compared with that of age-matched healthy control subjects. Such atherosclerosis in hemodialysis patients may be associated to some extent with secondary hyperparathyroidism.