Fecha de la publicación: 13/09/2021
Autor: Enrique M San Norberto (1), Álvaro Revilla (2), Ana Fernández-Urbón (3), Beatriz Gómez-Giralda (4), James H Taylor (5), Carlos Vaquero (2)
1Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain – firstname.lastname@example.org.
2Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
3Department of Anesthesiology, Valladolid University Hospital, Valladolid, Spain.
4Deparment of Nephrology, Rio Hortega University Hospital, Valladolid, Spain.
5Department of Cardiac Surgery, Valencia General University Hospital, Valencia, Spain.
Background: Intima media thickness (IMT), vascular calcifications and ankle-brachial pressure index (ABPI) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients.
Methods: Between January 2018 and March 2019, a physician-initiated, nonrandomized, prospective study was conducted. Carotid IMT, vascular calcifications analysis values and measurements of the ABPI, were made at baseline and after 1-year of follow-up.
Results: A total of 284 patients, 152 patients with dialysis (100 hemodialysis (HD) and 52 CAPD (continuous ambulatory peritoneal dialysis)) and 132 patients with stage 4 chronic kidney disease (control group), were included (55% male, 67 [29-88] years). The values of carotid IMT at baseline were higher in the HD group than in the CAPD group (1.10±0.08 mm vs 0.08±0.04 mm, p=0.004). Adragao and Kauppila scores were higher in the HD group than in the CAPD group (2.56±2.10 vs 1.08±2.02, p=0.009; and 7.40±6.86 vs 4.44±5.26, p<0.001; respectively). These differences remained after 1-year of follow-up. Pathological ABPI after 1-year follow-up was more prevalent in the HD group than in the CAPD or control groups (32.0% vs 19.4% vs 7.7%, respectively, p=0.042). Multivariate regression analysis revealed that age, gender, dialysis type and LDLc were independent predictors for carotid IMT increase; age, dialysis type and smoking for vascular calcifications increase on Adragao score; and dialysis type on Kauppila score. Only the dialysis type was the independent predictor for all vascular calcifications markers.
Conclusions: Dialysis, particularly HD, is an independent risk factor for cardiovascular calcification increase in ESRD patients.