Carotid intima media thickness and aortic calcification index closely relate to cerebro‐ and cardiovascular disorders in hemodialysis patients

Abstract

Aim: Atherosclerosis can be evaluated by carotid intima media thickness (IMT), the aortic calcification index (ACI), and pulse wave velocity (PWV). We investigated which test was most closely related to cerebro-and cardiovascular disorders (CCVD) in hemodialysis patients. Methods: Maximum IMT (max-IMT), ACI, and PWV were examined in 110 hemodialysis patients, using carotid ultrasonography, abdominal CT and a blood pressure pulse wave instrument, respectively. Blood hemoglobin A1c (HbA1c), serum total cholesterol, high density lipoprotein cholesterol, triglyceride, total protein, albumin, high sensitivity C reactive protein (hs-CRP), and tumor necrosis factor a were measured. The patients were divided into two groups; with and without CCVD and the degree of atherosclerosis was evaluated in each group. Results: Compared to the CCVD (-) group, the CCVD (+) group showed significantly higher percentages of males and diabetic patients, higher levels of HbA1c (5.14 vs 4.83%) and hs-CRP (0.320 vs 0.167 mg/dL), an older age group (64.5 vs 57.5 years), a greater max-IMT (2.05 vs 1.19 mm), and a higher ACI (71.8 vs 41.0%); and significantly lower diastolic blood pressure (82.8 vs 89.2 mmHg). Multiple logistic regression analysis showed that the factors influencing the development of CCVD were age (odds ratio: 1.092), ACI (odds ratio: 1.025), and max-IMT (odds ratio: 2.006). However, PWV did not significantly relate to CCVD. Conclusions: In hemodialysis patients, the ACI and max-IMT were significantly associated with CCVD, but the association of PWV was weak. A prospective cohort study is warranted to determine the risk factors for CCVD in hemodialysis patients.

486 The implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism

“…25,26 In addition, we have previously described several aspects of aortic calcification as follows: (A) burden of aortic calcification has a negative effect on postoperative renal function in renal transplant patients; 22 (B) ACI progression correlates with the occurrence of postoperative cardiovascular events in renal transplant patients; 22 and (C) ACI progression is closely associated with the occurrence of cardiovascular events in hemodialysis patients. 23 Therefore, aortic calcification is a useful indicator to quantify arterial degradation, and ACI should be selected as a potential predictor for persistent hypertension after adrenalectomy.…”

“…22,23 When calcified intimas of the section 1 (i = 1) were five-twelfths, calcification of section 1 will be scored 5/12 = 41.7% ( Figure 1A). The average value of section 1 -10 is ACI (%).…”

“…19 Aortic calcification can be quantitatively measured by abdominal computed tomography (CT) on the aortic calcification index (ACI). ACI is widely used [20][21][22][23] and defines 12 levels of calcification as a percentage. We previously reported the clinical significance of ACI among hemodialysis patients and renal transplant recipients.…”

“…We previously reported the clinical significance of ACI among hemodialysis patients and renal transplant recipients. 22,23 However, no study addresses the relationship between ACI and postoperative hypertension after adrenalectomy.…”

Editorial Comment

“…In the current issue, the association between CCVD and aortic calcification index or maximum intima media thickness in long-term ACI and max-IMT relate to CCVD in HD patients hemodialytic patients is reported. 2 However, the study design is retrospective and the number of patients enrolled is small. Furthermore, the outcome (development of CCVD) has already occurred prior to the measurements of vascular parameters.…”