Carotid Artery Intima-Media Thickness and Heart Valve Calcifications in Hemodialysis Patients with Hyperparathyroidism (A Pilot Study)
Author(s): Isa Ardahanli, Mehmet Serdar Cengizhan, Mehmet Celik, Saadet Kader, Mustafa Akarslan, Mumtaz Takir
Objective: Cardiovascular disease (CVD) is currently the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of this study was to examine carotid artery intima-media thickness (CIMT) and valvular calcification in asymptomatic hemodialysis (HD) patients, to compare them with healthy subjects, and to identify risk factors associated with atherosclerosis.
Materials and Methods: Forty-nine HD patients and age and sex-matched 48 healthy volunteers were enrolled in this study. Right and left carotid intima-media thicknesses (CIMTs) were measured, and echocardiographic evaluation of valve calcification was performed. CaxP product and parathormone (PTH) values were measured from venous blood samples.
Result: The mean CIMT thicknesses were 0.86 ± 0.16 mm in the patient group and 0.61 ± 0.11 mm in the control group. Mean CIMT was significantly higher in the patient group (p <0.001) and valve calcification was measured as 53% in the patient group. Aortic valve calcification in 22.5%, mitral valve calcification in 18.3%, and calcification in both valves in 12.2%. The rate of valve calcification in the control group was 10.4%. In the HD group, the mean PTH level was 578.2 pg/ml and in the healthy control group was 36.2 pg/ml. The CaxP product was significantly higher in the dialysis group than in the control group (p <0.001) (53.9 ± 11.5-33.6 ± 4.1, respectively). PTH value and CaxP product height correlated significantly with valve calcification and CIMT.
Conclusion: CIMT was more prominent as a sign of atherosclerotic development in HD patients and valve calcification was more frequent. In addition to classical risk factors, we have concluded that the uremic environment may contribute to an acceleration in the atherosclerotic process.