Advanced atherosclerosis in predialysis patients with chronic renal failure
Advanced atherosclerosis in predialysis patients with chronic renal failure
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DOI：
10.1046/j.1523-1755.2002.00372.x
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发表时间：
2002-06-01
影响因子：
19.6
通讯作者：
Nishizawa, Y
中科院分区：
文献类型：
--
作者：
Shoji, T;Emoto, M;Nishizawa, Y
背景。血液透析患者的动脉粥样硬化进展为颈动脉内膜中层厚度（CA-IMT）增加，尽管尚不清楚晚期动脉粥样硬化是由血液透析治疗还是慢性肾功能衰竭引起。本研究的目的是评估血液透析和肾功能衰竭对慢性肾功能衰竭患者CA-IMT的影响。方法。采用高分辨率B超超声检查开始透析前的110例慢性肾功能衰竭患者（CRF组）的CA-IMT，并与345例血液透析患者（HD组）和302名健康对照者的CA-IMT进行比较。他们都没有糖尿病，并且三组在年龄和性别上具有可比性。结果。与健康对照组相比，CRF和HD组的CA-IMT更高，而CRF和HD组的CA-IMT没有统计学差异。 HD组血液透析时间与CA-IMT之间无显着相关性。对全部受试者的多元回归分析表明，存在肾功能衰竭但未接受血液透析治疗是与 CA-IMT 增加相关的一个重要因素，与年龄、性别、血压、吸烟、高密度脂蛋白 (HDL) 和非 HDL 胆固醇水平无关。结论。这些结果表明，慢性肾功能衰竭患者在开始血液透析治疗前就存在动脉壁增厚的情况，支持了血液透析患者的晚期动脉粥样硬化并非由血液透析治疗引起，而是由肾功能衰竭和/或肾功能衰竭继发的代谢异常引起的观点。
Background. Atherosclerosis is advanced in hemodialysis patients as shown by increased intima-media thickness of carotid arteries (CA-IMT), although it is not established whether the advanced atherosclerosis results from hemodialysis treatment or from chronic renal failure. The purpose of this study was to evaluate the effects of hemodialysis and renal failure on CA-IMT in patients with chronic renal failure.Methods. CA-IMT was measured by high-resolution B-mode ultrasonography in 110 patients with chronic renal failure before starting dialysis (CRF group), and compared with CA-IMT of 345 hemodialysis patients (HD group) and 302 healthy control subjects. They were all nondiabetic and the three groups were comparable in age and gender.Results. As compared with the healthy control subjects, the CRF and HD groups had greater CA-IMTs, whereas CA-IMTs of the CRF and HD groups were not statistically different. There was no significant correlation between duration of hemodialysis and CA-IMT in the HD group. Multiple regression analysis in the total subjects indicated that presence of renal failure, but not being treated with hemodialysis, was a significant factor associated with increased CA-IMT independent of age, gender, blood pressure, smoking, high-density lipoprotein (HDL) and non-HDL cholesterol levels.Conclusions. These results demonstrate that thickening of arterial wall is present in patients with chronic renal failure before starting hemodialysis treatment, and support the concept that advanced atherosclerosis in hemodialysis patients is due not to hemodialysis treatment, but to renal failure and/or metabolic abnormalities secondary to renal failure.