Accelerated progression of arterial stiffness in dialysis patients compared with the general population

BACKGROUND/AIMS: The aim of this study was to compare the progression of aortic stiffness in chronic hemodialysis patients (CHP) with that of general population patients (GPP) over a 36-month period and to evaluate the determinants of this progression. METHODS: The study group included 80 patients undergoing hemodialysis (aged 59.3 +/- 11.8 years; duration of dialysis 5.47 +/- 5.16 years). The control group consisted of 60 patients (aged 57.5 +/- 10.9 years) with a glomerular filtration rate of > 60 mL/min/1.73 m2. Pulse wave velocity (PWV) was determined from time diversity propagation of the common carotid artery and femoral artery by Doppler ultrasound. Clinical and biochemical parameters were determined in serum using standard laboratory procedures. RESULTS: The mean PWV values at baseline and 36 months were 11.18 +/- 2.29 and 11.82 +/- 2.34 m/sec in the CHP group, and 9.02 +/- 1.89 and 9.29 +/- 1.93 m/sec in the GPP group, respectively. The average PWV progressions were 63.95 +/- 18.373 cm/sec in CHP and 27.28 +/- 28.519 cm/sec in GPP. By multiple regression analysis, hemoglobin (standardized coefficient beta [betast] = -0.405, p = 0.004; betast = -0.364, p = 0.011), albumin (betast = -0.349, p = 0.042; betast = -0.303, p = 0.034), CRP (betast = 0.458, p = 0.002; betast = 0.187, p = 0.008), and total cholesterol (betast = 0.236, p = 0.038; betast = 0.171, p = 0.078) were independently associated with PWV in the CHP and GPP groups, respectively. CONCLUSIONS: Accelerated arterial stiffness was more pronounced in the CHP group than in the GPP group. The independent determinants of this progression in both groups include traditional risk factors and blood levels of hemoglobin, albumin and CRP. Cholesterol and uremia-related factors are determinants only in CHP.

The Progression of Bone Mineral Density Loss in Dialysis Patients Compared with the General Population

BACKGROUND/AIMS: The aim of this study was to compare the progression of bone mass loss in chronic hemodialysis patients (CHPs) with that in general population patients (GPPs) over an 18-month period. METHODS: The control group consisted of 60 patients (aged 57.5 +/- 10.9 years) with a glomerular filtration rate > 60 mL/min/1.73 m2. The study group included 80 patients undergoing hemodialysis (aged 59.3 +/- 11.8 years; duration of dialysis 5.47 +/- 5.16 years). Bone mineral density (BMD) testing was conducted in both groups using dual energy X-ray absorptiometry at hip and lumbar spine regions at baseline and after 18 months. Biochemical parameters (albumin, C-reactive protein, calcium, ionized calcium, alkaline phosphatase, and parathyroid hormone) were determined in all participants using standard laboratory procedures. RESULTS: The mean values of BMD (average hip + lumbar spine) were 0.900 +/- 0.14 g/cm2 and 0.866 +/- 0.14 g/cm2 in the GPP and 0.823 +/- 0.16 g/cm2 and 0.769 +/- 0.13 g/cm2 in the CHP groups at baseline and 18 months, respectively. The statistical significance (p value) of hip bone loss progression over 18 months was 0.0577 for GPP and 0.0002 for CHP, whereas that of lumbar spine bone loss progression was 0.6820 for GPP and 0.5389 for CHP. CONCLUSIONS: The of progression bone mass loss was significantly greater in CHP than in GPP. Bone mass loss was evident even over 1 month, albeit in only the CHP with accelerated osteoporosis.