ABSTRACT
AIM: To perform ultrasound dopplerography (UD) investigation of severity and prevalence of atherosclerosis/calcinosis of the central and peripheral arteries in patients with chronic renal failure (CRF); to estimate correlation between the vascular lesions and cardiovascular risk factors. MATERIAL AND METHODS: UD of major arteries and echocardiography were made in 46 patients with CRF: 10 patients with initial CRF (creatinine 1.4-2.2 mg/dl) and 36 patients with terminal CRF on hemodialysis. RESULTS: Calcinates and atherosclerotic plaques were registered in the carotid and femoral arteries of all the patients. Atherosclerotic lesion was more frequent than calcinosis in the carotid arteries. Calcinosis was more frequent in the femoral arteries. The popliteal and tibial arteries were affected only by calcinosis which occurred in 20% patients with initial and 44.4% patients with terminal CRF. Calcinosis severity increased with progression of CRF while atherosclerosis severity depended more on the patients' age than on severity of CRF. The pulse wave speed in the carotid and femoral arteries was higher in marked left ventricular hypertrophy, seven (19.4%) of these patients had reduced ejection fraction of the left ventricle < 40%. CONCLUSION: Compound atherosclerotic/calcinosis lesion of the vessels is registered at early stages of CRF and progress with progression of renal failure.
Subject(s)
Calcinosis/epidemiology , Calcinosis/pathology , Carotid Artery Diseases/epidemiology , Carotid Artery Diseases/pathology , Kidney Failure, Chronic/epidemiology , Atherosclerosis/diagnostic imaging , Atherosclerosis/epidemiology , Atherosclerosis/pathology , Carotid Artery Diseases/diagnostic imaging , Disease Progression , Female , Humans , Male , Middle Aged , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/epidemiology , Peripheral Vascular Diseases/pathology , UltrasonographyABSTRACT
AIM: To estimate incidence and clinical significance of carotid and femoral arteries calcification in patients with terminal renal failure (TRF) on programmed hemodialysis (PH). MATERIAL AND METHODS: Thirty four patients (25 males and 9 females) with TRF were divided into two groups by severity of hyperphosphatemia: 15 patients with P < 6 mg/dl (group 1) and 19 patients with P > 6 mg/dl. The groups were matched by age (44.4 +/- 15.05 and 42.7 +/- 14.23 years, respectively) and PH duration (2.4 +/- 1.1 and 2.6 +/- 1.16 years, respectively). Calcification of the arteries and structure of the vascular wall were examined with ultrasonic dopplerography of the common carotid and femoral arteries. Measurements were made of intima-media complex (IMC) thickness, systolic and diastolic diameter of the right and left carotid artery. The arteries were studied for the presence of calcinates and atherosclerotic plaques. RESULTS: Patients of group 2 showed a correlation between a P level, incidence rate of common carotid arteries calcification, atherosclerotic plaques in the femoral arteries, IMC of the carotid and femoral arteries, left ventricular hypertrophy and a decline in a left ventricular diastolic function. A significant correlation was established between the rate of atherosclerotic plaques detection and age, male sex, smoking and history of PH. An increase in IMC and arterial rigidity was revealed in 12 (63.2%) of 19 patients of group 2. They had episodes of intradialysis hypotonia, 6 (31.6%) patients had acute coronary syndrome, 5 (26.3%) patients--cardiac arrhythmia. CONCLUSION: A significant contribution to formation of risk factors of cardiovascular complications in TRF patients on PH is made by disturbed phosphorus-calcium metabolism resulting in higher rigidity and diameter of the arteries. The above changes lead to a rise in systolic pressure and fall in diastolic one. Increased pulse pressure is an independent predictor of the risk to develop acute coronary syndrome.
