Ultrasound carotid intima-media thickness (CIMT) evaluation as a marker of cardiovascular damage in hemodialysis patients and in stable renal transplant recipients

The aim of the study was to evaluate the impact of traditional and non-traditional cardiac risks factors on CIMT (mm) evaluated by B-mode ultrasound and color flow mapping of the carotid artery bilaterally in hemodialysis (HD) pts and renal transplant recipients (RTRs).

In 148 HD pts and 79 RTRs CIMT is evaluated; simultaneously sCa, sPO4, PTH, cholesterol, HDL, LDL, homocystein (Hcy), and C-reactive protein (CRP) were determined.

CIMT was greater in HD pts than in RTRs (1.45±0.79 vs. 0.78±0.43mm, P<.000). Moreover, CIMT was greater in HD pts than in age-matched RTRs [HD vs. RTRs: <39 years, 0.85 vs. 0.56 (P<.01); 40–49, 1.19 vs. 0.72 (P<.000); 50–59, 1,26 vs. 0,94 (P=NS); 60–69, 1,59 vs. 1,05 (P=NS)]. In HD pts CIMT correlated also with sPO4, CaxPO4, HDL, and CRP (r=.410, P<.000; r=.399, P<.000; r=-.176, P<.05; r=.243, P<.01; respectively), while in RTRs CIMT correlated only with Hcy (r=.532, P<.000). In HD pts CaxPO4, PTH, Hcy, and CRP levels were higher than in RTRs (50±12 vs. 33±7mg/dl, P<.000; 405±358 vs. 113±97mg/dl, P<.000; 32±28 vs. 21±15µMol/L, P<.05; 3.98±4.50 vs. 2.88±3.82mg/L, P<.05; respectively).

In conclusion renal transplantation (RT) reduces some of the main cardiovascular risk factors, but does not eliminate all them. In fact, after RT Hcy levels keep on to be abnormally elevated. The increase of CIMT in HD occurs at young age already and progresses with ageing, RT seems to be able to regress it partially.