CALCIFIED PLAQUE IS COMMON IN THE CAROTID AND FEMORAL ARTERIES OF DIALYSIS PATIENTS WITHOUT CLINICAL VASCULAR-DISEASE

Background. Cardiac and vascular mortality are common in end-stage ren al disease (ERSD) and are often attributed to accelerated atherosclero sis. Subjects and methods. We studied 24 non-diabetic ESRD patients wi thout cardiac or vascular disease (M=12, F=12) and 24 age-, sex- and r ace-matched healthy controls. All underwent B-mode ultrasound for caro tid and femoral intima-media thickness (IMT) and plaque (% stenosis) t ogether with blood pressure (BP), and echocardiograms to determine lef t ventricular mass. Results. Both BP and mean IMT were similar in pati ents and controls. However, discrete plaque was present in 71% (17/24) of patients compared with 21% (5/24) of controls (P=0.001), and % ste nosis was greater in patients (carotid 12.2+/-11% vs 2.3+/-5.9%, P<0.0 004; femoral 16.4+/-19.1% vs 3.1+/-6.4%, P<0.003). Plaque was soft/ath eromatous in 3 of the 5 controls, but not in any of the 17 patients (P =0.007), all of whom had calcified lesions. BP and cholesterol were no t correlated with IMT or plaque in patients, but in control subjects c arotid IMT was correlated with systolic BP (r=0.66, P<0.0005) and dias tolic BP (r=0.45, P<0.03). In patients, the only independent variables related to vascular morphology were serum albumin which was inversely related to IMT (P<0.03) and to plaque (carotid P<0.05, femoral P<0.02 ) and age, which was related to femoral plaque only (P<0.04). Left ven tricular end-diastolic internal dimension, not LVMI, correlated positi vely with carotid IMT (P<0.04). Conclusion. Our results show that calc ified plaque is common in ESRD patients and hypoalbuminaemia may be an associated factor.