Smoking, blood pressure and serum albumin are major determinants of carotid atherosclerosis in dialysis patients

Aim: To investigate the relationship between carotid atherosclerosis and so me major cardiovascular risk factors in uremic patients on chronic dialysis . Methods: A cross-sectional study was carried out in 119 unselected dialysis patients (89 on hemodialysis and 30 on chronic ambulatory peritoneal dialy sis, CAPD). Fasting blood sampling for serum Lipids, albumin, hemoglobin, a nd echo-colour-Doppler evaluation of common carotid arteries were performed in all patients (during the non-dialysis day in hemodialysis patients). In hemodialysis patients BP was measured before and after dialysis; in CAPD p atients home BP values were recorded during the month before the study day. Results: Ninety-five patients had at least one plaque and 57 had at least f our plaques. Thirty-eight had mild and eleven severe carotid stenosis. In m ultiple regression models, the mean internal diameter of carotid arteries w as explained (R=0.52, P=0.0001) by systolic pressure (r=0.39), serum choles terol (r=-0.28), age (r=0.27) and smoking (r=0.24) while the degree of caro tid stenosis was predicted (R=0.39, P=0.0001) by age (r=0.36) and smoking ( r=0.25). The number of atherosclerotic plaques was explained (R=0.51, P=0.0 001) by age (r=0.36), smoking (r=0.25) and pulse pressure (r=0.20), serum a lbumin just failing to reach statistical significance (P = 0.06). However, serum albumin was a significant and independent predictor of the number of atherosclerotic plaques (r=-0.26) in hemodialysis patients (n=89). Sex, dia betes, Kt/V, duration of dialysis treatment, hemoglobin, serum calcium and phosphate did not add any predictive power to the models. Conclusions: In dialysis patients arterial pressure and smoking are associa ted with carotid atherosclerosis. Serum albumin appears to serve as an inde pendent predictor of carotid atherosclerosis.