Does renal failure cause an atherosclerotic milieu in patients with end-stage renal disease?

PURPOSE: Atherosclerotic vascular disease is the main cause of morbidity an d mortality in patients with end-stage renal disease, but the independent c ontribution of renal failure rather than associated risk factors is unclear . We sought to examine the relative contribution of these factors to the se verity of atherosclerosis by measuring intima-medial thickness and brachial artery reactivity in uremic patients and controls. SUBJECTS AND METHODS: Cardiovascular risk factors, including lipid and homo cysteine levels, were evaluated in 213 patients (69 on hemodialysis, 60 on peritoneal dialysis, and 82 nonuremic controls). High-resolution B-mode ult rasonography with automated off-line analysis was used to measure the intim a-medial thickness in the common carotid artery and to measure the lumen di ameter of the brachial artery at rest, during reactive hyperemia, and after sublingual nitroglycerine. The correlations of risk factors with intima-me dial thickness and brachial reactivity were examined using a general linear regression model. RESULTS: Patients with renal failure had a greater mean (+/- SEM) maximum i ntima-medial thickness than controls (0.83 +/- 0.02 mm versus 0.70 +/- 0.02 mm, P <0.05), but the brachial artery response to reactive hyperemia was n ot significantly different between the renal failure patients and the contr ol group (4.7% +/- 6.1% versus 6.1% +/- 8.6% dilatation, P >0.05). The urem ic state was an independent predictor of intima-medial thickness (r(2) = 0. 16, P <0.001) but not of brachial artery reactivity (P = 0.99). CONCLUSION: The atherosclerotic burden in patients with renal failure, as i ndicated by an increased intima-medial thickness, may reflect effects of ur emia that are independent of cardiovascular risk factors. (C)2001 by Excerp ta Medica, Inc.