Structure and function of the left ventricle and carotid artery in hemodialysis patients

Hemodialysis patients frequently show associated hypertension, which can le ad to a number of cardiovascular complications. The aim of this study was t o assess the effects of hypertension on the structure and function of the c arotid artery and left ventricle (LV) in hemodialysis patients. In addition , we investigated the contribution of hemodialysis and other risk factors. Fifty-two hemodialysis patients, 71 hypertensive patients (HT group) and 30 normotensive subjects (NT group) were included in this study. Hemodialysis patients were divided into two groups: 35 patients with hypertension (HDHT group), and 17 patients without hypertension (HDNT group). We measured int ima-media thickness(IMT), plaque score, end-diastolic diameter, and stiffne ss index beta of the carotid artery by ultrasonograptry, and LV mass index (LVMi), endocardial fractional shortening(FS), and midwall FS (MWS) by echo cardiography. A multiple stepwise regression analysis including hemodialysi s, hypertension, diabetes mellitus, and other risk factors was also perform ed. IMT was significantly higher in the HT and HDHT groups than in the NT g roup, Plaque score and diameter of the carotid artery were higher in the HD HT group than in the other three groups. The stiffness index beta was highe r in the HDHT group than in the non-hemodialysis groups. In multivariate an alysis, IMT was independently correlated with age and hypertension. Plaque score and stiffness index beta were independently associated with age, hype rtension, and hemodialysis. LVMi was higher in HT and hemodialysis-patients groups than in the NT group. Hypertension and hemodialysis were strong and independent predictors of LVMi. FS showed no significant differences among the four groups, but MWS was significantly lower among the hemodialysis pa tients than in the NT group. MWS was independently correlated with hemodial ysis and diabetes. In conclusion, hemodialysis per se advanced both atheros clerosis and arteriosclerosis of the carotid artery. Moreover, it increased LVMi and caused cardiac dysfunction, Associated hypertension might thus ac celerate the progression of atherosclerosis and arteriosclerosis of the car otid artery and the increase of LVMi.