Atherosclerosis occurs in patients undergoing maintenance hemodialysis

doi:10.3969/j.issn.2095-4344.2013.31.014

Abstract

Abstract:

BACKGROUND: Atherosclerosis is a common complication in diabetic nephropathy and hemodialysis patients. The effect of hemodialysis duration and other relative factors on the atherosclerosis of patients with diabetic nephropathy needs to be further observed and explored.
OBJECTIVE: To observe the atherosclerosis in the patients with different hemodialysis durations, then to evaluate the effect of hemodialysis duration and other relative factors on atherosclerosis of patients with diabetic nephropathy.
METHODS: The intima-media thickness of the carotid artery in the diabetic nephropathy hemodialysis group, non-diabetic nephropathy hemodialysis group and end-stage renal disease non-hemodialysis group was detected with high-frequency ultrasonic testing, and the healthy volunteers were as the normal control group. The relationship between the intima-media thickness of the carotid artery in the hemodialysis patients and hemodialysis duration was analyzed, and the changes of insulin resistance in each group were compared.
RESULTS AND CONCLUSION：Compared with the normal control group, the intima-media thickness of the carotid artery in the diabetic nephropathy hemodialysis group and non-diabetic nephropathy hemodialysis group was increased (P < 0.01); there was no significant difference of intima-media thickness of the carotid artery between 24 hours diabetic nephropathy hemodialysis group and end-stage renal disease non-hemodialysis group (P > 0.05); the intima-media thickness of the carotid artery in the 60 months diabetic nephropathy hemodialysis group was higher than that in the 24 hours diabetic nephropathy hemodialysis group
(P < 0.05); the intima-media thickness of the carotid artery in the 60 months diabetic nephropathy hemodialysis group was significantly higher than that in the end-stage renal disease non-hemodialysis group (P < 0.01). There was no significant difference of intima-media thickness of the carotid artery between 60 months diabetic nephropathy hemodialysis group, end-stage renal disease non-hemodialysis group and 24 hours diabetic nephropathy hemodialysis group (P > 0.05). The homeostasis model of assessment-insulin resistance value in the 24 hours diabetic nephropathy hemodialysis group was slightly lower than that in the diabetic nephropathy non-emodialysis group (P < 0.05), and the homeostasis model of assessment-insulin resistance value in the 60 months diabetic nephropathy hemodialysis group was significantly lower than that in the diabetic nephropathy non-emodialysis group (P < 0.01). The development of atherosclerosis on diabetic nephropathy patients can be affected by hemodialysis to some extent. And the effect is correlated with the hemodialysis duration.

Key words: organ transplantation, basic experiments of organ transplantation, diabetic nephropathy, hemodialysis, ultrasonograph, intima-media thickness of carotid artery, atherosclerosis, insulin resistance, uremia, low-density lipoprotein

CLC Number:

R318

Wu Dao-xu, Xu Yan. Atherosclerosis occurs in patients undergoing maintenance hemodialysis[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.31.014.

Figures/Tables 3

References

[1] Broumand B. Diabetes: changing the fate of diabetics in the dialysis unit. Blood Purif. 2007;25(1):39-47.

[2] Fasseas P, Brilakis ES, Leybishkis B, et al. Association of carotid artery intima-media thickness with complex aortic atherosclerosis in patients with recent stroke. Angiology. 2002;53(2):185-189.

[3] Dursun B, Dursun E, Capraz I, et al. Are uremia, diabetes, and atherosclerosis linked with impaired antioxidant mechanisms J Investig Med. 2008;56(2):545-552.

[4] Simon A, Gariepy J, Chironi G, et al. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. JHypertens. 2002;20(2):159-169.

[5] Nakamura T, Matsuda T, Kawagoe Y, et al. Effect of pioglitazone on carotid intima-media thickness and arterial stiffness in type 2 diabetic nephropathy patients. Metabolism. 2004;53(10):1382-1386.

[6] 匡鼎伟,丁峰,薛骏, 等.维持性血透患者颈动脉内膜中层厚度增厚及其影响因素分析[J].中华肾脏病杂志,2005,21(10):577-581.

[7] Joki N, Hase H, Saijyo T, et al. Combined assessment of cardiac systolic dysfunction and coronary atherosclerosis used to predict future cardiac deaths after starting hemodialysis. Am J Nephrol. 2003;23(6):458-465.

[8] Yokoyama H, Aoki T, Imahori M, et al. Subclinical atherosclerosis is increased in type 2 diabetic patients with microalbuminuria evaluated by intima-media thickness and pulse wave velocity. Kidney Int. 2004;66(1):448-454.

[9] Kobayashi S, Maejima S, Ikeda T, et al. Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. 2000; 15 (1):65-70.

[10] Elokely A, Shoukry A, Ghonemy TA, et al. Association of adiponectin with cardiovascular events in diabetic and non-diabetic hemodialysis patients. Saudi J Kidney Dis Transpl. 2012;23(4):736-742.

[11] Bondar' IA, Klimontov VV. Treatment of diabetes mellitus in dialysis patients. Ter Arkh. 2011;83(12):73-77.

[12] Abe M, Okada K, Kikuchi F, et al. Clinical investigation of the effects of pioglitazone on the improvement of insulin resistance and blood pressure in type 2-diabetic patients undergoing hemodialysis. Clin Nephrol. 2008;70(3):220-228.

[13] Lubowsky ND, Siegel R, Pittas AG. Management of glycemia in patients with diabetes mellitus and CKD. Am J Kidney Dis. 2007;50(5):865-879.

[14] Emoto M, Nishizawa Y, Maekawa K, et al. Homeostasis model assessment as a clinical index of insulin resistance in type2 diabetic patients treated with sulfonylureas. Diabetes Care. 1999;22:818-822.

[15] Pascazio L, Bianco F, Giorgini A, et al.Echo color Doppler imaging of carotid vessels in hemodialysis patients: evidence of high levels of atherosclerotic lesions. Am J Kidney Dis. 1996;28(5):713-720.

[16] Nakamura T, Matsuda T, Kawagoe Y, et al. Effect of pioglitazone on carotid intima-media thickness and arterial stiffness in type 2 diabetic nephropathy patients. Metabolism. 2004;53(10):1382-1386.

[17] Zhang L, Zhao F, Yang Y, et al. Association between carotid artery intima-media thickness and early-stage CKD in a Chinese population. Am J Kidney Dis. 2007;49(6):786-792.

[18] Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986;74(6):1399-1406.

[19] Hung AM, Ikizler TA. Factors determining insulin resistance in chronic hemodialysis patients. Contrib Nephrol. 2011;171:127-134.

[20] Takenaka T, Kanno Y, Ohno Y, et al. Key role of insulin resistance in vascular injury among hemodialysis patients. Metabolism. 2007;56(2):153-159.

[21] Toprak O, Cirit M, Yesil M, et al. Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease. Nephrol Dial Transplant. 2007;22(3):819-826.

[22] Bodlaj G, Berg J, Pichler R, et al. Prevalence, severity and predictors of HOMA-estimated insulin resistance in diabetic and nondiabetic patients with end-stage renal disease. J Nephrol. 2006;19(5):607-612.

[23] Borissova AM, Djambazova A, Todorov K, et al. Effect of erythropoietin on the metabolic state and peripheral insulinsensitivity in diabetic patients on haemodialysis. Nephrol Dial Transplant.1993;8(1):93.

[24] Shoji T, Emoto M, Nishizawa Y.HOMA index to assess insulin resistance in renal failure patients. Nephron. 2001;89: 348-349.

[25] Gullu H, Erdogan D, Caliskan M, et al. Interrelationship between noninvasive predictors of atherosclerosis: transthoracic coronary flow reserve, flow-mediated dilation, carotid intima-media thickness, aortic stiffness, aortic distensibility, elastic modulus, and brachial artery diameter. Echocardiography. 2006;23(10):835-842.

[26] Campuzano R, Moya JL, García-Lledó A, et al. Endothelial dysfunction, intima-media thickness and coronary reserve in relation to risk factors and Framingham score in patients without clinical atherosclerosis. J Hypertens. 2006;24(8): 1581-1588.

[27] Hung AM, Sundell MB, Egbert P, et al. A comparison of novel and commonly-used indices of insulin sensitivity in African American chronic hemodialysis patients. Clin J Am Soc Nephrol. 2011;6(4):767-774.

[28] Cade C; Norman AW. Vitamin D3 improves glouse intolerance and insulin secretion in the vitamin D deficient rat in vivo. Endocrinology. 1986;119:84-90.

[29] Liao MT, Sung CC, Hung KC, et al. Insulin resistance in patients with chronic kidney disease. J Biomed Biotechnol. 2012;2012:691369.

[30] Zang L, Fu P, Huang YQ, et al. [Vitamin D deficiency and carotid artery intima-media thickness and coronary calcification in patients with diabetic Nephropathy. Sichuan Da Xue Xue Bao Yi Xue Ban. 2012;43(3):420-424, 450.

[31] Falaknazi K, Tajbakhsh R, Sheikholeslami FH. Evaluation of association between intima-media thickness of the carotid artery and risk factors for cardiovascular disease in patients on maintenance hemodialysis. Saudi J Kidney Dis Transpl. 2012;23(1):31-36.

[32] Kim KJ, Lee BW, Kim HM, et al. Associations between cardio-ankle vascular index and microvascular complications in type 2 diabetes mellitus patients. J Atheroscler Thromb. 2011;18(4):328-336.