Background. In dialysis patients cardiovascular mortality is 10 to 20 times higher than in general population. It remains uncertain whether atherosclerosis of dialysis patients is effectively ...accelerated because many of dialysis patients have more or less marked vascular lesions already at the start of dialysis treatment. Subjects and methods. Using B-mode ultrasonography (ATL HDI 3000), we compared intima-media thickness (IMT) and plaque occurrence (indicators of atherosclerosis) in the common carotid arteries (CC), in the area of bifurcation (CB) and in the proximal part of internal carotid arteries (CI) in 28 hemodialysis patients (14 men and 14 women; mean age 49.4 years; mean duration of HD treatment 66.6 months) with that in 28 age-sex matched patients prior to initiation of hemodialysis. We also investigated possible differences in atherosclerotic risk factors in both groups. Results. The IMT values of CC (0.71 vs. 0.70 mm; p = 0.937), CB (0.81 vs. 0.77 mm; p = 0,423) and CI (0.72 vs. 0.71 mm; p = 0.935) were not significantly different in dialysis patients and patients starting dialysis treatment. We also found no difference in plaque occurrence (61% vs. 54%; p = 0.787) and in atherosclerotic risk factors (hypertension, smoking, lipids) between both groups. Conclusions. In our study we found no difference in atherosclerotic lesions in carotid arteries between dialysis patients and patients with end-stage renal failure starting dialysis treatment. Patients with chronic renal failure are at high risk for cardiovascular diseases so we should intervene earlier and more actively long before dialysis treatment in order to reduce the atherosclerotic risk factors.
Background: Vascular access remains the Achilles' heel of successful hemodialysis, and thrombosis is the leading cause of vascular access failure. Hyperhomocystinemia is common in hemodialysis ...patients and is associated with venous and arterial thrombosis in patients without end-stage renal disease. Subjects and methods: In the study, 65 hemodialysis patients with native arteriovenous fistula were included. Two groups of patients were defined: group A including 45 patients with their vascular access either never or only once thrombosed, and group B including 20 patients with two or more thromboses of their vascular access. We determined serum concentrations of total homocysteine (immunoassay, Abbott) in our patients. Results: In 63 (96.9%) patients, hyperhomocystinemia was presented. There was no statistically significant difference between group A and B regarding age, gender and duration of hemodialysis treatment. Total homocysteine concentrations were higher in group A (42.1 ± 18.6 µmol l) than in group B (36.1 ± 18.1 µmol l) patients but the difference was small and not statistically significant. Conclusion: We found no significant differences in total homocysteine concentrations between group A (thrombosis non-prone) and group B (thrombosis prone) patients. Our results suggest that thrombosis of native arteriovenous fistulas may not be caused by hyperhomocystinemia in these patients.
Our prospective 1-year study comprises 93 patients of both sexes, various ages and various dialysis duration. Among them, 31 patients with a concentration of Ca in blood under 2.7 mmol/l, a ...concentration of P under 1.8 mmol/l and a concentration of PTHi over 65 pg/ml (group 0) received calcitriol 0.25 microgramx418p4The control group consisted of patients not receiving calcitriol and having normal Ca and P metabolism (group 1). The rest of the patients had a concentration of P over 1.8 mmol/l and could not be given calcitriol. A comparison of the dynamics of average plasmic concentrations of Ca, P, AP, PTHi and X-ray changes in group 0 and 1 at the beginning of the investigation and 1 year later was carried out. At the termination of the 1-year treatment, when compared to the initial state, a statistically significant increase in the concentration of Ca (p < 0.005) and in the concentration of P (p < 0.005) was noted in group 0. The average concentration of PTHi decreased to the desired level, the X-ray changes characteristic of secondary hyperparathyroidism progressed more slowly in group 0.
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