Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease

Background. Cardiac and vascular mortality are common in end-stage renal disease (ERSD) and are often attributed to accelerated atherosclerosis. Subjects and methods. We studied 24 non-diabetic ESRD patients without cardiac or vascular disease (M=12, F=12) and 24 age-, sex- and race-matched healthy controls. All underwent B-mode ultrasound for carotid and femoral intima-media thickness (IMT) and plaque (% stenosis) together with blood pressure (BP), and echocardiograms to determine left ventricular mass. Results. Both BP and mean IMT were similar in patients and controls. However, discrete plaque was present in 71% (17/24) of patients compared with 21% (5/24) of controls (P=0.001), and % stenosis was greater in patients (carotid 12.2+/-11% vs 2.3+/-5.9%, P<0.0004; femoral 16.4+/-19.1% vs 3.1+/-6.4%, P<0.003). Plaque was soft/atheromatous in 3 of the 5 controls, but not in any of the 17 patients (P=0.007), all of whom had calcified lesions. BP and cholesterol were not correlated with IMT or plaque in patients, but in control subjects carotid IMT was correlated with systolic BP (r=0.66, P<0.0005) and diastolic BP (r=0.45, P<0.03). In patients, the only independent variables related to vascular morphology were serum albumin which was inversely related to IMT (P<0.03) and to plaque (carotid P<0.05, femoral P<0.02) and age, which was related to femoral plaque only (P<0.04). Left ventricular end-diastolic internal dimension, not LVMI, correlated positively with carotid IMT (P<0.04). Conclusion. Our results show that calcified plaque is common in ESRD patients and hypoalbuminaemia may be an associated factor.