Hong Kong Journal of Nephrology

Volume 6 Number 2, 2004

B-mode Ultrasonography of Carotid and Femoral Arteries for Calcified Plaques in Chronic Renal Failure, Hemodialysis and Kidney Transplant Patients

Hamid Nasri
Section of Hemodialysis, Hajar Medical, Educational and Therapeutic Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.

Azar Baradaran
Department of Biochemistry, Reference Laboratories of Iran--Research Center, Tehran, Iran.

Objectives: To compare the presence of plaques in the carotid and femoral arteries of chronic renal failure (CRF) patients not yet on hemodialysis, or on maintenance hemodialysis, and kidney transplant patients with those of normal controls, and to consider the relationship of plaques to serum lipoprotein(a) [Lp(a)].
Methods: There were 130 subjects divided into four groups: group 1 comprised 29 healthy controls; group 2 was made up of 33 CRF patients; group 3 of 43 hemodialysis patients; group 4 had 25 kidney transplant recipients. All patients underwent B-mode ultrasonography examination of the right and left carotid and femoral arteries for plaques; they were scored from 0 (no plaques) to 4 (plaques at all 4 sites). After a 14-hour over- night fast, blood samples from all patients were evaluated for blood urea nitrogen, creatinine, and serum lipids, including Lp(a).
Results: A plaque score of zero was most common in group 1 (93%), followed by groups 4 (68%), 3 (51.2%), and 2 (39.4%). Plaque scores of 1-2 increased from group 1 (6.8%) through groups 2 (24.3%) and 3 (25.6%) to group 4 (32%). Plaque scores of 3-4 were lowest in groups 1 and 4 (0%) and highest in group 2 (36.4%); they were 23.3% in group 3. Serum Lp(a) in groups 1, 2, 3, and 4 were 42, 56, 55, and 54 mg/dL, respectively. There were significant differences in plaque scores (p < 0.001) and serum Lp(a) (p = 0.016) among the four groups. A significant positive correlation was found between plaque score and patient age in groups 2, 3, and 4. There was a significant correlation between plaque score and serum Lp(a) in group 3.
Conclusion: Age is an important factor in the occurrence of arterial plaques in renal failure patients, before dialysis and on maintenance hemodialysis, and in kidney transplant patients. The positive association between serum Lp(a) and arterial plaques in hemodialysis patients may indicate that Lp(a) is a factor in the rapidly progressive atherosclerosis seen in hemodialysis patients.

Key words: arterial plaques, atherosclerosis, lipoprotein(a), chronic renal failure, hemodialysis, kidney transplant

目的:以三類慢性腎衰竭(CRF)患者—尚未開始接受血液透析者、正在長期接受血液透析者、及腎臟移植接受者為對象,調查動脈粥狀斑塊的出現情形及其與血清脂蛋白(a)[Lp(a)] 的關係,並與健康對照組作出比較。
方法:本研究共有 4 組共 130 位病人:健康自願者(n = 29)、CRF患者(n = 33)、血液透析接受者(n = 43)、及腎臟移植接受者(n = 25),均接受 B-mode 超音波程序,以檢查兩側的頸動脈及股動脈是否出現斑塊,並以 0(無斑塊)至 4(四個部位均有斑塊)作出評分。此外,在經過 14 小時的通宵禁食後,研究人員對病人進行血液化驗,以測量尿素氮、肌酸酐、及各項血脂的濃度[包括Lp(a)]。
結果:無斑塊比率以對照組最高(93%),其他依降序為移植組(68%)、透析組(51.2%)、及 CRF 組(39.4%)。各組在斑塊評分 1-2 的比率上,按升序為對照組(6.8%)、CRF 組(24.3%)、透析組(25.6%)、及移植組(32%)。斑塊評分 3-4 以對照組及移植組為零比率;CRF 組及透析組則分別為 36.4% 及23.3%。血清 Lp(a)的結果為(mg/dL):對照組(42)、CRF 組(56)、透析組(55)、及移植組(54)。各組間的顯著差異均可見於斑塊評分(p < 0.001)及血清 Lp(a)(p = 0.016)上。在各組的 CRF 患者中,斑塊評分與病人年齡之間存在顯著的正相關性﹔斑塊評分與血清 Lp(a)的正相關性則僅可見於透析組中。
結論:對於各類慢性腎衰竭患者,包括尚未開始接受血液透析者、正在長期接受血液透析者、及腎臟移植接受者,年老是出現動脈粥狀斑塊的危險因子之一。在正在接受血液透析的腎衰竭患者中,血清 Lp(a)是促成動脈粥狀硬化發展的一個可能因素。

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