I1 fumo, la pressione arteriosa e l'albuminemia sono fattori predittivi indipendenti del danno vascolare negli uremici in dialisi

Objective: To investigate the relationship between atherosclerosis, arterial hypertension and other risk factors in uremic patients. Study design: A cross-sectional study in 119 dialysis patients (89 on hemodialysis and 30 on CAPD). Methods: Fasting blood sampling for serum lipids, albumin, hemoglobin, as well as echo-color-Doppler evaluation of common carotid arteries were performed in all patients (during the non-dialysis day in hemodialysis patients). Results: Ninety-five patients had at least one plaque and 57 had at least four plaques. Thirty-eight patients had mild and eleven subjects had severe carotid stenosis. In multiple regression models, the mean internal diameter of carotid arteries correlated to systolic pressure (β=0.36), serum cholesterol (β=-0.25), age (β=0.24) and smoking (β=0.17) (R=0.52, P=0.0001) while the degree of carotid stenosis was predicted by age (β=0.27) and smoking (β=0.23) (R=0.39, P=0.0001). Furthermore, the number of atherosclerotic plaques correlated by age (β=0.35), smoking (β=0.22) and pulse pressure (β=0.18) (R=0.51, P=0.0001) while serum albumin just failed to reach statistical significance (β=-0.16, P=0.06). However, in hemodialysis patients (n=89) serum albumin was a significant and independent predictor of the number of atherosclerotic plaques (β=-0.22). The Kt/Value, duration of dialysis treatment, hemoglobin, serum calcium and phosphate did not add any predictive power to the models. Conclusions: In dialysis patients arterial pressure and smoking are indipendent risk factors of atherosclerosis. Furthermore in hemodialysis patients, serum albumin is an independent predictor of atherosclerosis.