Vascular Calcification, Inflammation and Coronary Flow Velocity in Hemodialysis Patients
Condition: Renal Dialysis; Cardiovascular Diseases; Atherosclerosis; Inflammation
MeSH terms: Cardiovascular Diseases; Atherosclerosis; Calcinosis; Vascular Calcification; Inflammation
Study type: Observational

Summary: 
      The aim of this cross-sectional study is to determine the correlation of coronary artery
      calcification as measured by electron-beam computerized tomography and coronary flow reserve
      measured by trans-thoracic Doppler echocardiography in hemodialysis patients. The
      investigators also assessed the carotid artery parameters by measuring intima media thickness
      that can accurately describe the process of arterial wall changes due to atherosclerosis.
      Possible association of coronary flow reserve with inflammation and arterial calcification in
      hemodialysis patients was also evaluated.
    

Detailed description: 
      Cardiovascular mortality is a major cause of death in end-stage renal disease (ESRD).
      Therefore, the identification of coronary artery disease (CAD) in ESRD is an important task
      for nephrologists. Coronary angiography is the gold standard for detecting extent and
      severity of coronary atherosclerosis. It was necessary to determine whether coronary
      angiography, which is an invasive and contrast using procedure, should be performed in all
      high-risk individuals or whether noninvasive testing could reliably identify patients with
      critical coronary lesions. The coronary artery calcification (CAC) in uremic patients
      undergoing hemodialysis reflects the severity of atherosclerotic vascular disease and
      predicts the cardiovascular events. Recent studies of chronic kidney disease (CKD) patients
      have shown significant incidence and rapid progression rates of CAC. Coronary electron-beam
      computerized tomography (EBCT) could be used as screening test to identify cardiovascular
      disease (CVD) in CKD patients. In coronary artery disease, left ventricular diastolic
      dysfunction was found to be correlated with reduced coronary flow reserve (CFR) in patients
      with hypertension and left ventricular hypertrophy. This shows that in patients with vascular
      calcification, CFR measurement by trans-thoracic Doppler echocardiography (TTDE) as a
      non-invasive and an easy test has a usage advantage during risk stratification. CFR
      represents the capacity of the coronary circulation to dilate following an increase in
      myocardial metabolic demands. By using this method, impairment of CFR can be assessed before
      development of angiographically detectable stenosis in epicardial coronary arteries and we
      are able to investigate early coronary microvasculature pathology. The aim of this
      cross-sectional study, is to determine the correlation of CAC as measured by EBCT and CFR
      measured by TTDE. We also assessed the carotid artery parameters by measuring intima media
      thickness that can accurately describe the process of arterial wall changes due to
      atherosclerosis. Possible association of CFR with inflammation and arterial calcification was
      also evaluated.
    

Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        End stage renal disease patients and normotensive healthy controls were studied for the
        assessment of coronary artery calcification score by electron-beam computerized tomography
        and coronary flow reserve trans-thoracic Doppler harmonic echocardiographyby.
      
Keywords: Atherosclerosis; Cardiovascular disease; Hemodialysis; Inflammation; Vascular calcification