SONOGRAPHIC EVALUATION OF AORTOILIAC ATHEROSCLEROSIS IN CHRONIC RENAL FAILURE PATIENTS OLDER THAN 45 YEARS: A CASE-CONTROL STUDY

Patients with chronic kidney disease (CKD) encounter many complications and morbidities. One of these major complications is accelerated atherosclerosis which is believed to be multifactorial in CKD and dialysis patients. Ultrasonographic evaluation of arteries has been proposed as an accurate and non-invasive method in assessing the process of atherosclerosis. Atherosclerotic plaque and intima-media thickness (IMT) could readily be evaluated by color Doppler ultrasonography (CDU). This study aimed at evaluating the CDU findings regarding aortoiliac atherosclerosis in hemodialysis CKD patients older than 45 years.

In an analytic-descriptive study, 50 hemodialysis patients aged 45 years or older were recruited during a 14-month period in Tabriz Imam Reza Teaching Center. Another 50 age- and sex-matched healthy individuals served as the controls. CDU was employed to determine the atherosclerosis process of aortoiliac arteries in both groups. Lumen stenosis >70% of internal diameter was considered as the “significant stenosis”. The iliac IMT was also determined on both sides.

There were 28 males and 22 females in the case group with a mean age of 56.54±8.52 years while there were 25 males and 25 females in the control group with a mean age of 55.74±7.66 years (p>0.05). The mean duration of hemodialysis was 22.76±14.35 (6-58) months in the CKD group. The median abdominal aortic diameter was significantly lower in the case group compared to the control group (13 vs. 17 mm; p<0.001). There were 5 cases (10%) with abdominal aortic aneurysm in the CKD group with no similar cases in the other group (p=0.03). The median maximum IMT of the iliac arteries was significantly higher in the dialysis group compared to that in the control group (0.9 vs. 0.6 mm; p<0.001). There was no significant stenosis in aortoiliac arteries. Frequency of the cases with atherosclerotic atheromas in aorta and iliac arteries was significantly higher in the CKD patients compared to the control group (54% vs. 12%; p<0.001).

Although there was no significant stenosis in aortoiliac arteries in hemodialysis patients, the atherosclerosis was significantly more advanced in these vessels compared to healthy counterparts.