THE ASSOCIATION AMONG CAROTID IMT, PULSE WAVE VELOCITY AND VASCULAR ACCESS FAILURE IN HAEMODIALYSIS PATIENTS

Abstract BACKGROUND AND AIMS Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) have an increased risk of cardiovascular mortality and morbidity. We aimed to compare the value of IMT with tests such as coronary CT and pulse wave velocity (PWV) as predictors of cardiovascular risk in ESRD patients undergoing maintenance dialysis and examine their association with cardiovascular disease. METHOD We reviewed the participants’ medical records, including height, body weight, smoking status, alcohol intake, medication history, aetiology of ESRD, HD vintage and blood pressure which were measured during haemodialysis. Carotid doppler was performed by a skilled sonographer who was unaware of the aims of the study and blinded to the laboratory findings. For PWV measurement, patients lie down, rest for at least 5 minutes and stop smoking and coffee for 3 h before the measurement. BaPWV is measured by recording pulse waves of both arms and ankles from the pressure signal obtained by measuring 4-extremity blood pressure. RESULTS A total of 100 patients were included, of whom 51 (50.5%) were men. The median age was 66 years (interquartile range 58–76 years). The median vintage of haemodialysis was 47.5 months (range 31.3–89.1 months). There were no significant differences between the high IMT group and the low IMT group in sex, haemodialysis vintage, ESRD aetiology and type of vascular access. However, age was significantly older in the high IMT group. IMT was significantly associated with PWV [hazard ratio (HR) 2.109; 95% confidence interval (95% CI) 1.037–4.291, P = 0.039). After adjusting for age, sex and presence of diabetes, IMT was independently associated with PWV (HR 2.110, 95% CI 1.036–4.298, P = 0.040). The risk of recurrent vascular access failure was higher in the high IMT group (HR 1.615, 95% CI 1.460–5.669, P = 0.034). CONCLUSION IMT was associated with PWV and recurrent access failure. Thus, IMT may be suggested as a potential predictor of vascular access failure.