CORRELATION OF CAROTID INTIMA-MEDIA THICKNESS WITH CLINICAL AND BIOCHEMICAL PARAMETERS IN HEMODIALYSIS PATIENTS: A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.71000/r3qmx256Keywords:
Carotid Intima-media Thickness , Atherosclerosis, Chronic Kidney Disease, Hemodialysis, , Risk Factors, Ultrasonography, , Vascular Stiffness.Abstract
Background: Cardiovascular disease remains the leading cause of mortality in patients with end-stage renal disease (ESRD), and carotid intima-media thickness (CIMT) has emerged as a non-invasive surrogate marker for subclinical atherosclerosis. In patients undergoing hemodialysis, chronic inflammation, metabolic abnormalities, and traditional risk factors may accelerate vascular changes. Early identification of such vascular alterations can guide timely interventions to reduce cardiovascular morbidity and mortality in this high-risk group.
Objective: To evaluate carotid intima-media thickness in patients on maintenance hemodialysis and investigate its association with clinical and biochemical parameters.
Methods: This cross-sectional study was conducted over six months at the Department of Nephrology, Combined Military Hospital, Rawalpindi. A total of 145 adult patients with ESRD undergoing hemodialysis for at least three months were enrolled. Patients with acute infections, inflammatory conditions, recent carotid surgery, or incomplete data were excluded. Demographic, clinical, and biochemical data were collected through structured questionnaires and laboratory assessments. CIMT was measured bilaterally at three predefined carotid artery sites using a GE Voluson E6 ultrasound machine. Data analysis was performed using SPSS version 20, with significance set at p < 0.05.
Results: Participants had a mean age of 46.3 ± 12.4 years, with 58.6% males. Hypertension (81.3%), lipid disorders (90.3%), and diabetes mellitus (52.4%) were prevalent. Elevated serum creatinine (6.8 ± 2.1 mg/dL), triglycerides (158 ± 82 mg/dL), and homocysteine (39.5 ± 28.4 μmol/L) were observed. Mean CIMT was 0.80 ± 0.15 mm (right) and 0.79 ± 0.14 mm (left), with increased CIMT (≥0.8 mm) seen in 72.4% and 69.0% of patients, respectively. CIMT was significantly correlated with age, CKD duration, dialysis time, hypertension, diabetes, lipid levels, creatinine, triglycerides, and homocysteine.
Conclusion: There is a high burden of subclinical atherosclerosis among hemodialysis patients, as indicated by increased CIMT and its strong associations with modifiable and disease-specific risk factors. Addressing hypertension, diabetes, and dyslipidemia may be critical to reducing cardiovascular complications in this population.
References
Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney international supplements. 2022 Apr 1;12(1):7-11.
Khan A, Cheema MF, Fatima R, Cheema SS, Butt Z, Gillani S, Ahmad A, Ullah MS, Jalal U, Cheema S. Prevalence of chronic kidney disease in a high-risk population in urban Lahore, Pakistan: a cross-sectional study. Cureus. 2024 Jun 27;16(6): e63296.
Ahmed J, Azhar S, ul Haq N, Hussain S, Stájer A, Urbán E, Gajdács M, Jamshed S. Awareness of chronic kidney disease, medication, and laboratory investigation among nephrology and urology patients of Quetta, Pakistan. International journal of environmental research and public health. 2022 Apr 20;19(9):5015.
Zoccali C, Mallamaci F, Adamczak M, de Oliveira RB, Massy ZA, Sarafidis P, Agarwal R, Mark PB, Kotanko P, Ferro CJ, Wanner C. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovascular research. 2023 Aug;119(11):2017-32.
Wanyu K, Guangfeng G, Hua G. The effect of bone mineral metabolism disorder on cardiovascular events in uremia patients. Frontiers in Medical Science Research. 2023 Mar 10;5(3).
Fujii H. Is Oxidative Stress a Key Player for Progression of Cardiovascular Disease in Dialysis Patients? Journal of atherosclerosis and thrombosis. 2021 Mar 1;28(3):227-9.
Wang XR, Yuan L, Shi R, Li H, Wang DG, Wu YG. Predictors of coronary artery calcification and its association with cardiovascular events in patients with chronic kidney disease. Renal Failure. 2021 Jan 1;43(1):1172-9.
Naem M, Karem K, William V, Ghareeb M. Carotid Intima-Media Thickness as a Cardiovascular Risk Factor in Patients with Chronic Kidney Disease. QJM: An International Journal of Medicine. 2024 Jun 1;117(Supplement_1): hcae070-119.
Torres-Machorro A, Anaya-Ayala JE, Lopez-Mendez A, Martinez-Quesada JI, García-Alva JR, Cuen-Ojeda C, Lozano-Corona R, Luna L, Hinojosa CA. Multi-perspective ultrasound evaluation of Carotid Intima-Media thickness in hemodialysis access patients and its possible use to predict clinical outcomes. Vascular. 2024 May 31:17085381241258554.
Azouaou LT, Adnane M, Khelfi A, Ballouti W, Arab M, Toualbi C, Chader H, Tahae R, Seba A. Oxidative stress accelerates the carotid atherosclerosis process in patients with chronic kidney disease. Archives of Medical Science-Atherosclerotic Diseases. 2020 Sep 14;5(1):245-54.
Moosazadeh M, Ebrahimnejad P, Sohrab M, Rafiei A, Abastabar M, Khazaee-Pool M, Mahboubi S, Kheradmand M. Undiagnosed hypertension and diabetes mellitus in the Tabari cohort: a population-based study. BMC Public Health. 2024 Nov 18;24(1):3199.
Pan Q, Gao S, Gao X, Yang N, Yao Z, Hu Y, Miao L, Chen Z, Wang G. Relation of kidney function and homocysteine in patients with hypothyroidism. Endocrine Connections. 2021 May 1;10(5):502-10.
Wong SW, Rojas-Canales D, Tucker E, Mcnicholas K, Mehdron AS, Gleadle J. MICRORNA ANALYSIS OF GROWING KIDNEYS. InNephrology 2022 Oct 1 (Vol. 27, pp. 68-68). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY.
Kanda E. Protein Energy Wasting in Chronic Kidney Disease. Recent Advances of Sarcopenia and Frailty in CKD. 2020:35-55.
Huang Z, Fang J, Song A, Tong Y, Deng H, Wei S, Ji O, Hu C, Li P, Zhang C, Liu Y. The association between self-management ability and malnutrition-inflammation-atherosclerosis syndrome in peritoneal dialysis patients: a cross-sectional study. BMC nephrology. 2021 Dec; 22:1-9.
Hagemann R, Watanabe MT, Hueb JC, Martín LC, Silva VDS, Caramori J. Assessment of atherosclerosis and endothelial dysfunction risk factors in patients with primary glomerulonephritis. J Bras Nefrol. 2024;46(1):29-38.
Dragoș D, Timofte D, Georgescu MT, Manea MM, Vacaroiu IA, Ionescu D, et al. Cardiovascular Calcifications Are Correlated with Inflammation in Hemodialysis Patients. Medicina (Kaunas). 2023;59(10).
Zafar Mohtashami A, Hadian B, Heidarian M, Khalili P. Carotid Intima-media Thickness in Hemodialysis Patients and Related Biochemical and Clinical Factors. Iran J Kidney Dis. 2023;1(1):28-36.
Bolignano D, Greco M, Arcidiacono V, Presta P, Caglioti A, Andreucci M, et al. Circulating Omentin-1, Sustained Inflammation and Hyperphosphatemia at the Interface of Subclinical Atherosclerosis in Chronic Kidney Disease Patients on Chronic Renal Replacement Therapy. Medicina (Kaunas). 2022;58(7).
Moustafa B, Zekry H, Hashim RH, Salah DM, Abdelfattah AA, Sobhy R. Echocardiographic findings in children with chronic kidney disease. Saudi J Kidney Dis Transpl. 2020;31(6):1234-44.
Kara AV, Ozdemir R, Inan H, Ozdemir BO, Hayme S, Cosgun MS. Effect of serum magnesium level on carotid intima media thickness in hemodialysis patients. BMC Nephrol. 2025;26(1):270.
Karaer Büberci R, Öztekin PS, Duranay M. The relationship between apelin and carotid intima media thickness, and the presence of plaque in dialysis patients. Semin Dial. 2022;35(4):337-42.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muhammad Sufian Pasha , Khalid Mehmood Raja, Ramisha Arif, Muhammad Sulaiman Pasha, Ayesha Arif, Umair Ahmed (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
