Comparison of carotid intima-media thickness between hemodialysis and peritoneal dialysis patients.

Abstract

Background: Patients with chronic kidney disease (CKD) are at high risk of developing cardiovascular disease (CVD). Carotid intima-media thickness (cIMT) is a strong predictor of CVD. Klotho has been associated with increased atherosclerotic plaque stability in CKD patients.

Aim: To investigate the association between dialysis modality and cIMT in dialysis patients.

Methods: A cross-sectional study of 83 dialysis patients, 40 hemodialysis (HD) patients and 43 peritoneal dialysis (PD) patients, who met the inclusion criteria. Anamnesis, carotid artery ultrasonography (USG), and laboratory tests were performed on all patients. cIMT measurements were performed in 6 carotid territories using arterial USG.

Results: PD patients had lower cIMT [0.53 (0.47; 0.67) vs 0.63 (0.54; 0.70); P = 0.005]. Younger age in PD patients was independently associated with lower cIMT (β = 0.006; P = 0.003). PD patients had a lower FGF23/Klotho ratio compared to HD patients [26.26 (13.32; 69.45) vs 67.34 (16.56; 131.35); P = 0.039]. Similarly, in PD patients, a moderate positive correlation was found between calcium, phosphorus, and CaxP product levels with fibroblast growth factor 23 (FGF-23) levels. However, the strength of the correlation was reduced when correlated with the FGF-23/Klotho ratio.

Conclusion: This study showed that PD patients have lower cIMT than HD patients. Younger age was independently associated with lower cIMT. On the other hand, FGF-23 and the FGF-23/Klotho ratio were significantly positively correlated with CaxP product in PD patients, but not in HD patients. Klotho reduces the strength of this correlation, thus appearing play an important role in the lower cIMT in these PD patients.