OCCLUSIVE ARTERIAL-DISEASE IN UREMIC AND HEMODIALYSIS PATIENTS AND RENAL-TRANSPLANT RECIPIENTS - STUDY OF INCIDENCE OF ARTERIAL-DISEASE AND OF PREVALENCE OF RISK-FACTORS IMPLICATED IN PATHOGENESIS OF ARTERIOSCLEROSIS

  • 1 January 1977
    • journal article
    • research article
    • Vol. 46  (182) , 197-214
Abstract
The prevalence of clinical and sub-clinical occlusive arterial disease and of risk factors implicated in the pathogenesis of arteriosclerosis was assessed in 21 patients with chronic renal failure, 27 on maintenance hemodialysis and 51 renal allograft recipients. Clinical occlusive arterial disease was present in 27 patients and sub-clinical arterial disease, in 34. Myocardial infarction, cerebral thrombosis and lower limb arterial thrombosis occurred only in the transplant recipients. These patients were followed longer than the other 2 groups. In the allograft recipients, the cumulative incidence of any occlusive arterial disease was 416 per 1000, and that of coronary heart disease was 267 per 1000 at 6 yr. Hypertension was present in 76% of patients prior to renal replacement therapy. Following the institution of definitive therapy, hypertension was of shorter duration and less common in hemodialysis patients than in renal transplant recipients. Uremic and hemodialysis patients with occlusive arterial disease had required antihypertensive medication for significiantly longer than those free of arterial disease. Transplant recipients with hypertension had a greater mean serum creatinine, were receiving a larger maintenance dosage of corticosteroids and less frequently had undergone prior bilateral nephrectomy than those transplant patients without hypertension. Serum lipid levels were elevated in 62% of patients. In the uremic and hemodialysis patients hypertriglyceridemia was the predominant abnormality, while in the transplant recipients combined hypertriglyceridemia/hypercholesterolemia was more frequent. Despite regular aluminium hydroxide therapy, 81% of the uremic and hemodialysis patients had a calcium .times. phosphate product higher than normal. Arterial and/or soft tissue calcification as demonstrable in 20-38% of patients within each group, but could not be related to the calcium .times. phosphate product or radiographic evidence of hyperparathyroidism. Glucose intolerance was present in 71% of the uremic and hemodialysis patients and 33% of the transplant recipients. Hyperuricemia, cigarette smoking, obesity and a sedentary existence were also prevalent. The majority of patients had several risk factors implicated in the pathogenesis of arteriosclerosis. Occlusive arterial disease is a major problem in patients with end stage renal disease, being no less common after transplantation than with long-term maintenance dialysis. The etiology is multifactorial.