Relation of Carotid Intima-Media Thickness and Silent Cerebral Infarction to Cardiovascular Events and All-Cause Mortality in Chronic Hemodialysis Patients

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Objective Silent cerebral infarction (SCI) and increased carotid intima-media thickness (IMT) have been found to be associated with future stroke in the general population. We investigated whether a combination of SCI and increased IMT is a predictor of cardiovascular events and all-cause mortality in chronic hemodialysis (HD) patients. Methods We performed a retrospective cohort study of 70 HD patients who had one or more risk factors for atherosclerosis but no history of cardiovascular disease. We performed cranial magnetic resonance imaging (MRI) and measured carotid IMT at baseline, and then evaluated the risks of cardiovascular events and all-cause mortality by using Cox proportional hazards models. The Kaplan-Meier method and a log-rank test were used to compare event-free survival. Results SCI was present in 25 patients (35.7%) at baseline. During an average follow-up of 46.3±14.3 months (range: 19 to 56 months), 15 patients (21.4%) died and 16 (22.9%) experienced a new cardiovascular event. The presence of SCI in combination with increased carotid IMT at baseline was independently associated with cardiovascular events and all-cause mortality after adjustment for age, sex, duration of dialysis, and traditional vascular risk factors. Conclusion SCI, similar to carotid IMT, is an independent predictor of cardiovascular events and all-cause mortality in chronic HD patients.