Carotid Intima-Media Thickness and Liver Histology in Hemodialysis Patients with Non-Alcoholic Fatty Liver Disease

BACKGROUND: The prevalence of atherosclerotic cardiovascular disease in chronic hemodialysis (HD) patients has been demonstrated to be higher than in healthy people. Severe liver fibrosis is strongly associated with early carotid atherosclerosis and it might reduce the survival of patients who undergo both renal replacement therapy and transplantation. OBJECTIVES: To assess whether nonalcoholic fatty liver disease was associated with altered intima-media thickness in HD patients as an independent marker of subclinical atherosclerosis. METHODS: Forty-two patients undergoing HD and 48 patients with normal renal function were enrolled; all patients had high levels of aminotransferases and an ultrasonographic diagnosis of liver steatosis. The control group included 60 healthy subjects. Laboratory tests for inflammatory and oxidative markers, ultrasonographic liver evaluation, carotid intima-media thickness measurement and liver biopsy were performed. RESULTS: Different degrees of fibrosis were detected in the present study cohort. Worse liver histopathological scores and higher plasma levels of C-reactive protein, reactive oxygen species and vascular cell adhesion molecule 1 were found in HD patients. Carotid intimamedia thickness was significantly higher (P<0.005) in patients with histological steatosis. CONCLUSIONS: HD patients may develop active and progressive chronic hepatitis faster than patients with normal renal function and the thickness of their carotid intima-media might be markedly increased. These two conditions seem to be independent of classical risk factors and metabolic syndrome. They might be related to high levels of oxidant agents and an inflammatory state, which are typical of patients undergoing HD. Independently related with traditional risk factors for cardiovascular disease, nonspecific inflammation and oxidation-reduction imbalance may play an important role in the progression of nonalcoholic fatty liver disease and atherosclerotic disease in HD patients.