Comparative Analysis of Atherosclerotic Changes in the Carotid Artery: A Cross-sectional Study of Hemodialysis Versus Peritoneal Dialysis Patients

Abstract

Background: Carotid artery atherosclerosis tends to progress more rapidly among dialysis-dependent patients; however, the contribution of selected dialysis modality — specifically hemodialysis (HD) versus peritoneal dialysis (PD) — has yielded inconsistent findings in the literature. Objectives: This study seeks to analyze carotid artery calcification (CAC), stenosis, and intima-media thickness (CIMT) using Doppler ultrasound, as well as newly emerged atherogenic indices in patients undergoing regular HD versus PD. Methods: A comparative cross-sectional study design was utilized, involving thirty-two randomly selected patients undergoing either HD or PD (16 HD and 16 PD), conducted from January to May 2024 at dialysis centers associated with Shiraz University of Medical Sciences in Iran. Data were analyzed using IBM SPSS Statistics (version 27) employing Mann-Whitney U, Fisher’s exact test, and regression models. Results: Four atherogenic indices were evaluated, namely the total cholesterol to high-density lipoprotein (HDL)-C ratio, low-density lipoprotein (LDL)-C to HDL-C ratio, Lipoprotein Combined Index, and remnant cholesterol. Notably, all indices were significantly elevated among PD patients (P = 0.002, 0.020, 0.001, and 0.008, respectively). Conversely, CAC was more common in HD patients, especially in the right carotid artery (50% vs. 12.5%, P = 0.027). Additionally, carotid artery stenosis was exclusively identified among HD patients (31.3%, P = 0.022). No significant disparities were found in average CIMT or the CIMT measurements of the right or left carotid arteries across the groups. These findings remained consistent regardless of age, gender, underlying causes of kidney failure, and serum biochemistry, particularly serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) levels. Conclusions: Patients undergoing HD had worse structural carotid disease, while patients undergoing PD had a worse atherogenic lipid profile. These disparities between modalities make it even more important to have personalized cardiovascular risk assessment and monitoring plans. Additionally, the limitations of CIMT suggest the need for integration with more sensitive imaging modalities to better evaluate medial calcification, thereby informing clinical decision-making and personalized care strategies for end-stage kidney disease patients.