Abstract Several studies showed that carotid atherosclerosis and stiffness are independent prognostic factors of cardiovascular morbidity and mortality in the general population and in end- stage renal disease patients. However, the impact of established risk factors on carotid structural and elastic properties in non-diabetic elderly hemodi- alysis patients with negative history for cardiovas- cular disease has not been fully elucidated. In this paper, we investigated the effect of established and potential risk factors on carotid atherosclerosis and stiffness. Thirty stable, non-symptomatic, non- diabetic patients, aged 65-years and older (mean age 71.4 – 4.15, range 65–79) on hemodialysis for more than 6 months, were included. All patients underwent B-mode ultrasonography of common carotid artery estimating intima-media wall thick- ness and wall-to-lumen ratio bilaterally and checking for the presence of plaques. Carotid elasticity was evaluated by compliance, distensi- bility, and the incremental elastic modulus (Einc), whereas systemic arterial stiffening was evaluated by the augmentation index provided by tonometry of radial artery. Our results showed that presence of carotid plaques and wall thickening were fre- quent findings in this population (76% and 73.3%, respectively) and they were positively associated with fibrinogen (P < 0.005), diastolic blood pres- sure (P < 0.004), visceral obesity (P < 0.001) and bio-intact PTH (i-PTH) (P = 0.03). Overall, sys- temic and carotid stiffness were strongly correlated with hs-CRP (P = 0.018), serum ferritin (P = 0.02) with age (P = 0.03), lipids (P = 0.03) and i-PTH (P = 0.05). In conclusion, our findings show that stiffening and atherosclerosis in non-symptomatic elderly HD patients are very common and they are related not only to hemodynamic changes (dia- stolic blood pressure), inflammation (hs-CRP, fibrinogen, ferritin) or metabolic dysfunction (in- creased i-PTH, abnormal lipid profile), but also to abnormal fat deposition (increased waist to hip ratio and waist circumference). Considering the high morbidity and mortality of elderly patients, close monitoring of these parameters could be useful to prevent cardiovascular events. Keywords Elderly Æ Hemodialysis Æ Atherosclerosis Æ Carotid stiffness Æ Distenibility Æ Einc P. Tseke (&) Æ E. Grapsa Æ A. Laggouranis Renal Unit, General Hospital ‘‘ALEXANDRA’’, Alexandroupoleos 48, 115 27 Athens, Greece e-mail: tsekedaki@hotmail.com K. Stamatelopoulos Æ A. Protogerou Æ C. Papamichael Vascular Laboratory, Department of Clinical Therapeutics, University of Athens, General Hospital ‘‘ALEXANDRA’’, Athens, Greece E. Samouilidou Biochemical Laboratory, Department of Clinical Therapeutics, University of Athens, General Hospital ‘‘ALEXANDRA’’, Athens, Greece Int Urol Nephrol (2006) 38:801–809 DOI 10.1007/s11255-006-9000-1 123 ORIGINAL PAPER Atherosclerotic risk factors and carotid stiffness in elderly asymptomatic HD patients Paraskevi Tseke Æ Eirini Grapsa Æ Kimon Stamatelopoulos Æ Elisabeth Samouilidou Æ Athanasios Protogerou Æ Christos Papamichael Æ Antonios Laggouranis Received: 1 February 2006 / Accepted: 5 April 2006 / Published online: 7 November 2006 Ó Springer Science+Business Media B.V. 2006