Influence of Residual Renal Function in Carotid Modeling as a Marker of Early Atherosclerosis in Dialysis Patients Merita Rroji, 1 Nereida Spahia, 1 Saimir Seferi, 1 Myftar Barbullushi, 1 and Goce Spasovski 2 1 Department of Nephrology-Dialysis, UHC “Mother Teresa”, Tirana, Albania, and 2 University Department of Nephrology, Medical Faculty, University of Skopje, Skopje, Macedonia Abstract: Atherosclerosis is frequently present in patients with chronic kidney disease (CKD) treated with dialysis. We evaluated the association between residual renal function (RRF), phosphate level, inflammation and other risk factors in carotid modeling as a marker of early atherosclerosis in peritoneal dialysis (PD) compared with hemodialysis (HD) patients. We studied 39 stable PD and 53 HD patients on renal replacement therapy (RRT) for 3 to 36 months duration. B-mode ultrasonography was used to determine carotid artery intima media thickness (CIMT). We classified patients with atherosclerosis if they have CIMT >10 mm and or presence of plaque. Out of our total dialysis population studied of 92 patients, 16.3% were diabetics and 57.6% were on hemodialysis. Expectedly, PD patients had a higher RRF (P < 0.001), 24 h urine volume (P < 0.001); C-reactive protein (P= 0.047), and a lower serum phosphate (P= 0.01), PTH (P < 0.05), alkaline phosphatase (P < 0.05), and albumin levels (P < 0.001) compared to hemodialysis patients. Atherosclerosis was found in 66.3% of patients and in 100% of a diabetic population. There was no significant difference in the presence of atherosclerosis between PD and HD patients [56.4 vs 73.6% HD, respectively]. Multiple regression analysis showed age, diabetes, HD modality, RRF, phosphate, PTH and pulse pressure as independent parameters associated with atherosclerosis. Apart from the traditional risk factors like age and diabetes, our study showed a link of atherosclerosis with metabolic abnormalities secondary to renal failure. We demonstrated a novel, independent association between RRF and atherosclerosis, underlining the importance of preservation of the RRF in dialysis patients. Key Words: Dialysis, Inflammation, Phosphate, Pulse pressure, Residual renal function. The risk of cardiovascular death is substantially elevated in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) and peritoneal dialysis (PD). As compared to the general population, dialysis patients have over 10 times higher relative risk for cardiovascular (CV) mortality (1). The pathway from CV risk factors exposure to overt CV disease partly varies from the development and progress of atherosclerosis. Intima media thickness (IMT) is considered a marker of early atherosclerotic changes (2) and carotid artery intima media thickness (CIMT) is increasingly used as a surrogate marker of early atherosclerosis (3). IMT emerged as a strong and independent predictor of cardiovascular events (4). The increasing CIMT and presence of plaque were shown to be powerful predictors of adverse outcome in ESRD and especially in HD patients (4). Atherosclerosis was also investigated in PD patients (5). Identification of this preclinical pathologic state associated with hemodynamic and humoral abnormalities may thus enable a more precise approach to risk prediction (6). Besides traditional risk factors (6) including hypertension, diabetes, dyslipidemia, and advanced age, novel risk factors such as CKD-mineral and bone disorders (CKD-MBD), vascular-valve calcification, increased oxidative stress, and chronic low-grade inflammation were also highly prevalent (6–8). Finally, there is now clear evidence that preserving the residual renal function (RRF) remains important after the commencement of dialysis not only for providing a modest solute clearance but also for maintaining fluid balance, and removal of middle molecular uremic toxins (9,10). The RRF is one of Received December 2016; revised January 2017. Address correspondence and reprint requests to Merita Rroji, UHC “Mother Teresa”– Department of Nephrology-Dialysis, Dibra Street, Nr 370 Tirana 1001, Albania. E-mail: meritarroji@yahoo.com Therapeutic Apheresis and Dialysis 2017; ••(••):••–•• doi: 10.1111/1744-9987.12548 © 2017 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy 1